New possibilities of treatment for panic attacks in elderly patients: escitalopram versus citalopram.
OBJECTIVE
Panic attacks may represent additional therapeutic problems in the elderly. The utility of citalopram in panic attacks has been widely investigated. Here, we compare the efficacy and safety of citalopram, with its S-enantiomer escitalopram at half dosage as to citalopram, in elderly patients who have panic attacks.


METHODS
This was an open community-based study. Forty patients who have panic attacks, according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria, were enrolled. Fifty percent of the patients were assigned for 8 weeks' treatment with escitalopram, and the remaining 50% were assigned to treatment with citalopram. The primary outcome measure was the weekly rate of panic attacks. The secondary outcome measures were the Hamilton scale for anxiety and depression and the Cooper Disability Scale. Analysis of variance by repeated measures was applied to calculate differences between groups.


RESULTS
A similar decrease in weekly rate of panic attacks, in the scores of Hamilton Scale for anxiety and depression and in the Cooper Disability Scale scores, was observed in both groups after 8 weeks, but a significant variation of outcome measures from baseline was observed already after 2 weeks in the escitalopram group (P < 0.001) and only after 4 weeks in the citalopram group (P < 0.01).


CONCLUSIONS
Escitalopram could be considered among the drugs of first choice in elderly patients with panic attacks because of its good efficacy and safety and for the advantage of reducing the total dose and of a more rapid onset of action as compared with citalopram, although further studies are needed to confirm these results.
Rampello
Liborio
L
Department of Neurosciences, University of Catania, Italy. rampello@unict.it
Alvano
Alessandro
A
Raffaele
Rocco
R
Malaguarnera
Mariano
M
Vecchio
Ignazio
I
D000368:Aged; D018687:Antidepressive Agents, Second-Generation / Q000008:administration & dosage / Q000627:therapeutic use*; D001007:Anxiety / Q000150:complications / Q000188:drug therapy; D015283:Citalopram / Q000008:administration & dosage / Q000627:therapeutic use*; D003863:Depression / Q000150:complications / Q000188:drug therapy; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male; D016584:Panic Disorder / Q000150:complications / Q000188:drug therapy*; D011569:Psychiatric Status Rating Scales; D013237:Stereoisomerism; D013997:Time Factors; D016896:Treatment Outcome
D018687:Antidepressive Agents, Second-Generation; D015283:Citalopram