Update on pharmacological treatment of panic disorder

Abstract: The aim of this review was to summarize the recent evidences regarding the pharmacological treatment of panic disorder (PD). The authors performed a systematic review of the literature regarding the pharmacological treatment of PD since the year 2000. Only open studies, placebo-controlled studies or comparative clinical trials were selected. Recent clinical trials confirmed the efficacy of fluvoxamine, venlafaxine, paroxetine, citalopram, sertraline, paroxetine, fluoxetine, imipramine, clomipramine, clonazepam, and inositol in the treatment of PD. The new drugs escitalopram, mirtazapine, duloxetine, and nefazodone may also be effective in the treatment of this disorder. Compounds with reported effectiveness in the treatment of PD included those with serotonergic, serotonergic and noradrenergic, and GABAergic activity. Serotonin and noradrenaline reuptake inhibitors (SNRI) and serotonin selective reuptake inhibitors (SSRI) are the first-line compounds in the treatment of PD. These drugs were better tolerated than tricyclics and benzodiazepines, besides having low risk of dependence and complications of overdosing. The serotonergic, noradrenergic, and GABAergic pathways play a major role in the fear network and in the physiopathology of PD. A better understanding of the role of these neurotransmitter systems in PD will allow the development of more effective drugs for this psychiatric condition.