scholarly journals Clomipramine and fluoxetine effects in the treatment of panic disorder

2003 ◽  
Vol 3 (3) ◽  
pp. 27-31 ◽  
Author(s):  
Semra Čavaljuga ◽  
Ifeta Ličanin ◽  
Elvedina Kapić ◽  
Dubravka Potkonjak
Keyword(s):  
Panic Disorder ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Rating Scale ◽  
Panic Attacks ◽  
Duration Of Treatment ◽  
Double Blind ◽  
Psychiatric Interview ◽  
Favourable Response ◽  
Double Blind Clinical Trial ◽  
History Of

Panic disorder (PD) is an acute psychobiologic reaction manifested by intense anxiety and panic attacks, that occur unpredictably with subjective sense of intense apprehension or terror, accompanied by temporary loss of the ability to plan, think, or reason and the intense desire to escape or flee the situation. Panic attacks may last from a few seconds to an hour or longer, Symptoms typically include, among others, palpitations, tachycardia, hypertension, chest pain, dyspnoea, and fear of loosing control or going crazy and vague feeling of imminent doom or death. Since pharmacotherapy of PD includes the administration of selective serotonin reuptake inhibitors and tricyclic antidepressants, the objective of this study was to perform a pilot double blind clinical trial designed to compare the effects of two studied drugs in the treatment of PD.A total number of 40 patients with a history of panic disorder were randomly assigned into two groups of 20 patients each. Hamilton anxiety rating scale and Standard Psychiatric Interview were methods for PD assessment. One group was treated with clomipramine hydrochloride (ANAFRANIL®) 75 mg/day and the other with fluoxetine (OXETIN®) 60 mg/day. Both drugs were administrated by mouth (PO) two times-a-day in equally divided doses for 6 weeks.Both studied agents produced similar antipanic effectiveness. Favourable response was achieved in 95% of patients treated with fluoxetine and 90% of patients treated with clomipramine. The onset of antipanic effects was quicker in all clomipramine treated patients, while fluox-etine produced more-favourable response in male patients. The duration of treatment with both antidepres-sants studied should be at least 10 weeks, instead of 6 weeks.

scholarly journals Double-blind clonazepam vs placebo in panic disorder treatment

2000 ◽  
Vol 58 (4) ◽  
pp. 1025-1029 ◽  
Author(s):  
ALEXANDRE MARTINS VALENÇA ◽  
ANTONIO EGIDIO NARDI ◽  
ISABELLA NASCIMENTO ◽  
MARCO A. MEZZASALMA ◽  
FABIANA L. LOPES ◽  
...  
Keyword(s):  
Panic Disorder ◽  
Rating Scale ◽  
Panic Attacks ◽  
Fixed Dose ◽  
Fisher Exact Test ◽  
Double Blind ◽  
Exact Test ◽  
Dsm Iv ◽  
Disorder Treatment ◽  
Hamilton Rating Scale

OBJECTIVE: To assess the effectiveness of clonazepam, in a fixed dose (2 mg/day), compared with placebo in the treatment of panic disorder patients. METHOD: 24 panic disorder patients with agoraphobia were randomly selected. The diagnosis was obtained using the structured clinical interview for DSM-IV . All twenty-four subjects were randomly assigned to either treatment with clonazepam (2 mg/day) or placebo, during 6 weeks. Efficacy assessments included: change from baseline in the number of panic attacks; CGI scores for panic disorder; Hamilton rating scale for anxiety; and panic associated symptoms scale. RESULTS: At the therapeutic endpoint, only one of 9 placebo patients (11.1%) were free of panic attacks, compared with 8 of 13 (61.5%) clonazepam patients (Fisher exact test; p=0,031). CONCLUSION: the results provide evidence for the efficacy of clonazepam in panic disorder patients.

FEATURES OF THERAPY FOR PANIC DISORDER, ASSOCIATED WITH THE SARS-COV-2 PANDEMIC

Vestnik ◽  
2021 ◽  
pp. 313-318
Author(s):  
Л.Б. Куанова ◽  
Г.М. Жуламанова
Keyword(s):  
Panic Disorder ◽  
Rating Scale ◽  
Panic Attacks ◽  
Qtc Interval ◽  
Obsessive Compulsive ◽  
Significant Similarity ◽  
Therapy Regimen ◽  
Compulsive Disorder ◽  
History Of ◽  
First Time

