Sertraline in the Treatment of Panic Disorder: A Double-Blind Multicenter Trial

Pohl, Robert; Wolkow, Robert; Clary, Cathryn M.

doi:10.1176/ajp.155.9.1189

Cited by 119 publications

(63 citation statements)

References 21 publications

(17 reference statements)

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“…In a relapse prevention trial over 36 weeks, it was as effective as the TCA clomipramine (Lecrubier and Judge 1997) (A). Á Sertraline was also effective in DBPC studies (Londborg et al 1998;Pohl et al 1998;Pollack et al 1998) and one non-inferiority comparator trial . In a relapse prevention study over 26 weeks, which followed open treatment over 1 year, sertraline was superior to placebo .…”

Section: Panic Disorder and Agoraphobiamentioning

confidence: 95%

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders – First Revision

Bandelow

Zohar

Hollander

et al. 2008

The World Journal of Biological Psychiatry

697

402

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In this report, which is an update of a guideline published in 2002 (Bandelow et al. 2002, recommendations for the pharmacological treatment of anxiety disorder, obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) are presented. Since the publication of the first version of this guideline, a substantial number of new randomized controlled studies of anxiolytics have been published. In particular, more relapse prevention studies are now available that show sustained efficacy of anxiolytic drugs. The recommendations, developed by the World Federation of Societies of Biological Psychiatry (WFSBP) Task Force for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders, a consensus panel of 30 international experts, are now based on 510 published randomized, placebo-or comparator-controlled clinical studies (RCTs) and 130 open studies and case reports. First-line treatments for these disorders are selective serotonin reuptake inhibitors (SSRIs), serotonin-noradrenaline reuptake inhibitors (SNRIs) and the calcium channel modulator pregabalin. Tricyclic antidepressants (TCAs) are equally effective for some disorders, but many are less well tolerated than the SSRIs/ SNRIs. In treatment-resistant cases, benzodiazepines may be used when the patient does not have a history of substance abuse disorders. Potential treatment options for patients unresponsive to standard treatments are described in this overview. Although these guidelines focus on medications, non-pharmacological were also considered. Cognitive behavioural therapy (CBT) and other variants of behaviour therapy have been sufficiently investigated in controlled studies in patients with anxiety disorders, OCD, and PTSD to support them being recommended either alone or in combination with the above medicines.

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Section: Panic Disorder and Agoraphobiamentioning

confidence: 95%

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders – First Revision

Bandelow

Zohar

Hollander

et al. 2008

The World Journal of Biological Psychiatry

697

402

View full text Add to dashboard Cite

show abstract

“…Selective serotonin reuptake inhibitors (SSRIs) are effective in treating panic attacks and have less negative associated side effects (Pohl et al, 1998;Al Haddad et al, 2001) yet little is known about the serotonergic neuronal systems that may contribute to the prevention and attenuation of recurrent panic attacks. The present study utilized a model of anxiety with vulnerability to panic-like responses developed by Shekhar and colleagues, which involves inhibiting γ-amino butyric acid (GABA)-ergic tone in the hypothalamus, in order to assess anxiety-like behavioral responses and i.v.…”

Section: Introductionmentioning

confidence: 99%

Disruption of GABAergic tone in the dorsomedial hypothalamus attenuates responses in a subset of serotonergic neurons in the dorsal raphe nucleus following lactate-induced panic

