Magazine article Clinical Psychiatry News

Panic Attack Relapse? Restarting Drugs Is Effective

Magazine article Clinical Psychiatry News

Panic Attack Relapse? Restarting Drugs Is Effective

Article excerpt


NEW YORK -- Patients with panic disorder can be effectively treated with either a benzodiazepine or a selective serotonin reuptake inhibitor, or both, but even long-term therapy might not prevent relapse in the majority of patients.

That's the conclusion of a team of Brazilian researchers who compared clonazepam, paroxetine, and a combination of the two in patients with panic disorder in a randomized, open-label trial.

By the third year of follow-up, about 77% of patients had experienced a relapse despite being treated for 3 years, and after 6 years, 94% of patients had experienced at least one new panic attack, reported Dr. Antonio E. Nardi of the Federal University of Rio de Janeiro.

However, resumption of therapy with either drug or with a different medication was successful in preventing or reducing the incidence of additional attacks in nearly all patients.

"We propose to discontinue drug treatment as soon as patients are asymptomatic for 1 year and to restart treatment at the first sign of relapse," he said at the annual meeting of the American Psychiatric Association.

The good and the bad

The benzodiazepine clonazepam and the SSRI paroxetine each have their advantages and drawbacks, Dr. Nardi said.

Clonazepam has a rapid onset of action, decreases anticipatory anxiety, and has a good safety profile in terms of interactions and overdose risk. On the other hand, patients might experience withdrawal symptoms, develop memory problems, and become dependent on the agent.

Paroxetine has well-documented antidepressive effects and little if any potential for abuse but can cause sexual dysfunction, hyperstimulation, anticholinergic effects, and weight gain.

With either agent, from 20% to 40% of patients remain symptomatic after short- or intermediate-term treatment, and relapse is frequent, even after 1 year of treatment, Dr. Nardi said.

The investigators designed an open-label clinical trial in which patients would be randomized to either clonazepam 2 mg/day or paroxetine 40 mg/day. Those who did not respond well to either drug were switched after 8 weeks to a combination of the drugs at or near the dose levels assigned for the individual drugs. …

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