Введение. В силу существенной схожести симптомов острого респираторного синдрома SARS-CoV-2 и панического расстройства (ПР), диагностика представляет значительные трудности. ПР имеют тенденцию развиваться хронически, с рецидивами на протяжении всей жизни. Цель работы: выявить особенности клинического проявления ПА/ПР на фоне COVID-19 и обосновать оптимальную схему терапии. Методы. Проведен анализ данных 86 пациентов, у которых диагностировано ПР при обращении на консультативный неврологический прием КФ UMC с мая 2020 г по май 2021 г. Скрининг панического расстройства проведен по Шкале тревоги Шихана (Sheehan Anxiety Rating Scale, ShARS). Результаты. Среди пациентов было 54 (62,8%) женщины и 32(37,2%) мужчины. По шкале ShARS тяжелым тревожное расстройство (80 баллов и выше) определено у 39 (45,3%), у остальных тревога (от 30 до 80 баллов) - клинически выраженная. Диагноз ПР у 21(24,4%) был диагностирован ранее заражения ковидной инфекцией. У остальных, выставлен впервые 26 (30,2%) пациентам, ранее не обращавшихся к неврологу и 39 (45,3%) пациентам, обращавшихся к неврологу с диагнозами соматоформная вегетативная дисфункция, сосудистая цефалгия, мигрень, обсессивно-компульсивное расстройство. Бронхиальная астма отмечалась в анамнезе в 13 (15,1%) случаях. Разновидности панических приступов были расценены как большие (развернутые) ПР (4 симптома и более) - у 55 (64%), в остальных случаях как симптоматически бедные. Особенность течения ПР на фоне SARS-CoV-2 определяется возникновением на фоне ипохондрических фобий. В то же время агорафобии и избегающего поведения, характерных для ПР, не отмечалось. Заключение. Использование бензодиазепинов для анксиолитических целей, противоастматических препаратов может быть контрпродуктивным в лечении тревожных расстройств. Ятрогенный риск наслаивается на возможную гипокалиемию, удлинение интервала QTc, артериальную гипертензию, вызванную COVID-19. Оценка результатов проведённого нейрофармакологического анализа и назначения препаратов анксиолитического действия Бифрен, в более тяжелых случаях ПР Прегабина показала клинический положительный эффект. Introduction. Due to the significant similarity between the symptoms of SARS-CoV-2 acute respiratory syndrome and panic disorder (PD), diagnosis presents significant difficulties. PD tend to develop chronically, with lifelong relapses. Purpose of the work: to identify the features of the clinical manifestation of PD in the presence of COVID-19 and to substantiate the optimal therapy regimen. Methods. We analyzed the data of 86 patients who were diagnosed with PD when they applied for a consultative neurological appointment CF UMC from May 2020 to May 2021. Panic disorder was screened according to the Sheehan Anxiety Rating Scale (ShARS). Results. Among the patients there were 54 (62.8%) women and 32 (37.2%) men. On the ShARS scale, severe anxiety disorder (80 points and higher) was identified in 39 (45.3%), in the rest anxiety (from 30 to 80 points) was clinically expressed. The diagnosis of PD in 21 (24.4%) was diagnosed earlier than contracting a covid infection. The rest were exposed for the first time to 26 (30.2%) patients who had not previously visited a neurologist and 39 (45.3%) patients who visited a neurologist with diagnoses of somatoform autonomic dysfunction, vascular cephalgia, migraine, obsessive-compulsive disorder. A history of bronchial asthma was observed in 13 (15.1%) cases. The types of panic attacks were regarded as large (extensive) PR (4 symptoms or more) - in 55 (64%), in other cases as symptomatically poor. The peculiarity of the course of PR against the background of SARS-CoV-2 is determined by the occurrence of hypochondriac phobias against the background. At the same time, agoraphobia and avoidant behavior characteristic of PD were not observed. Conclusion. The use of benzodiazepines for anxiolytic purposes, anti-asthma drugs may be counterproductive in the treatment of anxiety disorders. The iatrogenic risk is superimposed on possible hypokalemia, prolongation of the QTc interval, arterial hypertension caused by COVID-19. Evaluation of the results of the neuropharmacological analysis and the appointment of drugs with anxiolytic action Bifren, in more severe cases of Pregabin in PR showed a clinical positive effect.

scholarly journals Fear of body symptoms and sensations in patients with panic disorders and patients with somatic diseases

2009 ◽  
Vol 137 (11-12) ◽  
pp. 659-663 ◽  
Author(s):  
Milan Latas ◽  
Danilo Obradovic ◽  
Marina Pantic
Keyword(s):  
Myocardial Infarction ◽  
General Population ◽  
Panic Disorder ◽  
Somatic Symptoms ◽  
The Body ◽  
Panic Attacks ◽  
Somatic Illness ◽  
History Of ◽  
Body Sensations ◽  
High Level

