Laiana A Quagliato1, Fiammetta Cosci2,3, Richard I Shader4, Edward K Silberman5, Vladan Starcevic6, Richard Balon7, Steven L Dubovsky8, Carl Salzman9, John H Krystal10, Steve J Weintraub11, Rafael C Freire1, Antonio E Nardi1. 1. Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil. 2. Department of Health Sciences, University of Florence, Florence, Italy. 3. Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands. 4. Department of Immunology, Tufts University School of Medicine, Boston, MA, USA. 5. Department of Psychiatry, Tufts Medical Center, Boston, MA, USA. 6. University of Sydney, Sydney, NSW, Australia. 7. Departments of Psychiatry and Behavioral Neurosciences and Anesthesiology, Wayne State University School of Medicine, Detroit, MI, USA. 8. Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, Buffalo, NY, USA. 9. Harvard Medical School, Beth Israel Deaconess Medical Center and Massachusetts Mental Health Center, Boston, MA, USA. 10. Yale University, New Haven, CT, USA. 11. Washington University, Saint Louis, MO, USA.
Abstract
BACKGROUND: Benzodiazepines (BZs) and selective serotonin reuptake inhibitors (SSRIs) are effective in the pharmacologic treatment of panic disorder (PD). However, treatment guidelines favor SSRIs over BZs based on the belief that BZs are associated with more adverse effects than SSRIs. This belief, however, is currently supported only by opinion and anecdotes. AIM: The aim of this review and meta-analysis was to determine if there truly is evidence that BZs cause more adverse effects than SSRIs in acute PD treatment. METHODS: We systematically searched Web of Science, PubMed, Cochrane Central Register of Controlled Trials, and clinical trials register databases. Short randomized clinical trials of a minimum of four weeks and a maximum of 12 weeks that studied SSRIs or BZs compared to placebo in acute PD treatment were included in a meta-analysis. The primary outcome was all-cause adverse event rate in participants who received SSRIs, BZs, or placebo. RESULTS: Overall, the meta-analysis showed that SSRIs cause more adverse events than BZs in short-term PD treatment. Specifically, SSRI treatment was a risk factor for diaphoresis, fatigue, nausea, diarrhea, and insomnia, whereas BZ treatment was a risk factor for memory problems, constipation, and dry mouth. Both classes of drugs were associated with somnolence. SSRIs were associated with abnormal ejaculation, while BZs were associated with libido reduction. BZs were protective against tachycardia, diaphoresis, fatigue, and insomnia. CONCLUSION: Randomized, blinded studies comparing SSRIs and BZs for the short-term treatment of PD should be performed. Clinical guidelines based on incontrovertible evidence are needed.
BACKGROUND:Benzodiazepines (BZs) and selective serotonin reuptake inhibitors (SSRIs) are effective in the pharmacologic treatment of panic disorder (PD). However, treatment guidelines favor SSRIs over BZs based on the belief that BZs are associated with more adverse effects than SSRIs. This belief, however, is currently supported only by opinion and anecdotes. AIM: The aim of this review and meta-analysis was to determine if there truly is evidence that BZs cause more adverse effects than SSRIs in acute PD treatment. METHODS: We systematically searched Web of Science, PubMed, Cochrane Central Register of Controlled Trials, and clinical trials register databases. Short randomized clinical trials of a minimum of four weeks and a maximum of 12 weeks that studied SSRIs or BZs compared to placebo in acute PD treatment were included in a meta-analysis. The primary outcome was all-cause adverse event rate in participants who received SSRIs, BZs, or placebo. RESULTS: Overall, the meta-analysis showed that SSRIs cause more adverse events than BZs in short-term PD treatment. Specifically, SSRI treatment was a risk factor for diaphoresis, fatigue, nausea, diarrhea, and insomnia, whereas BZ treatment was a risk factor for memory problems, constipation, and dry mouth. Both classes of drugs were associated with somnolence. SSRIs were associated with abnormal ejaculation, while BZs were associated with libido reduction. BZs were protective against tachycardia, diaphoresis, fatigue, and insomnia. CONCLUSION: Randomized, blinded studies comparing SSRIs and BZs for the short-term treatment of PD should be performed. Clinical guidelines based on incontrovertible evidence are needed.
Authors: Tatyana Strekalova; Dmitrii Pavlov; Alexander Trofimov; Daniel C Anthony; Andrei Svistunov; Andrey Proshin; Aleksei Umriukhin; Alexei Lyundup; Klaus-Peter Lesch; Raymond Cespuglio Journal: Int J Mol Sci Date: 2022-02-13 Impact factor: 5.923
Authors: Richard Balon; Vladan Starcevic; Edward Silberman; Fiammetta Cosci; Steven Dubovsky; Giovanni A Fava; Antonio E Nardi; Karl Rickels; Carl Salzman; Richard I Shader; Nicoletta Sonino Journal: Braz J Psychiatry Date: 2020-03-09 Impact factor: 2.697
Authors: Simon Jc Davies; David Rudoler; Claire de Oliveira; Anjie Huang; Paul Kurdyak; Andrea Iaboni Journal: J Psychopharmacol Date: 2022-02-01 Impact factor: 4.562