et al. 2008

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Panic patients are vulnerable to induction of panic attacks by subthreshold interoceptive stimuli such as intravenous (i.v.) sodium lactate infusions. Facilitation of serotonergic signaling with selective serotonin re-uptake inhibitors (SSRIs) can suppress anxiety and panic-like responses, but the mechanisms involved are not clearly defined. We investigated the effects of i.v. 0.5M sodium lactate or saline, in control and panic-prone rats on c-Fos expression in serotonergic neurons within subdivisions of the midbrain/pontine raphe nuclei. Rats were chronically infused with either the GABA synthesis inhibitor l-allylglycine (l-AG) into the dorsomedial hypothalamus (DMH) to make them panic-prone, or the enantiomer d-allylglycine (d-AG) in controls. Lactate increased c-Fos expression in serotonergic neurons located in the ventrolateral part of the dorsal raphe nucleus (DRVL) and ventrolateral periaqueductal gray (VLPAG) of control, but not panicprone, rats. The distribution of lactate-sensitive serotonergic neurons in d-AG-treated rats is virtually identical to previously defined pre-sympathomotor serotonergic neurons with multisynaptic projections to peripheral organs mediating "fight-or-flight"-related autonomic and motor responses. We hypothesize that serotonergic neurons within the DRVL/VLPAG region represent a "sympathomotor control system" that normally limits autonomic/behavioral responses to innocuous interoceptive and exteroceptive stimuli, and that dysfunction of this serotonergic system contributes to an anxiety-like state and increases vulnerability to panic in animals and humans.

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“…Randomized clinical trials have demonstrated the effectiveness of fluoxetine [Michelson et al, 1998[Michelson et al, , 1999[Michelson et al, , 2001Tiller et al, 1999], fluvoxamine [Black et al, 1993;den Boer, 1998;Sharp et al, 1997], paroxetine [Ballenger et al, 1998b;Oehrberg et al, 1995], sertraline [Londborg et al, 1998;Pohl et al, 1998;Pollack et al, 1998;Rapaport et al, 2001;Sheikh et al, 2000], citalopram [Wade et al, 1997], and escitalopram [Stahl et al, 2003] for panic disorder. Fluoxetine, paroxetine, and sertraline have received regulatory approval for panic disorder in the United States.…”

Section: Introductionmentioning

confidence: 99%

A double-blind study of the efficacy of venlafaxine extended-release, paroxetine, and placebo in the treatment of panic disorder

Pollack¹,

Lepola²,

Koponen³

et al. 2006

Depress. Anxiety

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To date, no large-scale, controlled trial comparing a serotonin-norepinephrine reuptake inhibitor and selective serotonin reuptake inhibitor with placebo for the treatment of panic disorder has been reported. This double-blind study compares the efficacy of venlafaxine extended-release (ER) and paroxetine with placebo. A total of 664 nondepressed adult outpatients who met DSM-IV criteria for panic disorder (with or without agoraphobia) were randomly assigned to 12 weeks of treatment with placebo or fixed-dose venlafaxine ER (75 mg/day or 150 mg/ day), or paroxetine 40 mg/day. The primary measure was the percentage of patients free from full-symptom panic attacks, assessed with the Panic and Anticipatory Anxiety Scale (PAAS). Secondary measures included the Panic Disorder Severity Scale, Clinical Global Impressions-Severity (CGI-S) andImprovement (CGI-I) scales; response (CGI-I rating of very much improved or much improved), remission (CGI-S rating of not at all ill or borderline ill and no PAAS full-symptom panic attacks); and measures of depression, anxiety, phobic fear and avoidance, anticipatory anxiety, functioning, and quality of life. Intent-to-treat, last observation carried forward analysis showed that mean improvement on most measures was greater with venlafaxine ER or paroxetine than with placebo. No significant differences were observed between active treatment groups. Panic-free rates at end point with active treatment ranged from 54% to 61%, compared with 35% for placebo. Approximately 75% of patients given active treatment were responders, and nearly 45% achieved remission. The placebo response rate was slightly above 55%, with remission near 25%. Adverse events were mild or moderate and similar between active treatment groups. Venlafaxine ER and paroxetine were effective and well tolerated in the treatment of panic disorder.

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Sertraline in the Treatment of Panic Disorder: A Double-Blind Multicenter Trial

Abstract: Sertraline is an effective and well-tolerated treatment for patients with panic disorder.

Cited by 119 publications

References 21 publications

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders – First Revision

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders – First Revision

Disruption of GABAergic tone in the dorsomedial hypothalamus attenuates responses in a subset of serotonergic neurons in the dorsal raphe nucleus following lactate-induced panic

A double-blind study of the efficacy of venlafaxine extended-release, paroxetine, and placebo in the treatment of panic disorder

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