Introduction. A cognitive model of aetiology of panic disorder assumes that people who experience frequent panic attacks have tendencies to catastrophically interpret normal and benign somatic sensations - as signs of serious illness. This arise the question: is this cognition specific for patients with panic disorder and in what intensity it is present in patients with serious somatic illness and in healthy subjects. Objective. The aim of the study was to ascertain the differences in the frequency and intensity of 'catastrophic' cognitions related to body sensations, and to ascertain the differences in the frequency and intensity of anxiety caused by different body sensations all related to three groups of subjects: a sample of patients with panic disorder, a sample of patients with history of myocardial infarction and a sample of healthy control subjects from general population. Methods. Three samples are observed in the study: A) 53 patients with the diagnosis of panic disorder; B) 25 patients with history of myocardial infarction; and C) 47 healthy controls from general population. The catastrophic cognitions were assessed by the Agoraphobic Cognitions Questionnaire (ACQ) and the Body Sensations Questionnaire (BSQ). These questionnaires assess the catastrophic thoughts associated with panic and agoraphobia (ACQ) and the fear of body sensations (BSQ). All study subjects answered questionnaires items, and the scores of the answers were compared among the groups. Results. The results of the study suggest that: 1) There is no statistical difference in the tendency to catastrophically interpret body sensations and therefore to induce anxiety in the samples of healthy general population and patients with history of myocardial infarction; 2) The patients with panic disorder have a statistically significantly more intensive tendency to catastrophically interpret benign somatic symptoms and therefore to induce a high level of anxiety in comparison to the sample of patients with the history of serious somatic illness (myocardial infarction) and the sample of healthy general population. Conclusion. The tendency to catastrophically interpret benign somatic symptoms and therefore to induce a high level of anxiety in patients with panic disorder, confirms the cognitive aetiology model of panic disorder and suggests that it should be the focus of prophylactic and therapeutic management of patients with panic disorder.

Recurrent episodes of intense fear, shortness of breath, racing heart, and sweating

2021 ◽  
pp. 111-118
Author(s):  
Christina L. Macenski
Keyword(s):  
Panic Disorder ◽  
Gold Standard ◽  
Panic Attack ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Behavioral Therapy ◽  
Panic Attacks ◽  
Shortness Of Breath ◽  
Intense Fear ◽  
Therapy Intervention ◽  
Norepinephrine Reuptake

Panic disorder consists of recurrent, unexpected panic attacks accompanied by persistent worry about future attacks and/or a maladaptive change in behavior related to the attacks. A panic attack is defined as an abrupt surge of intense fear or discomfort that reaches a peak within minutes that occurs in conjunction with several other associated symptoms such as palpitations, sweating, trembling, shortness of breath, and chest pain. Features of panic disorder that are more common in adolescents than in adults include less worry about additional panic attacks and decreased willingness to openly discuss their symptoms. All patients with suspected panic disorder should undergo a medical history, physical examination, and laboratory workup to exclude medical causes of panic attacks. Cognitive behavioral therapy (CBT) including interoceptive exposures is the gold standard therapy intervention. Medications including selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) can also help reduce symptoms.

Escitalopram Versus SNRI Antidepressants in the Acute Treatment of Major Depressive Disorder: Integrative Analysis of Four Double-Blind, Randomized Clinical Trials

CNS Spectrums ◽  
2009 ◽  
Vol 14 (6) ◽  
pp. 326-333 ◽  
Author(s):  
Susan G. Kornstein ◽  
Dayong Li ◽  
Yongcai Mao ◽  
Sara Larsson ◽  
Henning F. Andersen ◽  
...  
Keyword(s):  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Randomized Clinical Trials ◽  
Rating Scale ◽  
Severe Depression ◽  
Major Depressive ◽  
Double Blind ◽  
Madrs Score ◽  
Treatment Difference

