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Am Fam Physician. 1999;59(4):1003-1004

The treatment of panic disorder with tricyclic antidepressants, monoamine oxidase inhibitors and benzodiazepines has been proved to be effective. Each of these classes of medications has drawbacks, including side effects and, in the case of benzodiazepines, addiction potential. Selective serotonin reuptake inhibitors (SSRIs) have a pharmacologic and therapeutic profile that could offer an advantage over the other medications in treating panic disorder. Pohl and colleagues studied the efficacy and safety of sertraline, an SSRI, in the treatment of panic disorder.

The study was a double-blind, randomized, parallel-group design with a flexible dosage schedule comparing sertraline to placebo. Patients with an established diagnosis of panic disorder based on the Diagnostic and Statistical Manual of Mental Disorders, 3rd ed. (DSM III-R) guidelines were included in the study. Patients also had to have at least one unanticipated panic attack within four weeks of the start of the trial. After a two-week lead-in period with placebo, the patients were randomized to either the treatment or the placebo group. The treatment group began taking sertraline in a dosage of 25 mg per day for one week, then, with flexible titration, 50 to 200 mg per day. During and after the study period, patients were evaluated for symptoms, number of panic attacks and duration of anticipatory anxiety regarding the panic attack. Side effects were also monitored in both groups.

A total of 168 patients were enrolled in the study. There were no differences between the placebo and treatment groups with regard to baseline demographics, clinical characteristics or social functioning. In the sertraline treatment group, 9 percent of the patients stopped taking the medication because of side effects; only 1 percent stopped because of lack of efficacy. A significant number of patients in the treatment group experienced a decrease in the frequency of panic attacks, with 62 percent of the treated patients remaining free of any attacks at the end of the study period. The treatment group also had a decrease in the severity of symptoms during an attack and reported less anxiety before the attacks. The most common adverse events were gastrointestinal in nature (33 percent reported nausea, and 24 percent reported diarrhea). Dry mouth was reported by 19 percent of the patients; other adverse events included ejaculation failure (11 percent) and decreased libido (10 percent). The authors conclude that sertraline is a well-tolerated and highly effective treatment for panic disorders. Therapeutic responses occurred rapidly and without a notable risk of jitteriness with a 25-mg starting dosage. Sertraline appears to be most effective at a dosage of 50 to 200 mg.

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