SEROTONERGIC COMPOUNDS IN PANIC DISORDER, OBSESSIVE-COMPULSIVE DISORDER AND ANXIOUS DEPRESSION - A CONCISE REVIEW

The recognition that antidepressants are effective in panic and anxiet y disorders had led to the evaluation of drugs selective for serotonin uptake in an attempt to dissect the neurotransmitters responsible for panic disorder. Fluvoxamine is the best studied of the selective sero tonin reuptake inhibitors (SSRIs) and recent double-blind studies have confirmed earlier findings showing a reduced number and duration of p anic attacks. In addition, fluvoxamine attenuates the 'accessory sympt oms' of panic disorder such as depression and anxiety. Fluoxetine has only been evaluated in open trials, although these results are general ly positive. Paroxetine has shown similar efficacy to clomipramine in a large, controlled study, although the other SSRIs have seldom been i nvestigated. Fluvoxamine lacks the activating properties possessed by some SSRIs and this also makes it a useful candidate for the treatment of anxious depression. The efficacy of fluvoxamine in obsessive-compu lsive disorder has been established in several double-blind, placebo-c ontrolled trials. In clinical terms, fluvoxamine is approximately as e ffective as clomipramine, but with a decidedly better adverse event pr ofile. Fluoxetine has also proved effective in obsessive-compulsive di sorder, although a recent meta-analysis suggests that fluvoxamine may be somewhat more effective. The other SSRIs have not been sufficiently well studied to justify conclusive statements.