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Serotonin uptake inhibitors are superior to imipramine and alprazolam in
alleviating panic attacks: a meta-analysis
Boyer W.
Serotonin uptake inhibitors are superior to imipramine and alprazolam in
alleviating panic attacks: a meta-analysis
International Clinical Psychopharmacology,
1995,
10,
pp. 45-49
Record status
This record is a structured abstract written by CRD reviewers. The original
has met a set of quality criteria.
Author's objective
To assess the relative efficacy of serotonin reuptake inhibitors, imipramine
and alprazolam in the treatment of panic disorder. Type of
intervention
Treatment
Specific interventions included in the review
Serotonin reuptake inhibitors (paroxetine, fluvoxamine, zimelidine,
clomipramine), imipramine and alprazolam.
Participants included in the review
Patients with panic disorder (n=2348).
Outcomes assessed in the review
The number of patients who were panic free was the main outcome measure, but
in four studies global improvement measures were used and in one study the
Hamilton Anxiety Scale was used.
Study designs of evaluations included in the review
Randomised controlled trials.
What sources were searched to identify primary studies?
Medline, Embase and Psychlit were searched and traditional bibliographic
methods were used.
Criteria on which the validity (or quality) of studies was assessed
Patients had to have been diagnosed by DSM-III criteria for agoraphobia with
panic or DSM-III-R panic disorder. Randomised controlled trials had to be
prospective, double-blind and placebo-controlled.
How were the judgements of validity (or quality) made?
Not stated.
How were decisions on the relevence of primary studies made?
Not stated.
How was the data extracted from primary studies?
Not stated.
Number of studies included
27
How were the studies combined?
Improvement ratios (based on the binomial effect size display, interpreted as
the proportion of patients who improved with placebo or active medicine) and
their 95% confidence intervals were calculated.
How were differences between studies investigated?
Comparisons were made of effect sizes within each treatment group.
Significant heterogeneity of effect sizes was found within each treatment
group. Dosage effects were also investigated as a source of variance.
Results of the review
Alprazolam, imipramine and the serotonin reuptake inhibitors were each
significantly superior to placebo in alleviating panic. Serotonin reuptake
inhibitors were significantly superior to both imipramine (p=0.0004) and
alprazolam (p=0.004). The superiority of the serotonin reuptake inhibitors
remained, but was less pronounced when they were compared to studies which
used higher doses of imipramine (p=0.04) or alprazolam (p=0.005). There was
no significant difference between alprazolam and imipramine (p=0.11).
Was any cost information reported?
No
Author's conclusions
A serotonin reuptake inhibitor should be the first choice for the treatment of
most patients with panic disorder. Imipramine and alprazolam should usually
be the second-line treatments for patients who cannot tolerate or do not
respond to a serotonin reuptake inhibitor.
CRD commentary
Little information is given on the searches carried out, for example the years
included, the strategy used or even all of the databases searched. As the
authors found significant heterogeneity of effect sizes within each treatment
group, some caution should be exercised, as not all the variance in effect
sizes can be explained by the type of drug administered.
Subject index terms
Subject Indexing from the National Library of medicine: Alprazolam/tu
[Therapeutic Use]; Imipramine/tu [Therapeutic Use]; Panic-Disorder/dt [Drug
Therapy]; Serotonin-Uptake-Inhibitors/tu [Therapeutic Use]; Alprazolam/ad
[Administration & Dosage]; Double-Blind-Method; Imipramine/ad [Administration
& Dosage]; Panic-Disorder/px [Psychology]; Prospective-Studies;
Psychiatric-Status-Rating-Scales; Randomized-Controlled-Trials;
Serotonin-Uptake-Inhibitors/ad [Administration & Dosage]; Human
Copyright
University of York, 1998
Database no.: DARE-920019
