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Evidence summaries

Antidepressants and Benzodiazepines for Panic Disorder in Adults

In panic disorder, there might possibly be no differences between antidepressants and benzodiazepines in efficacy and tolerability, even though the evidence is insufficient. However, antidepressants appear to be more effective than placebo in treating panic disorder. Level of evidence: "C"

Summary

A Cochrane review [Abstract] 1 included 35 studies with a total of 6785 subjects. Of them 5365 subjects in the arms of interest (antidepressant and benzodiazepines as monotherapy) were included. There was no difference between antidepressants and benzodiazepines in terms of response rate (RR 0.99, 95% CI 0.67 to 1.47; 2 studies, n=215). Benzodiazepines were more beneficial than antidepressants in terms of dropouts due to any cause, even if CI ranges from almost no difference to benefit with benzodiazepines (RR 1.64, 95% CI 1.03 to 2.63; 7 studies, n = 1449). Serotonin reuptake inhibitors (SSRIs) are better tolerated than TCAs, when looking at the number of patients experiencing adverse effects. There were no clinically significant differences between individual benzodiazepines. Information on adverse effects was very limited.

Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment), imprecise results (few patients in most of trials) and indirectness (only a few trials provided data for primary outcomes).

Another Cochrane review [Abstract] 2 included 41 RCTs including a total of 8252 patients. Duration of the intervention ranged from 8 to 28 weeks. Antidepressants were beneficial in comparison with placebo in terms of efficacy measured as failure to respond (RR 0.72, 95% CI 0.66 to 0.79; 30 trials, n= 6500). The number needed to treat for an additional beneficial outcome (NNTB) was 7 (95% CI 6 to 9). Antidepressants were better than placebo at the number of dropouts due to any cause (RR 0.88, 95% CI 0.81 to 0.97; 30 trials, n=7850). Considering antidepressant classes, TCAs showed a benefit over placebo, while for SSRIs and SNRIs we observed no difference. TCAs and SSRIs produced more dropouts due to adverse effects in comparison with placebo, while the CI for SNRI, noradrenergic reuptake inhibitors (NRI) and other antidepressants were wide and included the possibility of no difference.

Comment: The quality of evidence is downgraded by inconsistency (heterogeneity in outcomes).

Clinical comments

Note

Date of latest search:

References

  • Bighelli I, Trespidi C, Castellazzi M et al. Antidepressants and benzodiazepines for panic disorder in adults. Cochrane Database Syst Rev 2016;9():CD011567. [PubMed]
  • Bighelli I, Castellazzi M, Cipriani A et al. Antidepressants versus placebo for panic disorder in adults. Cochrane Database Syst Rev 2018;4():CD010676. [PubMed]

Primary/Secondary Keywords