ABSTRACT
OBJECTIVE: This study determined the efficacy and safety of sertraline in the treatment of patients with panic disorder. METHOD: The study was a randomized, double-blind, parallel-group, flexible-dose comparison of sertraline and placebo in outpatients with a DSM-III-R diagnosis of panic disorder with or without agoraphobia. After a 2-week single-blind placebo lead-in, 168 patients entered a 10-week double-blind phase in which they were randomly assigned to treatment with either sertraline or placebo. RESULTS: Sertraline was significantly more effective than placebo in decreasing the number of full and limited-symptom panic attacks. Among patients who completed the study, the mean number of panic attacks per week dropped by 88% in the sertraline-treated patients and 53% in the placebo-treated patients. Sertraline-treated patients also had significantly more improvement than placebo-treated patients in scores on the Quality of Life Enjoyment and Satisfaction Questionnaire, patient global evaluation, and Clinical Global Impression severity of illness and global improvement scales. Overall, patients tolerated sertraline well, and only 9% terminated treatment because of side effects. CONCLUSIONS: Sertraline is an effective and well-tolerated treatment for patients with panic disorder.
Subject(s)
1-Naphthylamine/analogs & derivatives , Panic Disorder/drug therapy , Selective Serotonin Reuptake Inhibitors/therapeutic use , 1-Naphthylamine/therapeutic use , Adult , Agoraphobia/drug therapy , Agoraphobia/epidemiology , Agoraphobia/psychology , Ambulatory Care , Comorbidity , Double-Blind Method , Drug Administration Schedule , Female , Humans , Male , Panic Disorder/epidemiology , Panic Disorder/psychology , Placebos , Psychiatric Status Rating Scales/statistics & numerical data , Quality of Life , Sertraline , Treatment OutcomeABSTRACT
The authors review the studies on discontinuation of lithium therapy in terms of subsequent relapse or possible withdrawal symptoms. Withdrawal symptoms following lithium discontinuation including heightened anxiety, sleep disturbances and irritability remain controversial. Relapse of the primary illness following lithium discontinuation is a well documented serious complication.
Subject(s)
Lithium/adverse effects , Substance Withdrawal Syndrome/etiology , Animals , Bipolar Disorder/drug therapy , Humans , Lithium/therapeutic use , Neurotransmitter Agents/physiology , Rats , RecurrenceABSTRACT
The effect of lithium on platelet count was studied by examining 12 patients treated with lithium carbonate without any additional medication, 13 patients treated with lithium carbonate with additional psychotropic medication, 25 patients with major affective disorder prior to any treatment, 25 patients with panic disorder prior to any treatment and 25 healthy controls. The platelet counts were increased in the group of subjects treated with lithium carbonate without any additional psychotropic medication. The increase was not clinically significant.
Subject(s)
Affective Disorders, Psychotic/blood , Anxiety Disorders/blood , Depressive Disorder/blood , Fear/physiology , Lithium/pharmacology , Panic/physiology , Platelet Count/drug effects , Affective Disorders, Psychotic/drug therapy , Drug Therapy, Combination , Female , Humans , Lithium/administration & dosage , Lithium Carbonate , Male , Psychotropic Drugs/administration & dosageSubject(s)
Adrenergic beta-Antagonists/pharmacology , Anxiety Disorders/chemically induced , Fear/drug effects , Lactates , Panic/drug effects , Anxiety Disorders/prevention & control , Humans , Isoproterenol/pharmacology , Lactic Acid , Propranolol/pharmacology , Receptors, Adrenergic, beta/drug effectsSubject(s)
Anxiety/psychology , Fear/drug effects , Lactates , Panic/drug effects , Adult , Female , Humans , Infusions, Parenteral , Lactates/administration & dosage , Lactic Acid , Male , Models, PsychologicalABSTRACT
Both sodium lactate and isoproterenol can produce anxiety symptoms in patients with panic attacks. We administered both substances intravenously under placebo-controlled, double-blind conditions to patients with panic attacks and normal control subjects. We measured changes in anxiety levels using the Hamilton Anxiety Scale, State-Trait Anxiety Inventory, and a Panic Severity Scale. Measurements of respiratory rate and blood pH, pO2, pCO2, HCO3, and base excess were used to determine the relationship of hyperventilation to the symptoms induced by the infusions. Heart rate, epinephrine and norepinephrine levels were measured to determine whether there are changes related to palpitations and chest pain. Finger temperature and galvanic skin response were monitored to see whether any changes correlate with subject reports of hot or cold flashes and sweating. In this presentation, we will describe the clinical and biochemical changes that occur during panic attacks.
Subject(s)
Anxiety Disorders/physiopathology , Fear/physiology , Isoproterenol , Lactates , Panic/physiology , Adult , Anxiety Disorders/diagnosis , Double-Blind Method , Female , Humans , Lactic Acid , Male , Personality Inventory , Psychiatric Status Rating ScalesABSTRACT
The QT interval is a noninvasive measurement obtained from electrocardiographic tracings. Long QT intervals occur in individuals at risk for fatal cardiac arrhythmias, and tricyclic antidepressant drugs can produce an increase in the QT interval. In this study, the authors compared the QT intervals from drug-free depressed patients, patients with substance use disorders, and normal control subjects. QT prolongation occurred more frequently (p less than .05) and severely (p less than .01) in the drug-free depressed subjects than in the controls. These results suggest that some drug-free depressed patients have increased QT intervals. These patients may be at risk for sudden, unexpected cardiac arrhythmias unrelated to the cardiotoxic effects of tricyclic antidepressant drugs.
Subject(s)
Depressive Disorder/physiopathology , Electrocardiography , Heart Conduction System/drug effects , Heart Conduction System/physiopathology , Humans , Opioid-Related Disorders/physiopathologyABSTRACT
Patients with a preexisting thyroiditis may be particularly susceptible to a rapid onset of lithium-induced hypothyroidism. The evidence for this hypothesis is reviewed and a case report illustrating this phenomena is presented.
