Abstract
A role for second-generation antipsychotics (SGAs) in the treatment of panic disorders (PD) has been proposed, but the actual usefulness of SGAs in this disorder is unclear. According to the PRISMA guidelines, we undertook an updated systematic review of all of the studies that have examined, in randomized controlled trials, the efficacy and tolerability of SGAs (as either monotherapy or augmentation) in the treatment of PD, with or without other comorbid psychiatric disorders. Studies until 31 December 2015 were identified through PubMed, PsycINFO, Embase, Cochrane Library and Clinical trials.gov. Among 210 studies, five were included (two involving patients with a principal diagnosis of PD and three involving patients with bipolar disorder with comorbid PD or generalized anxiety disorder). All were eight-week trials and involved treatments with quetiapine extended release, risperidone and ziprasidone. Overall, a general lack of efficacy of SGAs on panic symptoms was observed. Some preliminary indications of the antipanic effectiveness of risperidone are insufficient to support its use in PD, primarily due to major limitations of the study. However, several methodological limitations may have negatively affected all of these studies, decreasing the validity of the results and making it difficult to draw reliable conclusions. Except for ziprasidone, SGAs were well tolerated in these short-term trials.
Highlights
Panic disorder (PD) is a highly prevalent, debilitating psychiatric disorder [1]
A recent proof-of-concept randomized controlled trials (RCTs) [26] appraised the efficacy of quetiapine extended release (XR) co-administration treatment compared to placebo in a small sample of selective serotonin reuptake inhibitors (SSRIs)-/serotonin-norepinephrine reuptake inhibitors (SNRIs)-resistant patients, with a principal diagnosis of PD and a Clinical Global
Based on the PRISMA guidelines [25], we provided a systematic review of the RCTs investigating the efficacy and tolerability of second-generation antipsychotics (SGAs) in the treatment of PD, with or without other comorbid psychiatric disorders
Summary
Panic disorder (PD) is a highly prevalent (lifetime prevalence rate of 3%–4%), debilitating psychiatric disorder [1]. SSRIs, such as paroxetine, sertraline, fluoxetine and citalopram, and SNRIs, such as venlafaxine, are considered to be first-line treatment agents because of their efficacy and favorable side effect (SE) profile [3,4]. Despite these treatment options, in short-term clinical trials, 17%–64% of participants with PD did not respond adequately to pharmacotherapy and continued to have PAs and/or avoidance symptoms [5]. The rate of relapses within six months of drug discontinuation is 25%–50%, the rate of residual panic-phobic symptoms is up to 50%, and up to 30% of patients still have a full-blown disorder after 3–6 years [3,6]
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