Are there advances in pharmacotherapy for panic disorder? A systematic review of the past five years

Daniela Caldirola*, Alessandra Alciati, Alice Riva, Giampaolo Perna

*Corresponding author for this work

Research output: Contribution to journal(Systematic) Review article peer-review

9 Citations (Web of Science)

Abstract

Introduction: Several effective medications are available for treating panic disorder (PD). However, outcomes are unsatisfactory in a number of patients, suggesting the usefulness of expanding the array of antipanic drugs and improving the quality of response to current recommended treatments. Areas covered: The authors have performed an updated systematic review of pharmacological studies (phase III onwards) to examine whether advances have been made in the last five years. Only four studies were included. D-cycloserine no longer seemed promising as a cognitive-behavioral therapy (CBT) enhancer. Some preliminary findings concerning the optimization of recommended medications deserved consideration, including: the possibility that SSRIs are more effective than CBT alone in treating panic attacks, combined therapy is preferable when agoraphobia is present, and clonazepam is more potent than paroxetine in decreasing panic relapse. Expert opinion: Given the lack of novel treatments, expanding a personalized approach to the existing medications seems to be the most feasible strategy to improve pharmacotherapy outcomes regarding PD. Recent technological progress, including wearable devices collecting real-time data, 'big data' platforms, and application of machine learning techniques might help make outcome prediction more reliable. Further research on previously promising novel treatments is also recommended.
Original languageEnglish
Pages (from-to)1357-1368
Number of pages12
JournalExpert Opinion on Pharmacotherapy
Volume19
Issue number12
DOIs
Publication statusPublished - 1 Jan 2018

Keywords

  • Clonazepam
  • d-cycloserine
  • panic disorder
  • personalized
  • pharmacotherapy
  • selective serotonin reuptake inhibitors (SSRIs)
  • paroxetine
  • COGNITIVE-BEHAVIORAL THERAPY
  • RANDOMIZED-CONTROLLED-TRIAL
  • D-CYCLOSERINE ENHANCEMENT
  • LONG-TERM TREATMENT
  • ANXIETY DISORDERS
  • REUPTAKE INHIBITOR
  • DOUBLE-BLIND
  • FOLLOW-UP
  • OREXIN 1
  • PAROXETINE

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