Introduction : Serotonergic agents have greater effectiveness than noradrenergic ones in the treatment of Panic Disorder (PD). However preliminary studies suggested that reboxetine might be effective in the treatment of PD. We compared the effectiveness and tolerability of reboxetine and paroxetine in the treatment of PD. Methods: Sixty-eight patients with PD were assigned to treatment groups in a single-blind, randomized design. Each patient was assessed at day 0 and 90 by the Panic Associated Symptoms Scale (PASS), the Sheehan Disability Scale (SDS) and the Fear Questionnaire (FQ). Side effects were also recorded. Results: Reduction of PASS scores was significantly greater in the paroxetine group than in the reboxetine one. Vice versa we did not find any significant differences for other outcome measures. Sexual dysfunction and weight gain were significantly less frequent in the reboxetine group. Conclusions: The results showed a greater effect of paroxetine on panic attacks than reboxetine, while no differences for anticipatory anxiety and avoidance were found, suggesting a different role of noradrenaline and serotonin in the treatment of PD.
References
1 American Psychiatric A ssociation. Diagnostic and Statistical Manual of Mental Disorders (4th ed.) Washington DC; APA 1994
2
Argyle N, Deltito J, Allerup P. et al .
The Panic-Associated Symptom Scale: measuring the severity of panic disorder.
Acta Psychiatr Scand.
1991;
83
20-26
3
Ballenger J C, Wheadon D E, Steiner M. et al .
Double-blind, fixed-dose, placebo-controlled study of paroxetine in the treatment of panic disorder.
Am J Psychiatry.
1998;
155
36-42
4
Belzung C, El Hage W, Moindrot N. et al .
Behavioral and neurochemical changes following predatory stress in mice.
Neuropharmacology.
2001;
41
400-408
5
Boerner R J, Moller H J.
The importance of new antidepressants in the treatment of anxiety/depressive disorders.
Pharmacopsychiatry.
1999;
32
119-126
6 Brown M T, Dubini A, Di Nicolo P. Double-blind, placebo-controlled study of reboxetine in panic disorder. Abstract presented at the symposium ”Norepineprine”: New Vistas for an old neurotransmitter. Key west, FL;
7
Cassano G B, Petracca A, Perugi G. et al .
Clomipramine for panic disorder: I. The first 10 weeks of a long-term comparison with imipramine.
J Affect Disord.
1988;
14
123-127
8
Cole B J, Robbins T W.
Dissociable effects of lesions to the dorsal or ventral noradrenergic bundle on the acquisition, performance, and extinction of aversive conditioning.
Behav Neurosci.
1987;
101
476-488
9
Den Boer J A, Westenberg H G.
Effect of a serotonin and noradrenaline uptake inhibitor in panic disorder; a double-blind comparative study with fluvoxamine and maprotiline.
Int Clin Psychopharmacol.
1988;
3
59-74
10
Dunner D, Kumar R.
Paroxetine: a review of clinical experience.
Pharmacopsychiatry.
1998;
31
89-101
11
Hoehn-Saric R, McLeod D R, Hipsley P A.
Effect of fluvoxamine on panic disorder.
J Clin Psychopharmacol.
1993;
13
321-326
12
Humble M, Wistedt B.
Serotonin, panic disorder and agoraphobia: short-term and long-term efficacy of citalopram in panic disorders.
Int Clin Psychopharmacol.
1992;
6 (Suppl 5)
21-39
13
Johnson M R, Lydiard R B.
The neurobiology of anxiety disorders.
Psychiatr Clin North Am.
1995;
18
681-725
14
Klein D F.
Delineation of two-responsive anxiety syndromes.
Psychopharmacologia.
1964;
5
397-408
15
Leon A C, Shear M K, Portera L. et al .
Assessing impairment in patients with panic disorder: the Sheehan Disability Scale.
Soc Psychiatry Psychiatr Epidemiol.
1992;
27
78-82
16
Marks I M, Mathews A M.
Brief standard self-rating for phobic patients.
Behav Res Ther.
1979;
17
263-267
17
Michael A, Andrews S.
Paroxetine-induced vaginal anaesthesia.
Pharmacopsychiatry.
2002;
35
150-151
18
Masand P S, Gupta S.
Selective serotonin-reuptake inhibitors: an update.
Harv Rev Psychiatry.
1999;
7
69-84
19
Masi G, Toni C, Mucci M. et al .
Paroxetine in child and adolescent outpatients with panic disorder.
J Child Adolesc Psychopharmacol.
2001;
11
151-157
20
Mavissakalian M R, Perel J M, Talbott-Green M. et al .
Gauging the effectiveness of extended imipramine treatment for panic disorder with agoraphobia.
Biol Psychiatry.
1998;
43
848-854
Angelo Bertani, MD
Dept. Neuropsychiatric Sciences
Vita-Salute University
San Raffaele Hospital
20 via Stamina d’Ancona
20127 Milan
Italy
Phone: 39 2 2643 3211
Fax: 39 2 2643 3265
Email: bertani.angelo@hsr.it