We observed the same finding when classes of antidepressants were compared with placebo .
When looking at dropouts due to adverse effects , which can be considered as a measure of tolerability , we found moderate- quality evidence showing that antidepressants as a whole are less well tolerated than placebo .
The identified studies comprehensively address the objectives of the present review .Based on these results , antidepressants may be more effective than placebo in treating panic disorder .
Antidepressants may also have benefit in comparison with placebo in terms of number of dropouts , but a less favourable profile in terms of dropout due to adverse effects .
However , the tolerability profile varied between different classes of antidepressants .
BACKGROUND Panic disorder is characterised by repeated , unexpected panic attacks , which represent a discrete period of fear or anxiety that has a rapid onset , reaches a peak within 10 minutes , and in which at least four of 13 characteristic symptoms are experienced , including racing heart , chest pain , sweating , shaking , dizziness , flushing , stomach churning , faintness and breathlessness .
It is common in the general population with a lifetime prevalence of 1 % to 4 % .
The treatment of panic disorder includes psychological and pharmacological interventions .
Amongst pharmacological agents , the National Institute for Health and Care Excellence ( NICE ) and the British Association for Psychopharmacology consider antidepressants , mainly selective serotonin reuptake inhibitors ( SSRIs ) , as the first-line treatment for panic disorder , due to their more favourable adverse effect profile over monoamine oxidase inhibitors ( MAOIs ) and tricyclic antidepressants ( TCAs ) .
Several classes of antidepressants have been studied and compared , but it is still unclear which antidepressants have a more or less favourable profile in terms of effectiveness and acceptability in the treatment of this condition .
OBJECTIVES To assess the effects of antidepressants for panic disorder in adults , specifically:1 .
to determine the efficacy of antidepressants in alleviating symptoms of panic disorder , with or without agoraphobia , in comparison to placebo;2 .
to review the acceptability of antidepressants  in panic disorder , with or without agoraphobia , in comparison with placebo ; and 3 .
to investigate the adverse effects of antidepressants  in panic disorder , with or without agoraphobia , including the general prevalence of adverse effects , compared to placebo .
A double-blind study of the efficacy of venlafaxine extended-release, paroxetine, and placebo in the treatment of panic disorder.
To date , no large-scale , controlled trial comparing a serotonin-norepinephrine reuptake inhibitor and selective serotonin reuptake inhibitor with placebo for the treatment of panic disorder has been reported . This double-blind study compares the efficacy of venlafaxine extended-release ( ER ) and paroxetine with placebo . A total of 664 nondepressed adult out patients who met DSM-IV criteria for panic disorder ( with or without agoraphobia ) were r and omly assigned to 12 weeks of treatment with placebo or fixed-dose venlafaxine ER ( 75 mg/day or 150 mg/day ) , or paroxetine 40 mg/day . The primary measure was the percentage of patients free from full-symptom panic attacks , assessed with the Panic and Anticipatory Anxiety Scale ( PAAS ) . Secondary measures included the Panic Disorder Severity Scale , Clinical Global Impressions -- Severity ( CGI-S ) and --Improvement ( CGI-I ) scales ; response ( CGI-I rating of very much improved or much improved ) , remission ( CGI-S rating of not at all ill or borderline ill and no PAAS full-symptom panic attacks ) ; and measures of depression , anxiety , phobic fear and avoidance , anticipatory anxiety , functioning , and quality of life . Intent-to-treat , last observation carried forward analysis showed that mean improvement on most measures was greater with venlafaxine ER or paroxetine than with placebo . No significant differences were observed between active treatment groups . Panic-free rates at end point with active treatment ranged from 54 % to 61 % , compared with 35 % for placebo . Approximately 75 % of patients given active treatment were responders , and nearly 45 % achieved remission . The placebo response rate was slightly above 55 % , with remission near 25 % . Adverse events were mild or moderate and similar between active treatment groups . Venlafaxine ER and paroxetine were effective and well tolerated in the treatment of panic disorder
We observed the same finding when classes of antidepressants were compared with placebo .
When looking at dropouts due to adverse effects , which can be considered as a measure of tolerability , we found moderate- quality evidence showing that antidepressants as a whole are less well tolerated than placebo .
The identified studies comprehensively address the objectives of the present review .Based on these results , antidepressants may be more effective than placebo in treating panic disorder .
Antidepressants may also have benefit in comparison with placebo in terms of number of dropouts , but a less favourable profile in terms of dropout due to adverse effects .
However , the tolerability profile varied between different classes of antidepressants .
BACKGROUND Panic disorder is characterised by repeated , unexpected panic attacks , which represent a discrete period of fear or anxiety that has a rapid onset , reaches a peak within 10 minutes , and in which at least four of 13 characteristic symptoms are experienced , including racing heart , chest pain , sweating , shaking , dizziness , flushing , stomach churning , faintness and breathlessness .
It is common in the general population with a lifetime prevalence of 1 % to 4 % .
The treatment of panic disorder includes psychological and pharmacological interventions .
Amongst pharmacological agents , the National Institute for Health and Care Excellence ( NICE ) and the British Association for Psychopharmacology consider antidepressants , mainly selective serotonin reuptake inhibitors ( SSRIs ) , as the first-line treatment for panic disorder , due to their more favourable adverse effect profile over monoamine oxidase inhibitors ( MAOIs ) and tricyclic antidepressants ( TCAs ) .
Several classes of antidepressants have been studied and compared , but it is still unclear which antidepressants have a more or less favourable profile in terms of effectiveness and acceptability in the treatment of this condition .
OBJECTIVES To assess the effects of antidepressants for panic disorder in adults , specifically:1 .
to determine the efficacy of antidepressants in alleviating symptoms of panic disorder , with or without agoraphobia , in comparison to placebo;2 .
to review the acceptability of antidepressants  in panic disorder , with or without agoraphobia , in comparison with placebo ; and 3 .
to investigate the adverse effects of antidepressants  in panic disorder , with or without agoraphobia , including the general prevalence of adverse effects , compared to placebo .