Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, University of Maastricht, Maastricht, the Netherlands.
Neuropsychiatr Dis Treat. 2011;7:621-37. doi: 10.2147/NDT.S12979. Epub 2011 Oct 19.
Although there are controversial issues (the "American view" and the "European view") regarding the construct and definition of agoraphobia (AG), this syndrome is well recognized and it is a burden in the lives of millions of people worldwide. To better clarify the role of drug therapy in AG, the authors summarized and discussed recent evidence on pharmacological treatments, based on clinical trials available from 2000, with the aim of highlighting pharmacotherapies that may improve this complex syndrome.
A systematic review of the literature regarding the pharmacological treatment of AG was carried out using MEDLINE, EBSCO, and Cochrane databases, with keywords individuated by MeSH research. Only randomized, placebo-controlled studies or comparative clinical trials were included.
After selection, 25 studies were included. All the selected studies included patients with AG associated with panic disorder. Effective compounds included selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants, selective noradrenergic reuptake inhibitors, and benzodiazepines. Paroxetine, sertraline, citalopram, escitalopram, and clomipramine showed the most consistent results, while fluvoxamine, fluoxetine, and imipramine showed limited efficacy. Preliminary results suggested the potential efficacy of inositol; D-cycloserine showed mixed results for its ability to improve the outcome of exposure-based cognitive behavioral therapy. More studies with the latter compounds are needed before drawing definitive conclusions.
No studies have been specifically oriented toward evaluating the effect of drugs on AG; in the available studies, the improvement of AG might have been the consequence of the reduction of panic attacks. Before developing a "true" psychopharmacology of AG it is crucial to clarify its definition. There may be several potential mechanisms involved, including fear-learning processes, balance system dysfunction, high light sensitivity, and impaired visuospatial abilities, but further studies are warranted.
尽管对于惊恐障碍（AG）的结构和定义存在争议问题（“美国观点”和“欧洲观点”），但该综合征得到了广泛认可，并且是全球数百万人生活中的负担。为了更好地阐明药物治疗在 AG 中的作用，作者总结并讨论了基于 2000 年以来可用的临床试验的最近药物治疗证据，旨在突出可能改善这种复杂综合征的药物治疗方法。
使用 MEDLINE、EBSCO 和 Cochrane 数据库，通过 MeSH 研究关键词进行了有关 AG 药物治疗的文献系统性回顾，仅纳入了随机、安慰剂对照研究或对照临床试验。
经过选择，纳入了 25 项研究。所有入选的研究均包括与惊恐障碍相关的 AG 患者。有效的药物包括选择性 5-羟色胺再摄取抑制剂、5-羟色胺-去甲肾上腺素再摄取抑制剂、三环抗抑郁药、选择性去甲肾上腺素再摄取抑制剂和苯二氮䓬类药物。帕罗西汀、舍曲林、西酞普兰、艾司西酞普兰和氯米帕明显示出最一致的结果，而氟伏沙明、氟西汀和丙咪嗪显示出有限的疗效。初步结果表明肌醇可能有效；D-环丝氨酸在改善暴露为基础的认知行为治疗的结果方面显示出混合的结果。在得出明确的结论之前，需要对后一类化合物进行更多的研究。
没有专门针对评估药物对 AG 影响的研究；在现有的研究中，AG 的改善可能是由于惊恐发作的减少。在制定真正的 AG 精神药理学之前，澄清其定义至关重要。可能涉及几个潜在的机制，包括恐惧学习过程、平衡系统功能障碍、高光敏感性和受损的视空间能力，但需要进一步研究。
