title: Reboxetine and citalopram in panic disorder: a single-blind, cross-over, flexible-dose pilot study.
abstract: Both noradrenergic and serotonergic systems have been implicated in the pathophysiology of panic disorder. The advent of selective serotonin (5-HT) reuptake inhibitors (SSRIs) (e.g. citalopram) and, more recently, selective noradrenergic (NA) reuptake inhibitors (NRIs) (e.g. reboxetine) has provided potentially important avenues of treatment for the disorder. To date, the comparative efficacy of selective NA and 5-HT reuptake inhibitors for panic disorder remains unresolved. Nineteen patients with panic disorder were randomized in a single-blind, cross-over design to either citalopram or reboxetine for 8 weeks and after a 2-week washout were switched to the other study drug. At week 18, seven of 13 patients (54%) in the intent-to-treat sample responded to reboxetine and nine of 11 patients responded to citalopram (82%). Both citalopram and reboxetine led to significant improvements in panic attack severity with no apparent between-drug differences in efficacy. However, citalopram demonstrated superior efficacy in treating depressive symptoms. One non-responder to citalopram responded to reboxetine and three non-responders to reboxetine responded to citalopram. Although SSRIs are viewed as a first-line treatment for panic disorder, these results suggest that a NA agent such as reboxetine may also have a role. These data also suggest an advantage for citalopram in treating comorbid depressive symptoms, although some patients may respond preferentially to an SSRI and other patients to an NRI.
authors.affiliation: MRC Unit on Anxiety and Stress Disorders, Department of Psychiatry, University of Stellenbosch, PO Box 19063, Tygerberg 7505, Cape Town, South Africa. sseedat@sun.ac.za
authors.forename: Soraya
authors.initials: S
authors.lastname: Seedat
authors.forename: Eugene
authors.initials: E
authors.lastname: van Rheede van Oudtshoorn
authors.forename: Jacqueline E
authors.initials: JE
authors.lastname: Muller
authors.forename: Norma
authors.initials: N
authors.lastname: Mohr
authors.forename: Dan J
authors.initials: DJ
authors.lastname: Stein
mesh_terms: D000284:Administration, Oral; D018759:Adrenergic Uptake Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D000328:Adult; D015283:Citalopram / Q000494:pharmacology / Q000627:therapeutic use*; D015897:Comorbidity; D018592:Cross-Over Studies; D003863:Depression / Q000188:drug therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009025:Morpholines / Q000494:pharmacology / Q000627:therapeutic use*; D016584:Panic Disorder / Q000188:drug therapy*; D010865:Pilot Projects; D000077593:Reboxetine; D017367:Selective Serotonin Reuptake Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D016037:Single-Blind Method; D016896:Treatment Outcome
chemical_list: D018759:Adrenergic Uptake Inhibitors; D015283:Citalopram; D009025:Morpholines; D000077593:Reboxetine; D017367:Selective Serotonin Reuptake Inhibitors