Selective serotonin reuptake inhibitors are probably the best first option for patients with panic disorder

Reference

Chawla N, Anothaisintawee T, Charoenrungrueangchai K, et al. Drug treatment for panic disorder with or without agoraphobia: systematic review and network meta-analysis of randomised controlled trials. BMJ 2022;376:e066084.

Synopsis

These researchers identified randomized controlled trials that evaluated medicines to treat panic disorder (with or without agoraphobia) by searching 3 databases as well as reference lists of identified studies and meta-analyses. They included 87 studies published in any language that included a total of 12,800 participants and 12 drug classes, with 2 researchers independently selecting studies for inclusion and abstracting the data. Alas, only one study was at low risk of bias, and all studies were of short duration (12 weeks or less). All the other studies suffered from issues of randomization, allocation concealment (which could affect outcomes), or risk of a selective reporting of outcomes (many studies were conducted before registration of study protocols was a standard practice). The authors used network meta-analysis, a method of comparing different drug treatments when they weren’t studied in head-to-head trials. Evaluating the effect on remission, which was defined as no panic attacks for at least one week by the end of the study, all drug classes studied were more effective than placebo, with benzodiazepines, tricyclic antidepressants, and selective serotonin reuptake inhibitors (SSRIs), in that order, as the top 3 best treatments for remission. All 3 drug classes were associated with an increased likelihood of adverse effects, with SSRIs having the least likelihood. Among the SSRIs, sertraline and escitalopram were associated with high remission and low risk of adverse events.