The efficacy of azapirones is uncertain due to the lack of meta-analysable data for the primary outcome and low- quality evidence for secondary efficacy outcomes .
A small amount of moderate- quality evidence suggested that the acceptability of azapirones for panic disorder was lower than for placebo .
If further research is to be conducted , studies with larger sample sizes , with different azapirones and with less risk of bias are necessary to draw firm conclusions regarding azapirones for panic disorder
BACKGROUND Panic disorder is common in the general population .
It is often associated with other psychiatric disorders , such as drug dependence , major depression , bipolar disorder , social phobia , specific phobia and generalised anxiety disorder .
Azapirones are a class of drugs used as anxiolytics .
They are associated with less drowsiness , psychomotor impairment , alcohol potentiation and potential for addiction or abuse than benzodiazepines .
However , azapirones are not widely used in the treatment of panic disorder and evidence for their efficacy is unclear .
It is important to find out if azapirones are effective and acceptable in the treatment of panic disorder .
OBJECTIVES To assess the effects of azapirones on panic disorder in adults , specifically:1 .
to determine the efficacy of azapirones in alleviating symptoms of panic disorder , with or without agoraphobia , in comparison with placebo;2 .
to review the acceptability of azapirones in panic disorder , with or without agoraphobia , in comparison with placebo ; and 3 .
to investigate adverse effects of azapirones in panic disorder with or without agoraphobia , including general prevalence of adverse effects , compared with placebo .
Reduced Serotonin Type 1A Receptor Binding in Panic Disorder
Recent animal models suggest that disturbances in serotonin type-1A receptor ( 5-HT1AR ) function may contribute to chronic anxiety , although it is not clear at all whether such models constitute relevant models for panic disorder ( PD ) in humans . The selective 5-HT1AR radiolig and [18F]trans-4-fluoro-N-2-[4-(2-methoxyphenyl)piperazin-1-yl]ethyl]-N-(2-pyridyl)cyclohexanecarboxamide ( FCWAY ) permits in vivo assessment of central 5-HT1AR binding using positron emission tomography ( PET ) . We studied 16 unmedicated symptomatic out patients with PD and 15 matched healthy controls . Seven patients had an additional diagnosis of a current major depressive episode , however PD was the primary diagnosis . A 120 min PET study of  5-HT1AR  binding was acquired using a GE Advance scanner in three-dimensional mode . Using quantitative PET image analysis , regional values were obtained for [18F]-FCWAY volume of distribution ( DV ) , corrected for plasma protein binding , and K1 , the delivery rate of [18F]-FCWAY from plasma to tissue . MRI scanning was performed using a GE Signa Scanner ( 3.0 Tesla ) to provide an anatomical framework for image analysis and partial volume correction of PET data . PD patients showed lower DV in the anterior cingulate ( t = 4.3 ; p < 0.001 ) , posterior cingulate ( t = 4.1 ; p < 0.001 ) , and raphe ( t = 3.1 ; p = 0.004 ) . Comparing patients with PD , patients with PD and comorbid depression , and healthy controls revealed that DVs did not differ between PD patients and PD patients with comorbid depression , whereas both patient groups differed significantly from controls . These results provide for the first time in vivo evidence for the involvement of 5-HT1ARs in the pathophysiology of PD
The efficacy of azapirones is uncertain due to the lack of meta-analysable data for the primary outcome and low- quality evidence for secondary efficacy outcomes .
A small amount of moderate- quality evidence suggested that the acceptability of azapirones for panic disorder was lower than for placebo .
If further research is to be conducted , studies with larger sample sizes , with different azapirones and with less risk of bias are necessary to draw firm conclusions regarding azapirones for panic disorder
BACKGROUND Panic disorder is common in the general population .
It is often associated with other psychiatric disorders , such as drug dependence , major depression , bipolar disorder , social phobia , specific phobia and generalised anxiety disorder .
Azapirones are a class of drugs used as anxiolytics .
They are associated with less drowsiness , psychomotor impairment , alcohol potentiation and potential for addiction or abuse than benzodiazepines .
However , azapirones are not widely used in the treatment of panic disorder and evidence for their efficacy is unclear .
It is important to find out if azapirones are effective and acceptable in the treatment of panic disorder .
OBJECTIVES To assess the effects of azapirones on panic disorder in adults , specifically:1 .
to determine the efficacy of azapirones in alleviating symptoms of panic disorder , with or without agoraphobia , in comparison with placebo;2 .
to review the acceptability of azapirones in panic disorder , with or without agoraphobia , in comparison with placebo ; and 3 .
to investigate adverse effects of azapirones in panic disorder with or without agoraphobia , including general prevalence of adverse effects , compared with placebo .