Antidepressants and benzodiazepines for panic disorder in adults

In panic disorder, there might possibly not be any differences between antidepressants and benzodiazepines in efficacy and tolerability, even though the evidence is insufficient.

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

Summary

A Cochrane review 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. However, only a few trials provided data for primary outcomes. 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.

Clinical comments

Date of latest search:

Ədəbiyyat

1. Bighelli I, Trespidi C, Castellazzi M et al. Antidepressants and benzodiazepines for panic disorder in adults. Cochrane Database Syst Rev 2016;9():CD011567.