Effect of Fluvoxamine on Panic Disorder

Department of Psychiatry and Behavioral Sciences, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287-7144.
Journal of Clinical Psychopharmacology (Impact Factor: 3.24). 11/1993; 13(5):321-6. DOI: 10.1097/00004714-199310000-00004
Source: PubMed


Several reports suggest that selective serotonin reuptake blockers are helpful in the treatment of panic disorder. The aim of the study was to compare fluvoxamine with placebo in 50 panic disorder patients by using an 8-week, double-blind, parallel-groups design. Weekly assessment included a panic attack diary (frequency and severity), the Montgomery-Asberg Depression Scale, the Clinical Anxiety Scale, and the Sheehan Disability Scale. Although both groups improved on all measures, the fluvoxamine group experienced significantly less frequent major panic attacks from the third week on and significantly lower ratings on anxiety, depression, and disability from the sixth week on. Mean ratings of the severity of major and the severity and frequency of minor attacks were not affected differently by fluvoxamine and placebo. At the end of the study, significantly more patients on fluvoxamine were free of major and minor panic attacks. The results indicate that: (1) the administration of fluvoxamine, as compared with placebo, led to a significant reduction in the number of panic attacks. (2) The severity of panic attacks was not affected by fluvoxamine. (3) The effect of fluvoxamine on anxiety, depressive mood, and disability differed from placebo only after 6 weeks of treatment, after which the placebo group showed either no further improvement or a reversal of symptoms. (4) Participation in a drug study, even without additional psychotherapy, led to significant improvement in all patients.

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    • "At that point, 43% of the fluvoxamine recipients vs 25% of cognitive therapy and 4% of placebo recipients were free of panic attacks. Hoehn-Saric et al (1993) compared fluvoxamine with placebo in 50 PD patients, using an 8-week, double-blind, parallel-groups design. At the end of the study, significantly more patients on fluvoxamine were free of major and minor panic attacks than those on placebo. "
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    ABSTRACT: Panic disorder (PD) is a common, persistent and disabling mental disorder. It is often associated with agoraphobia. The present article reviews the current status of pharmacotherapy for PD with or without agoraphobia as well as the current status of treatments combing pharmacotherapy with cognitive behavior therapy (CBT). The review has been written with a focus on randomized controlled trials, meta-analyses, and reviews that have been published over the past few years. Effective pharmacological treatments include tricyclic antidepressants, monoamine oxidase inhibitors, selective serotonin reuptake inhibitors, serotonin norepinephrine reuptake inhibitors, and various benzodiazepines. Treatment results obtained with CBT compare well with pharmacotherapy, with evidence that CBT is at least as effective as pharmacotherapy. Combining pharmacotherapy with CBT has been found to be superior to antidepressant pharmacotherapy or CBT alone, but only in the acute-phase treatment. Long term studies on treatments combining pharmacotherapy and CBT for PD with or without agoraphobia have found little benefit, however, for combination therapies versus monotherapies. New investigations explore the potential additional value of sequential versus concomitant treatments, of cognitive enhancers and virtual reality exposure therapy, and of education, self management and Internet-based interventions.
    Neuropsychiatric Disease and Treatment 09/2008; 4(4):779-95. · 1.74 Impact Factor
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    • "Within the TCAs, both imipramine and clomipramine have been studied (Cross National Collaborative Panic Study, Second Phase Investigators, 1992; Papp et al., 1997). The currently available SSRIs citalopram, escitalopram , fluvoxamine, fluoxetine, paroxetine, and sertraline have all been proven more effective than pill-placebo in reducing symptomatology in PD (Ballenger et al., 1998a; Black et al., 1993; Hoehn-Saric et al., 1993; Lecrubier et al., 1997; Michelson et al., 1998; Rapaport et al., 1998; Sharp et al., 1996; Wade et al., 1997). The daily dosages of these antidepressants are similar to those used in the treatment of major depressive disorder (see Table 1). "
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    ABSTRACT: This paper reviews the literature on the pharmacotherapy of panic disorder, in order to address the questions (1) what is the first-line pharmacotherapy of choice for panic disorder?, (2) for how long should maintenance pharmacotherapy be continued, and (3) what is the optimal approach to the treatment-refractory patient with panic disorder. A MEDLINE search (1966-2003) was undertaken to collate randomized controlled trials of pharmacotherapy in panic disorder. A review of the evidence indicates that SSRIs are currently the first line agent of choice in panic disorder, and that pharmacotherapy should be continued for at least 1 year. There has been relatively little research on the pharmacotherapy of treatment-refractory panic disorder, and this area requires future attention.
    The International Journal of Neuropsychopharmacology 10/2005; 8(3):473-82. DOI:10.1017/S1461145705005201 · 4.01 Impact Factor
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    • "Escitalopram is the S-enantiomer of the racemate citalopram; therefore the clinical studies with citalopram may also be relevant for escitalopram (A). Á Fluvoxamine showed efficacy in a number of DBPC studies (Asnis et al. 2001; Black et al. 1993; de Beurs et al. 1995; den Boer and Westenberg 1990; Hoehn-Saric et al. 1993; Pols et al. 1993). In one study, fluvoxamine and the comparator imipramine were both more effective than placebo and equally effective (Bakish et al. 1996). "
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    ABSTRACT: In this report, recommendations for the pharmacological treatment of anxiety and obsessive-compulsive disorders are presented, based on available randomized, placebo- or comparator-controlled clinical studies. Selective serotonin reuptake inhibitors (SSRIs) are the first-line treatment for panic disorder. Tri2-cyclic antidepressants (TCAs) are equally effective, but they are less well tolerated than the SSRIs. In treatment-resistant cases, benzodiazepines like alprazolam may be used when the patient does not have a history of dependency and tolerance. Due to possible serious side effects and interactions with other drugs and food components, the irreversible monamine oxidase inhibitor (MAOI) phenelzine should be used only when first-line drugs have failed. In generalised anxiety disorder, venlafaxine and SSRIs can be recommended, while buspirone and imipramine may be alternatives. For social phobia, SSRIs are recommended for the first line, and MAOIs, moclobemide and benzodiazepines as second line. Obsessive-compulsive disorder is best treated with SSRIs or clomipramine.
    The World Journal of Biological Psychiatry 11/2002; 3(4):171-99. DOI:10.3109/15622970209150621 · 4.18 Impact Factor
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