New treatment options for panic disorder: clinical trials from 2000 to 2010.

INTRODUCTION: Panic disorder (PD) is a prevalent psychiatric disorder characterized by unexpected and recurrent panic attacks. PD patients present significant psychosocial impairment and a high risk of psychiatric comorbidities and suicide. PD should be treated effectively as soon as the symptoms emerge because the longer these patients remain without treatment, the worse the prognosis will be. AREAS COVERED: The authors carried out a systematic review of the literature regarding the pharmacological treatment of PD in the last 10 years. Only open studies, placebo-controlled studies or comparative clinical trials were selected. EXPERT OPINION: Compounds with reported effectiveness in the treatment of PD included tricyclic antidepressants, benzodiazepines, serotonin selective reuptake inhibitors (SSRIs), serotonin and noradrenaline reuptake inhibitors (SNRIs) and other drugs. SSRIs and SNRIs are the first-line compounds in the treatment of PD. These drugs were better tolerated than tricyclics and benzodiazepines as they had a low risk of dependence and overdosing complications. The serotonergic, noradrenergic and GABAergic pathways play a major role in the fear network and in the physiopathology of PD. A better understanding of the role of these neurotransmitter systems in PD will allow the development of more effective drugs for this psychiatric condition.