Abstract
BackgroundCurrent treatments of panic disorder (PD) are limited by adverse effects, poor efficacy, and need for chronic administration. The established safety profile of subanesthetic concentrations of xenon gas, which is known to act as a glutamate subtype NMDA receptor antagonist, coupled with preclinical studies demonstrating its effects in other anxiety related conditions, prompted us to evaluate its feasibility and efficacy in treatment of patients with PD.MethodsAn open-label clinical trial of xenon–oxygen mixture was conducted in 81 patients with PD; group 1 consisting of patients only with PD (N = 42); and group 2 patients with PD and other comorbidities (N = 39).ResultsBased on the analysis of the results of a number of psychometric scales used in this study (SAS, HADS, CGI), several conclusions can be made: (1) xenon is a potentially effective modality in acute treatment of PD; (2) an anti-panic effect of xenon administration persists for at least 6 months after the completion of the active phase of treatment; (3) xenon inhalation is well tolerated, with the drop-out rates being much lower than that of conventional pharmacotherapy (5.8% vs. 15%); (4) the severity of depressive disorders that frequently accompany PD can be significantly reduced with the use of xenon; (5) xenon may be considered as an alternative to benzodiazepines in conjunction with cognitive-behavioral therapy as a safe modality in treatment of anxiety disorder.ConclusionsThese data support the need for randomized double-blind clinical trials to further study xenon-based interventions.Trial registration This clinical trial was retrospectively registered on April 14th, 2017 as ISRCTN15184285 in the ISRCTN database.
Highlights
Current treatments of panic disorder (PD) are limited by adverse effects, poor efficacy, and need for chronic administration
One of the most common anxiety disorders is panic disorder (PD), with a 12 month prevalence in the US and in Europe estimated at 1.8 and 2.7% of the population, respectively [1, 2]; the main clinical feature of which is an unexpected panic attack (PA) that arises in the absence of any situational or emotional triggers, reaching its peak intensity within minutes, that is manifested by intense physical and cognitive symptoms, such as fear of recurrence, general health concerns, and behavioral changes [3, 4]
The greatest clinical evidence of efficacy in the treatment of PD has been demonstrated with the use of selective serotonin reuptake inhibitors (SSRIs), serotonin–norepinephrine reuptake inhibitors (SNRIs)
Summary
Current treatments of panic disorder (PD) are limited by adverse effects, poor efficacy, and need for chronic administration. Knowledge of benzodiazepines’ high risk of dependence [13, 14], often forces patients with PD leading an active lifestyle, to seek other, alternative methods of treatment. These side effects in themselves can exacerbate PD and become the triggers of panic attacks. There are frequent clinical scenarios where PD exists concomitantly with other psychiatric comorbidities or where panic attacks don’t reach the diagnostic threshold of a panic disorder, but have a significant impact on the course of the underlying disease and impair social functioning.
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