A Medline search of research on pharmacotherapy was undertaken , and a previous systematic review on the evidence -based pharmacotherapy of panic disorder was up date d. Selective serotonin reuptake inhibitors remain a first-line pharmacotherapy of panic disorder , with the serotonin noradrenaline reuptake inhibitor venlafaxine also an acceptable early option .
Temporary co-administration of benzodiazepines can be considered .
For patients not responding to first-line agents several pharmacotherapy options are available , but there is a notable paucity of data on the optimal choice
The evidence -based pharmacotherapy of panic disorder continues to evolve .
This paper review s data on first-line pharmacotherapy , evidence for maintenance treatment , and management options for treatment-refractory patients .
Evidence why paroxetine dose escalation is not effective in major depressive disorder: a randomized controlled trial with assessment of serotonin transporter occupancy.
Dose escalation is often used in depressed patients who fail to respond to st and ard doses of selective serotonin reuptake inhibitors , but clinical efficacy is equivocal . We aim ed to reassess the efficacy of paroxetine dose escalation and quantify whether paroxetine dose escalation increases occupancy of the serotonin transporter ( SERT ) more than placebo dose escalation in a r and omized controlled trial . We recruited 107 nonpsychotic , unipolar depressed out patients ( 18 - 70 years ; Hamilton Depression Rating Scale ( HDRS(17 ) ) > 18 ) from primary care and psychiatric outpatient departments . After 6 weeks , open-label paroxetine 20 mg per day ( T0 ) , nonresponding patients ( HDRS(17 ) decrease < 50 % ; n=60 ) were r and omized to double-blind paroxetine ( 30 - 50 mg per day as tolerable ) or placebo dose escalation ( paroxetine 20 mg per day+placebo ) . Patients were followed until 6 weeks after r and omization ( T1 ) . Forty-nine patients , drug free at study entry , underwent single-photon emission-computed tomography ( SPECT ) scanning before treatment and were scanned repeatedly at T0 and T1 .  Paroxetine serum concentrations and SERT occupancy were determined at T0 and T1 ( n=32 ) . We terminated the dose-escalation trial after an interim analysis . Thirty nonresponding patients were r and omized to paroxetine ( 46.7+/-5.5 mg per day ) , 27 to placebo dose escalation . Response rates were 10/30 ( 33.3 % ) and 10/27 ( 37.0 % ) , respectively . Repeated measurement analyses showed no significant effect for treatment ( p=0.88 , exceeding a priori stopping rules for futility ( p>0.5 ) ) . Overall dropout was higher for placebo ( 26.7 % ) than paroxetine ( 3.3 % ; p=0.03 ) . Paroxetine dose escalation increased  paroxetine serum concentrations ( p<0.001 ) . SPECT measurements ( 12 patients r and omized to paroxetine ( 46.9+/-4.8 mg ) and 14 to placebo dose escalation ) showed no significant increase of midbrain SERT occupancy ( 2.5+/-26.4 % , paroxetine ; 3.1+/-25.8 % placebo ; p=0.687 ) nor in diencephalon ( p=0.529 ) . Paroxetine dose escalation in depressed patients has no clinical benefit over placebo dose escalation . This is explained by the absence of significant increases of SERT occupancy by paroxetine dose escalation , despite increased paroxetine serum concentrations ( IS RCT N44111488 )
A Medline search of research on pharmacotherapy was undertaken , and a previous systematic review on the evidence -based pharmacotherapy of panic disorder was up date d. Selective serotonin reuptake inhibitors remain a first-line pharmacotherapy of panic disorder , with the serotonin noradrenaline reuptake inhibitor venlafaxine also an acceptable early option .
Temporary co-administration of benzodiazepines can be considered .
For patients not responding to first-line agents several pharmacotherapy options are available , but there is a notable paucity of data on the optimal choice
The evidence -based pharmacotherapy of panic disorder continues to evolve .
This paper review s data on first-line pharmacotherapy , evidence for maintenance treatment , and management options for treatment-refractory patients .