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Personalized pharmacotherapy may improve panic disorder treatment

Roughly 17 percent to 64 percent of patients who experience panic attacks do not respond well to drug therapy and continue to exhibit symptoms.

By Amy Wallace
Personalized pharmacotherapy may improve panic disorder treatment
Based on a large analysis of previous studies, researchers say personalized pharmacotherapy may be a superior approach for treating panic disorder and panic attacks than current standard practice. Photo by chuck stock/Shutterstock

April 26 (UPI) -- Researchers studied the potential of personalized pharmacotherapy to help doctors choose the best drug for individual patients who experience panic attacks.

Drug therapy is typically the first treatment choice for patients who have panic disorders, with the most common symptom being panic attacks. However, roughly 17 percent to 64 percent of patients do not respond adequately to drug therapy and often continue to experience panic attacks.

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"The major goal of a personalized treatment approach is to tailor interventions according to each patient's unique profile and characteristics," Dr. Daniela Caldirola, of the Department of Clinical Neurosciences at Hermanas Hospitalarias in Como, Italy, said in a press release. "Although still a challenging issue for clinicians, a personalized approach, based on reliable predictors of pharmacotherapy course, may provide relevant advances in treatment of psychiatric disorders. PD [panic disorder] a common and debilitating psychiatric condition, could greatly benefit from such an approach, because from a clinical perspective there is still a strong unmet need for more efficacious pharmacological interventions in this disorder."

Researchers reviewed more than 1,000 studies and identified 22 randomized, placebo-controlled studies of three drugs, paroxetine, venlafaxine XR, and alprazolam, that fit their criteria for analysis.

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The study aimed to identify sociodemographic and clinical characteristics that clinicians can easily evaluate before starting treatment. These include age, gender, duration of panic disorder, presence or severity of agoraphobia, number of panic attacks, severity of disorder and severity of general anxiety, or depressive symptoms along with clinical outcomes and tolerability of FDA-approved drugs.

Results showed very limited support for moderating effects of sociodemographic and clinical variables on short-term clinical outcomes and tolerability of the three drugs. However, the researchers did find that longer illness duration was associated with a lower rate of patients free of panic attacks at the end of trials comparing the drug venlafaxine XR to placebo.

They also found that the higher the age at the beginning of trials that compared paroxetine to placebo were associated with higher rates of patients dropping out of the studies due to adverse side effects, and the longer the treatment, the higher the rate of patients free from panic attacks at the end of the trials of venlafaxine XR.

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"The personalized approach to pharmacotherapy for PD, although at an early stage, appears to be the most promising way for increasing, within a reasonable time frame, the rate of successful outcomes in this disorder, similar to trends in other fields of medicine, like oncology," Caldirola said.

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The study was published in Personalized Medicine in Psychiatry.

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