TY - JOUR
T1 - Selective serotonin reuptake inhibitors and benzodiazepines in panic disorder
T2 - A meta-analysis of common side effects in acute treatment
AU - International Task Force on Benzodiazepines
AU - Quagliato, Laiana A.
AU - Cosci, Fiammetta
AU - Shader, Richard I.
AU - Silberman, Edward K.
AU - Starcevic, Vladan
AU - Balon, Richard
AU - Dubovsky, Steven L.
AU - Salzman, Carl
AU - Krystal, John H.
AU - Weintraub, Steve J.
AU - Freire, Rafael C.
AU - Nardi, Antonio E.
N1 - Publisher Copyright:
© The Author(s) 2019.
PY - 2019/11/1
Y1 - 2019/11/1
N2 - 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.
AB - 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.
KW - Adverse events
KW - antidepressants
KW - panic attacks
KW - treatment
UR - http://www.scopus.com/inward/record.url?scp=85070253857&partnerID=8YFLogxK
U2 - 10.1177/0269881119859372
DO - 10.1177/0269881119859372
M3 - Review article
C2 - 31304840
AN - SCOPUS:85070253857
SN - 0269-8811
VL - 33
SP - 1340
EP - 1351
JO - Journal of Psychopharmacology
JF - Journal of Psychopharmacology
IS - 11
ER -