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 controlled, prospective, 1-year trial of citalopram in the treatment of panic disorder.
BACKGROUND The objective of this study was to evaluate the efficacy and tolerability of citalopram in the long-term treatment of adult out patients with panic disorder with or without agoraphobia . METHOD Patients in this double-blind , parallel-group trial were assigned to 1 of 3 fixed dosage ranges of citalopram ( 10 or 15 mg/day , 20 or 30 mg/day , or 40 or 60 mg/day ) , 1 dosage range of clomipramine ( 60 or 90 mg/day ) , or placebo . After the completed 8-week acute treatment period , the eligible patients could continue the treatment for up to 1 year . Of the 475 patients who were r and omly assigned for the short-term trial , 279 agreed to continue double-blind treatment at their assigned doses . The primary efficacy measure used was the Clinical Anxiety Scale panic attack item , and the response was defined as no panic attacks ( score of 0 or 1 ) . The other key measures used were the Physician 's Global Improvement Scale , the Patient 's Global Improvement Scale , and the Hamilton Rating Scale for Anxiety ( HAM-A ) . RESULTS In all drug-treated groups , except the group receiving the lowest citalopram dose , the treatment outcome was generally better than with placebo . As determined by a life table analysis of response , the probability of response during the 12 months was significantly greater with all treatment regimens than with placebo ( p < .05 ) , with citalopram 20 or 30 mg/day demonstrating the best response . Panic attacks tended to disappear in all patients remaining in the study until the end of follow-up . Analysis of the difference in the number of patients in different treatment groups remaining in the study ( perhaps the best measure of long-term efficacy ) also demonstrated that the patients treated with citalopram in dosage ranges of 20 or 30 mg/day and 40 or 60 mg/day had better response than placebo-treated patients ( p < .0002 and p < .004 , respectively ) . HAM-A and Global Improvement Scale scores also showed that patients treated with active drug showed greater improvement than placebo-treated patients . All treatment groups showed no new or exceptional adverse event clusters . CONCLUSION Citalopram in the dosage range of 20 to 60 mg/day is effective , well tolerated , and safe in the long-term treatment of patients who have 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 .