Antidepressants versus placebo for panic disorder in adults

摘要: BACKGROUND Panic disorder is characterised by repeated, unexpected panic attacks, which represent a discrete period of fear or anxiety that has rapid onset, reaches peak within 10 minutes, and in at least four 13 characteristic symptoms are experienced, including racing heart, chest pain, sweating, shaking, dizziness, flushing, stomach churning, faintness breathlessness. It common the general population with lifetime prevalence 1% to 4%. The treatment includes psychological pharmacological interventions. Amongst agents, National Institute for Health Care Excellence (NICE) British Association Psychopharmacology consider antidepressants, mainly selective serotonin reuptake inhibitors (SSRIs), as first-line disorder, due their more favourable adverse effect profile over monoamine oxidase (MAOIs) tricyclic antidepressants (TCAs). Several classes have been studied compared, but it still unclear less terms effectiveness acceptability this condition. OBJECTIVES To assess effects adults, specifically:1. determine efficacy alleviating without agoraphobia, comparison placebo;2. review placebo; and3. investigate effects, compared placebo. SEARCH METHODS We searched Cochrane Common Mental Disorders' (CCMD) Specialised Register, CENTRAL, MEDLINE, EMBASE PsycINFO up May 2017. handsearched reference lists relevant papers previous systematic reviews. SELECTION CRITERIA All double-blind, randomised, controlled trials (RCTs) allocating adults DATA COLLECTION AND ANALYSIS Two authors independently checked eligibility extracted data using standard form. entered into Review Manager 5 double-check procedure. Information included study characteristics, participant intervention details settings. Primary outcomes failure respond, measured range response scales, acceptability, total number dropouts any reason. Secondary remit, symptom frequency anxiety, depression, social functioning, quality life patient satisfaction, various scales defined individual studies. used GRADE evidence each outcome MAIN RESULTS: Forty-one unique RCTs 9377 participants overall, whom we 8252 49 placebo-controlled arms interest (antidepressant monotherapy placebo alone) review. majority studies were moderate low inconsistency, imprecision risk selection performance bias.We found low-quality revealed benefit group respond (risk ratio (RR) 0.72, 95% confidence interval (CI) 0.66 0.79; = 6500; 30). magnitude corresponds needed treat an additional beneficial (NNTB) 7 (95% CI 6 9): means seven people would need be treated order one benefit. observed same finding when placebo.Moderate-quality suggested looking cause (RR 0.88, 0.81 0.97; 7850; NNTB 27 17 105); treating will result person fewer dropping out. Considering antidepressant classes, TCAs showed placebo, while SSRIs serotonin-norepinephrine inhibitor (SNRIs) no difference.When can considered measure tolerability, moderate-quality showing whole well tolerated than In particular, produced SNRI, noradrenergic (NRI) other wide possibility difference. AUTHORS' CONCLUSIONS identified comprehensively address objectives present review.Based on these results, may effective disorder. Efficacy quantified 7, implying Antidepressants also dropouts, dropout effects. However, tolerability varied between different antidepressants.The choice whether should prescribed clinical practice cannot made basis review.Limitations results include funding some pharmaceutical companies, only assessing short-term outcomes.Data from network meta-analysis psychopharmacological hopefully provide further useful information issue.