title: A randomized, naturalistic, parallel-group study for the long-term treatment of panic disorder with clonazepam or paroxetine.
abstract: This long-term extension of an 8-week randomized, naturalistic study in patients with panic disorder with or without agoraphobia compared the efficacy and safety of clonazepam (n = 47) and paroxetine (n = 37) over a 3-year total treatment duration. Target doses for all patients were 2 mg/d clonazepam and 40 mg/d paroxetine (both taken at bedtime). This study reports data from the long-term period (34 months), following the initial 8-week treatment phase. Thus, total treatment duration was 36 months. Patients with a good primary outcome during acute treatment continued monotherapy with clonazepam or paroxetine, but patients with partial primary treatment success were switched to the combination therapy. At initiation of the long-term study, the mean doses of clonazepam and paroxetine were 1.9 (SD, 0.30) and 38.4 (SD, 3.74) mg/d, respectively. These doses were maintained until month 36 (clonazepam 1.9 [SD, 0.29] mg/d and paroxetine 38.2 [SD, 3.87] mg/d). Long-term treatment with clonazepam led to a small but significantly better Clinical Global Impression (CGI)-Improvement rating than treatment with paroxetine (mean difference: CGI-Severity scale -3.48 vs -3.24, respectively, P = 0.02; CGI-Improvement scale 1.06 vs 1.11, respectively, P = 0.04). Both treatments similarly reduced the number of panic attacks and severity of anxiety. Patients treated with clonazepam had significantly fewer adverse events than those treated with paroxetine (28.9% vs 70.6%, P < 0.001). The efficacy of clonazepam and paroxetine for the treatment of panic disorder was maintained over the long-term course. There was a significant advantage with clonazepam over paroxetine with respect to the frequency and nature of adverse events.
authors.affiliation: Panic and Respiration Laboratory, Institute of Psychiatry, Federal University of Rio de Janeiro, National Institute for Translational Medicine(INCT-TM, Niteroi, Rio de Janeiro, Brazil. antonioenardi@gmail.com
authors.forename: Antonio E
authors.initials: AE
authors.lastname: Nardi
authors.forename: Rafael C
authors.initials: RC
authors.lastname: Freire
authors.forename: Marina D
authors.initials: MD
authors.lastname: Mochcovitch
authors.forename: Roman
authors.initials: R
authors.lastname: Amrein
authors.forename: Michelle N
authors.initials: MN
authors.lastname: Levitan
authors.forename: Anna L
authors.initials: AL
authors.lastname: King
authors.forename: Alexandre M
authors.initials: AM
authors.lastname: Valença
authors.forename: André B
authors.initials: AB
authors.lastname: Veras
authors.forename: Flávia
authors.initials: F
authors.lastname: Paes
authors.forename: Aline
authors.initials: A
authors.lastname: Sardinha
authors.forename: Isabella
authors.initials: I
authors.lastname: Nascimento
authors.forename: Valfrido L
authors.initials: VL
authors.lastname: de-Melo-Neto
authors.forename: Gisele P
authors.initials: GP
authors.lastname: Dias
authors.forename: Adriana Cardoso de O
authors.initials: AC
authors.lastname: E Silva
authors.forename: Gastão L
authors.initials: GL
authors.lastname: Soares-Filho
authors.forename: Rafael T
authors.initials: RT
authors.lastname: da Costa
authors.forename: Marco A
authors.initials: MA
authors.lastname: Mezzasalma
authors.forename: Marcele R
authors.initials: MR
authors.lastname: de Carvalho
authors.forename: Ana C
authors.initials: AC
authors.lastname: de Cerqueira
authors.forename: Jaime E
authors.initials: JE
authors.lastname: Hallak
authors.forename: José A
authors.initials: JA
authors.lastname: Crippa
authors.forename: Marcio
authors.initials: M
authors.lastname: Versiani
mesh_terms: D000293:Adolescent; D000328:Adult; D000927:Anticonvulsants / Q000008:administration & dosage* / Q000009:adverse effects; D001938:Brazil; D002998:Clonazepam / Q000008:administration & dosage* / Q000009:adverse effects; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D016584:Panic Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D017374:Paroxetine / Q000008:administration & dosage* / Q000009:adverse effects; D010555:Personality Inventory; D011446:Prospective Studies; D019233:Retreatment; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D055815:Young Adult
chemical_list: D000927:Anticonvulsants; D002998:Clonazepam; D017374:Paroxetine; D017367:Selective Serotonin Reuptake Inhibitors