Abstract
The objective of the present randomized, open-label, naturalistic 8-week study was to compare the efficacy and safety of treatment with clonazepam (N = 63) and paroxetine (N = 57) in patients with panic disorder with or without agoraphobia. Efficacy assessment included number of panic attacks and clinician ratings of the global severity of panic disorders with the clinical global impression (CGI) improvement (CGI-I) and CGI severity (CGI-S) scales. Most patients were females (69.8 and 68.4% in the clonazepam and paroxetine groups, respectively) and age (mean ± SD) was 35.9 ± 9.6 years for the clonazepam group and 33.7 ± 8.8 years for the paroxetine group. Treatment with clonazepam versus paroxetine resulted in fewer weekly panic attacks at week 4 (0.1 vs 0.5, respectively; P < 0.01), and greater clinical improvements at week 8 (CGI-I: 1.6 vs 2.9; P = 0.04). Anxiety severity was significantly reduced with clonazepam versus paroxetine at weeks 1 and 2, with no difference in panic disorder severity. Patients treated with clonazepam had fewer adverse events than patients treated with paroxetine (73 vs 95%; P = 0.001). The most common adverse events were drowsiness/fatigue (57%), memory/concentration difficulties (24%), and sexual dysfunction (11%) in the clonazepam group and drowsiness/fatigue (81%), sexual dysfunction (70%), and nausea/vomiting (61%) in the paroxetine group. This naturalistic study confirms the efficacy and tolerability of clonazepam and paroxetine in the acute treatment of patients with panic disorder.
Highlights
Panic disorder is a chronic debilitating illness characterized by severe, recurrent, spontaneous panic attacks with autonomic symptoms, with a lifetime prevalence rate of 5% [1]
SSRIs have been prescribed for panic disorder with or without agoraphobia for over a decade and are recommended as first-line treatment for panic disorder on the basis of their favorable safety profile [16]
The high proportion of patients suffering from agoraphobia was due to patients with a long history of panic disorder and agoraphobia often being referred to our institute
Summary
Panic disorder is a chronic debilitating illness characterized by severe, recurrent, spontaneous panic attacks with autonomic symptoms, with a lifetime prevalence rate of 5% [1]. Panic disorder, both with and without agoraphobia, can be profoundly physically and emotionally disabling for affected individuals, and is associated with substantial costs to society [2,3,4,5]. Pharmacotherapy is effective in the treatment of panic disorder compared with placebo [6,7,8]; it is problematic for several reasons.
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