Selective serotonin reuptake inhibitors may help achieve remission in panic disorders: BMJ

Bangkok, Thailand: Selective serotonin reuptake inhibitors (SSRIs) give excellent rates of remission with minimal risk of side effects for the treatment of the panic disorder, a recent study has stated. Sertraline and escitalopram, among SSRIs, were linked with high remission and a low risk of side effects. This study was conducted by Natasha Chawla and the team, the findings of whose work were published in the British Medical Journal (BMJ) on 25th November 2021.

The objective of this study was to identify medication classes and individual SSRIs with high remission rates and low risk of adverse effects in the treatment of panic disorder with or without agoraphobia.

A systematic review and network meta-analysis were used in this investigation, which examined data from Embase, Medline, and ClinicalTrials.gov from inception to June 17, 2021. This study's qualifying criteria included randomized controlled studies that included individuals aged 18 years with a panic disorder diagnosis, compared medications used to treat the panic disorder, and assessed outcomes of interest such as remissions, dropouts, and adverse events. The updated Cochrane risk of bias method for randomized trials was used to assess the risk of bias in the included studies. Random effects models were used in direct meta-analyses. To determine the comparative efficacy of medication classes and individual SSRIs, a two-stage network meta-analysis with the surface under the cumulative ranking curve (SUCRA) was utilized.

The key findings are as follow:

1. There were 87 studies with a total of 12 800 individuals and 12 medication classes that were suitable for inclusion.

2. Almost all of the studies (86/87) contained some kind of bias or were at high risk of bias. Tricyclic antidepressants, benzodiazepines, monoamine oxidase inhibitors, SSRIs, and serotonin-noradrenaline reuptake inhibitors (SNRIs) were associated with significantly higher remission rates than placebo, with risk ratios of 1.39, 1.47, 1.30, 1.38, and 1.27, respectively, in a network meta-analysis of remission.

3. The top three best therapies for remission, according to SUCRAs, are benzodiazepines, tricyclic antidepressants, and SSRIs. Tricyclic antidepressants, benzodiazepines, and SSRIs, on the other hand, were substantially related to an increased risk of adverse events when compared to placebo, with risk ratios of 1.79, 1.76, and 1.19, respectively.

4. The consistency assumption of adverse occurrences was preserved, but might still be present after excluding studies with a high number of female participants and those suffering from agoraphobia. A SUCRA cluster ranking plot of all medication classes that included both remission and adverse events revealed that SSRIs were linked with high remission and a low probability of adverse events. Sertraline and escitalopram, among individual SSRIs, gave high remission with an acceptable risk of side effects.

In conclusion, these data imply that SSRIs have a significant benefit while posing a minimal risk for the treatment of panic disorder. When compared to other SSRIs, sertraline and escitalopram were linked with high remission and a low risk of side effects when individual agents were investigated. However, because the conclusions were based on data with moderate to very low levels of confidence, they should be regarded with care.

Reference:

Chawla N, Anothaisintawee T, Charoenrungrueangchai K, Thaipisuttikul P, McKay G J, Attia J et al. Drug treatment for panic disorder with or without agoraphobia: systematic review and network meta-analysis of randomised controlled trials BMJ 2022; 376 :e066084 doi:10.1136/bmj-2021-066084