AbstractIntroduction: Recent data suggest that escitalopram may be more effective in severe depression than other selective serotonin reuptake inhibitors.Methods: Individual patient data from four randomized, double-blind comparative trials of escitalopram versus a serotonin/norepinephrine reuptake inhibitor (SNRI) (two trials with duloxetine and two with venlafaxine extended release) in outpatients (18–85 years of age) with moderate-to-severe major depressive disorder were pooled. The primary efficacy parameter in all four trials was mean change in the Montgomery-Asberg Depression Rating Scale (MADRS) score.Results: Significantly fewer escitalopram (82/524) than SNRI (114/527) patients prematurely withdrew from treatment due to all causes (15.6% vs. 21.6%, Fisher Exact: P=.014) and adverse events (5.3% vs. 12.0%, Fisher Exact: P <.0001). Mean reduction in MADRS score from baseline to Week 8 was significantly greater for the escitalopram group versus the SNRI group using the last observation carried forward (LOCF) approach [mean treatment difference at Week 8 of 1.7 points (P <.01)]. Similar results were observed in the severely depressed (baseline MADRS score ≥30) patient subset (mean treatment difference at Week 8 of 2.9 points [P <.001, LOCF]). Observed cases analyses yielded no significant differences in efficacy parameters.Conclusion: This pooled analysis indicates that escitalopram is at least as effective as the SNRIs (venlafaxine XR and duloxetine), even in severe depression, and escitalopram treatment was better tolerated.

scholarly journals Efficacy and tolerability of venlafaxine compared with selective serotonin reuptake inhibitors and other antidepressants: A meta-analysis

2002 ◽  
Vol 180 (5) ◽  
pp. 396-404 ◽  
Author(s):  
David Smith ◽  
Carrie Dempster ◽  
Julie Glanville ◽  
Nick Freemantle ◽  
Ian Anderson
Keyword(s):  
Systematic Review ◽  
Effect Size ◽  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Rating Scale ◽  
Remission Rate ◽  
Serotonin Reuptake Inhibitors ◽  
Selective Serotonin ◽  
Randomised Trials ◽  
Double Blind

BackgroundIn individual studies and limited meta-analyses venlafaxine has been reported to be more effective than comparator antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs).AimsTo perform a systematic review of all such studies.MethodWe conducted a systematic review of double-blind, randomised trials comparing venlafaxine with alternative antidepressants in the treatment of depression. The primary outcome was the difference in final depression rating scale value, expressed as a standardised effect size. Secondary outcomes were response rate, remission rate and tolerability.ResultsA total of 32 randomised trials were included. Venlafaxine was more effective than other antidepressants (standardised effect size was −0.14, 95% Cl −0.07 to −0.22). A similar significant advantage was found against SSRIs (20 studies) but nottricyclic antidepressants (7 studies).ConclusionsVenlafaxine has greater efficacy than SSRIs although there is uncertainty in comparison with other antidepressants. Further studies are required to determine the clinical importance of this finding.

Paroxetine in the Treatment of Panic Disorder a Randomised, Double-Blind, Placebo-Controlled Study

1995 ◽  
Vol 167 (3) ◽  
pp. 374-379 ◽  
Author(s):  
S. Oehrberg ◽  
P. E. Christiansen ◽  
K. Behnke ◽  
A. L. Borup ◽  
B. Severin ◽  
...  
Keyword(s):  
Panic Disorder ◽  
Cognitive Therapy ◽  
Panic Attacks ◽  
Controlled Study ◽  
Positive Trend ◽  
Double Blind ◽  
Treatment Groups ◽  
Efficacy Measures ◽  
The Mean ◽  
Primary Measure

BackgroundThis study compared the efficacy and tolerability of paroxetine with placebo in the treatment of panic disorder.MethodAfter three weeks of placebo, patients received 12 weeks of treatment with paroxetine (20, 40, or 60 mg) or placebo, and finally two weeks of placebo. Dosages were adjusted according to efficacy and tolerability. Standardised cognitive therapy was given to all patients. The primary measure of outcome was reduction in the number of panic attacks.ResultsAnalysis of the results showed statistically significant differences in favour of paroxetine between the two treatment groups in two out of the three primary measures of outcome, i.e. 50% reduction in total number of panic attacks and number of panic attacks reduced to one or zero over the study period. For the third measure of outcome, the mean change in the total number of attacks from baseline, there was a positive trend in favour of paroxetine. The results of the primary measures of outcome were strongly supported by the results of the secondary efficacy measures of outcome. In addition, paroxetine, at all doses, was very well tolerated.ConclusionParoxetine plus cognitive therapy was significantly more effective than placebo plus cognitive therapy in the treatment of panic disorder.

