Novel antidepressants and panic disorder: evidence beyond current guidelines.
OBJECTIVE
The aim of the present review is to summarize available evidence about the efficacy and side effects of novel antidepressants for the treatment of panic disorder.


METHODS
A literature search was undertaken using MEDLINE, ISI web of knowledge and references of retrieved articles. The search included articles published in English up to September 2009. Both controlled and uncontrolled trials were included. The quality of the reviewed articles was also assessed.


RESULTS
Fourteen mainly poor-quality studies were included. Mirtazapine showed some efficacy in reducing the number and the severity of panic symptoms in many uncontrolled studies and was comparable to selective serotonin reputake inhibitors (SSRIs) in direct-comparison studies. Reboxetine was significantly more efficacious than placebo but less effective than SSRIs. Further uncontrolled studies suggested preliminary evidence for the use of milnacipran and duloxetine as well. All drugs were usually well tolerated.


CONCLUSIONS
Current studies do not yet provide convincing evidence supporting the efficacy of mirtazapine, reboxetine, milnacipran and duloxetine for the treatment of panic disorder patients. However, on account of positive preliminary results, further research is warranted.
Institute of Psychiatry, University of Bologna, Bologna, Italy. alessandro.serretti@unibo.it
Alessandro
A
Serretti
Alberto
A
Chiesa
Raffaella
R
Calati
Giampaolo
G
Perna
Laura
L
Bellodi
Diana
D
De Ronchi
D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D003521:Cyclopropanes / Q000009:adverse effects / Q000627:therapeutic use*; D000068736:Duloxetine Hydrochloride; D006801:Humans; D008803:Mianserin / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000078764:Milnacipran; D000078785:Mirtazapine; D009025:Morpholines / Q000009:adverse effects / Q000627:therapeutic use*; D016584:Panic Disorder / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D000077593:Reboxetine; D013876:Thiophenes / Q000009:adverse effects / Q000627:therapeutic use*
D000928:Antidepressive Agents; D003521:Cyclopropanes; D009025:Morpholines; D013876:Thiophenes; D008803:Mianserin; D000068736:Duloxetine Hydrochloride; D000077593:Reboxetine; D000078785:Mirtazapine; D000078764:Milnacipran