Risks and benefits of medications for panic disorder: a comparison of SSRIs and benzodiazepines

ABSTRACT

Introduction: Panic disorder (PD) is a prevalent and disabling anxiety disorder that can be treated effectively. Selective serotonin reuptake inhibitors (SSRIs) and benzodiazepines are among the most frequently prescribed drugs for PD. In this article, the authors review the current evidence on efficacy, adverse events, and limitations of these two treatment options.

Areas covered: MEDLINE/Pubmed and Web of Science databases were searched for open or placebo-controlled trials on SSRIs and/or benzodiazepines in PD treatment.

Expert opinion: The literature search yielded 4,957 articles related to the theme. Of these, 24 articles were included in this review. Despite their usefulness in PD, SSRIs are associated with a delay of several weeks in onset of therapeutic effect and have the potential to exacerbate anxiety and panic early in the treatment course. Benzodiazepines present rapid onset of action, but can cause tolerance and dependence. Despite strong evidence of the effectiveness of SSRIs and benzodiazepines in the treatment of PD, few trials have performed head-to-head comparisons of these two drug classes. Future studies on the pharmacological treatment of PD should make direct comparisons of risks, benefits, and limitations of each group. This could help improve the evidence-based pharmacotherapy of PD.

KEYWORDS:

• Citalopram
• escitalopram
• paroxetine
• fluoxetine
• fluvoxamine
• sertraline
• clonazepam
• alprazolam
• adverse events

Article highlights

• Panic disorder is a prevalent and disabling anxiety disorder that can be treated effectively.

• There is evidence of the effectiveness of SSRIs and benzodiazepines in PD treatment.

• SSRIs are recommended as first-line treatments for PD and can assist in the treatment of comorbidities in PD, but they have slower onset of action, and have the potential to exacerbate anxiety and panic early in the treatment course.

• Benzodiazepines present rapid onset of action, but can cause withdrawal symptoms, tolerance and dependence.

• A relatively common practice is to combine SSRIs with benzodiazepines to provide more rapid, and potentially additive, clinical efficacy

• Evaluating risks and benefits of the most frequently prescribed drugs in PD could help improve evidence-based pharmacotherapy for this disorder.

This box summarizes key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose

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Funding

This paper has not been funded.