Drug treatment of panic disorder. A critical review of controlled clinical trials

The clinical efficacy of drug treatment for panic disorder has been evaluated in several studies, especially in the last decade. In this paper we reviewed double-blind controlled clinical trials of antidepressants and benzodiazepines in the treatment of panic disorder. Tricyclic antidepressants (principally imipramine) and benzodiazepines were equally effective in reducing panic symptomatology. This evidence does not support the hypothesis that panic-related symptomatology is a psychopathological entity, requiring a specific antidepressant drug treatment. The combination of psychological therapy with drug treatment was associated with even better outcome. On the other hand, the efficacy of MAOI remains to be demonstrated. Better compliance with benzodiazepines may favor the clinical use of these drugs rather than antidepressants. However, more prospective controlled studies including follow-up examinations are required, in order to assess the risk/benefit ratio of these treatments after long-term therapy.