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Are Noradrenergic Antidepressants a Valuable Choice in the Treatment of Panic Disorder? A Review and Meta Analysis

Published online by Cambridge University Press:  16 April 2020

A. Chiesa
Affiliation:
University of Bologna, Bologna, Italy
A. Serretti
Affiliation:
University of Bologna, Bologna, Italy
R. Calati
Affiliation:
University of Bologna, Bologna, Italy
G. Perna
Affiliation:
Università Vita Salute San Raffaele, Milano, Italy
L. Bellodi
Affiliation:
Università Vita Salute San Raffaele, Milano, Italy
D. De Ronchi
Affiliation:
University of Bologna, Bologna, Italy

Abstract

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Objective:

The aim of the present review and meta analysis is to evaluate the efficacy of new noradrenergic antidepressants (NAD) in the treatment of panic disorder (PD).

Methods:

A literature search was conducted using MEDLINE, ISI web of knowledge and references of selected articles. Data from fourteen papers focusing on venlafaxine, mirtazapine and reboxetine were entered in RevMan 4.2.10 Our primary outcome measures were the rate of response, remission and side effects of NAD compared to placebo. Further analysis included the end-point mean number of panic attacks, the Panic and Anticipatory Anxiety Scale and the Hamilton Scale for Anxiety’ values.

Results:

We found a significant higher rate of response (OR = 3.2, 95% CI=2.61 to 3.92), remission (OR = 2.14, 95% CI=1.72 to 2.66) and side effects (OR = 1.41, 95% CI=1.11 to 1.78) for NAD compared to placebo, even though the studies were very heterogeneous. Analysis performed on the three drugs individually showed higher rate of response for patients treated with venlafaxine and mirtazapine whereas no statistical difference was found between reboxetine and placebo. The number of panic attacks and the values of all scales measuring the intensity of panic disorder at the end of trial were significantly lower for patients treated with a NAD.

Conclusion:

Although the small sample size of some studies and limiting statistical assumptions could reduce the significativity of our findings, both venlafaxine and mirtazapine showed a significant efficacy for the treatment of PD which was comparable to selective serotonine reuptake inhibitors. Further studies on reboxetine are needed.

Type
P01-112
Copyright
Copyright © European Psychiatric Association 2009
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