Selective serotonin reuptake inhibitors and benzodiazepines in panic disorder: A meta-analysis of common side effects in acute treatment

Laiana A. Quagliato*, Fiammetta Cosci, Richard I. Shader, Edward K. Silberman, Vladan Starcevic, Richard Balon, Steven L. Dubovsky, Carl Salzman, John H. Krystal, Steve J. Weintraub, Rafael C. Freire, Antonio E. Nardi, Int Task Force Benzodiazepines

*Corresponding author for this work

Research output: Contribution to journalReview articleAcademicpeer-review

Abstract

Background: Benzodiazepines (BZs) and selective serotonin reuptake inhibitors (SSRIs) are effective in the pharmacologic treatment of panic disorder (PD). However, treatment guidelines favor SSRIs over BZs based on the belief that BZs are associated with more adverse effects than SSRIs. This belief, however, is currently supported only by opinion and anecdotes. Aim: The aim of this review and meta-analysis was to determine if there truly is evidence that BZs cause more adverse effects than SSRIs in acute PD treatment. Methods: We systematically searched Web of Science, PubMed, Cochrane Central Register of Controlled Trials, and clinical trials register databases. Short randomized clinical trials of a minimum of four weeks and a maximum of 12 weeks that studied SSRIs or BZs compared to placebo in acute PD treatment were included in a meta-analysis. The primary outcome was all-cause adverse event rate in participants who received SSRIs, BZs, or placebo. Results: Overall, the meta-analysis showed that SSRIs cause more adverse events than BZs in short-term PD treatment. Specifically, SSRI treatment was a risk factor for diaphoresis, fatigue, nausea, diarrhea, and insomnia, whereas BZ treatment was a risk factor for memory problems, constipation, and dry mouth. Both classes of drugs were associated with somnolence. SSRIs were associated with abnormal ejaculation, while BZs were associated with libido reduction. BZs were protective against tachycardia, diaphoresis, fatigue, and insomnia. Conclusion: Randomized, blinded studies comparing SSRIs and BZs for the short-term treatment of PD should be performed. Clinical guidelines based on incontrovertible evidence are needed.
Original languageEnglish
Article number0269881119859372
Pages (from-to)1340-1351
Number of pages12
JournalJournal of Psychopharmacology
Volume33
Issue number11
Early online date15 Jul 2019
DOIs
Publication statusPublished - Nov 2019

Keywords

  • Adverse events
  • panic attacks
  • antidepressants
  • treatment
  • TERM THERAPEUTIC USE
  • DOUBLE-BLIND
  • ANXIETY DISORDERS
  • PHARMACOLOGICAL-TREATMENT
  • COGNITIVE DECLINE
  • ADVERSE EVENTS
  • PLACEBO
  • MULTICENTER
  • ALPRAZOLAM
  • SERTRALINE

Cite this

Quagliato, L. A., Cosci, F., Shader, R. I., Silberman, E. K., Starcevic, V., Balon, R., Dubovsky, S. L., Salzman, C., Krystal, J. H., Weintraub, S. J., Freire, R. C., Nardi, A. E., & Int Task Force Benzodiazepines (2019). Selective serotonin reuptake inhibitors and benzodiazepines in panic disorder: A meta-analysis of common side effects in acute treatment. Journal of Psychopharmacology, 33(11), 1340-1351. [0269881119859372]. https://doi.org/10.1177/0269881119859372