Sertraline in the treatment of panic disorder

1998 ◽  
Vol 173 (1) ◽  
pp. 54-60 ◽  
Author(s):  
Peter D. Londborg ◽  
Robert Wolkow ◽  
Ward T. Smith ◽  
Eugene Duboff ◽  
Donald England ◽  
...  
Keyword(s):  
Panic Disorder ◽  
Adverse Events ◽  
Drop Out ◽  
Panic Attacks ◽  
Efficacy And Safety ◽  
Serious Adverse Events ◽  
Double Blind ◽  
Hamilton Anxiety Scale ◽  
Higher Doses ◽  
Clinical Global Impression Improvement

BackgroundThis study compared the efficacy and safety of sertraline to placebo in treating panic disorder.Method178 out-patients with panic disorder who exhibited at least four panic attacks during the four weeks prior to screening and three during the two weeks of lead-in were randomly assigned to 12 weeks of double-blind treatment with sertraline (50, 100 or 200 mg) or placebo.ResultsSertraline was superior to placebo in reducing the number of panic attacks, situational attacks, unexpected attacks, limited symptom attacks, and time spent worrying (all P < 0.01) and the Hamilton Anxiety Scale (P < 0.05), although Clinical Global Impression (Improvement) did not significantly differentiate groups at 12 weeks and at end-point. No serious adverse events were associated with sertraline. No dose relationship was found for adverse events; overall drop-out rates were not different for sertraline or placebo, although more sertraline-treated subjects discontinued for adverse events, typically early in the study. Only dry mouth and ejaculation failure (primarily ejaculation delay) were associated significantly with sertraline. Conclusions Sertraline was effective and safe in reducing panic attacks. Higher doses were no more effective than the 50 mg dose.

Thyroid Hormone Levels in Panic Disorder*

1987 ◽  
Vol 32 (6) ◽  
pp. 467-469 ◽  
Author(s):  
Vikram K. Yeragani ◽  
John M. Rainey ◽  
Robert Pohl ◽  
Aurelio Ortiz ◽  
Paula Weinberg ◽  
...  
Keyword(s):  
Panic Disorder ◽  
Thyroid Dysfunction ◽  
Clinical History ◽  
Panic Attacks ◽  
P Value ◽  
Mean Values ◽  
Trh Stimulation ◽  
History Of ◽  
The Mean ◽  
Normal Controls

A history of thyroid dysfunction has been reported in patients with phobic disorders. There is also evidence of a blunted TSH response to TRH stimulation in patients with panic disorder. In this study, values of T3, T4 and T7 were compared between 26 patients with panic attacks and 20 normal controls. Patients were diagnosed according to DSM-III criteria and those with a clinical history of thyroid dysfunction were excluded. Patients were not on any medication when the blood samples were drawn. The mean values of T3, T4 and T7 did not significantly differ between the two groups, suggesting no evidence of hypo or hyperthyroidism; however, the variance of distribution of T3, T4 and T7 values was significantly different between the two groups (Fmax values for T3: 2.55, p value < 0.05; T4: 3.15, p value < 0.01; T7: 2.55, p value < 0.05).

A Controlled Study of Cognitive Behaviour Therapy with Buspirone or Placebo in Panic Disorder with Agoraphobia

1995 ◽  
Vol 167 (5) ◽  
pp. 635-641 ◽  
Author(s):  
Jean Cottraux ◽  
Ivan-Druon Note ◽  
Charly Cungi ◽  
Patrick Légeron ◽  
François Heim ◽  
...  
Keyword(s):  
Panic Disorder ◽  
Multicentre Study ◽  
Cognitive Behaviour Therapy ◽  
Group Analysis ◽  
Panic Attacks ◽  
Controlled Study ◽  
Behaviour Therapy ◽  
Short Term ◽  
Double Blind ◽  
Cognitive Behaviour

BackgroundThis multicentre study compared a 16-week buspirone treatment with placebo in patients presenting with panic disorder with agoraphobia and also receiving cognitive behaviour therapy (CBT).MethodDouble-blind testing was maintained until week 68, but not tested; 91 patients were included; 14 placebo-responders excluded; 77 patients randomised; 48 reached week 16 and 41 reached week 68.ResultsAt week 16, within-group analysis showed significant improvements in agoraphobia, panic attacks, and depression in both groups. Generalised anxiety improved only in CBT + buspirone. Between-group comparisons showed buspirone to have an effect on generalised anxiety and agoraphobia. Changes in degree of agoraphobia and depression were correlated in subjects on CBT + buspirone only. A significantly higher proportion of women, and of subjects showing high avoidance dropped out. Positive expectations regarding medication predicted success in both groups. At week 68, improvement was retained without significant buspirone effect.ConclusionBuspirone enhanced the effects of cognitive behaviour therapy on generalised anxiety and agoraphobia in the short term.

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