Rosenberg R
Department of Biological Psychiatry, Psychiatric Hospital in Aarhus, University Hospital, Risskov, Denmark.
Pharmacol Toxicol. 1993 Jun;72(6):344-53. doi: 10.1111/j.1600-0773.1993.tb01343.x.
Drug treatment of panic disorder is reviewed with focus on recent controlled studies. The efficacy of alprazolam, a triazolobenzodiazepine, and imipramine, a tricyclic antidepressant, has consistently been demonstrated, but there is reasonable evidence that other benzodiazepines or antidepressants might also be effective if equipotent doses are used. Most controlled studies demonstrate drug efficacy on several psychopathological symptoms, including the core symptom panic attacks. Limited evidence indicates that alprazolam may be more efficacious in treating panic attacks than avoidance behaviour, and the reverse when imipramine is concerned. Drug efficacy appears to be most consistently documented in moderately to severely ill panic patients. The benzodiazepines are better tolerated than antidepressants in terms of patient acceptance, and the improvement sets in faster with benzodiazepines. In the presence of depressive symptoms considered secondary to panic attacks and/or agoraphobia, both types of drugs appear efficacious. Difficulty discontinuing high-dose benzodiazepine treatment remains the most important side effect of the treatment but sedation can, like anticholinergic side effects of the tricyclic antidepressants, be troublesome, thereby diminishing patient compliance. The role of newly developed antidepressants with a more specific mode of action and milder side effects awaits evaluation in controlled trials.
本文回顾了惊恐障碍的药物治疗，重点关注近期的对照研究。三唑并苯二氮䓬类药物阿普唑仑和三环类抗抑郁药丙咪嗪的疗效已得到持续证实，但有合理证据表明，如果使用等效剂量，其他苯二氮䓬类药物或抗抑郁药可能也有效。大多数对照研究表明，药物对多种精神病理症状有效，包括核心症状惊恐发作。有限的证据表明，阿普唑仑在治疗惊恐发作方面可能比回避行为更有效，而丙咪嗪则相反。药物疗效似乎在中度至重度惊恐障碍患者中得到最一致的记录。就患者接受度而言，苯二氮䓬类药物比抗抑郁药耐受性更好，且使用苯二氮䓬类药物时症状改善更快。在存在继发于惊恐发作和/或广场恐惧症的抑郁症状时，这两类药物似乎都有效。停用高剂量苯二氮䓬类药物治疗困难仍然是治疗最重要的副作用，但镇静作用，就像三环类抗抑郁药的抗胆碱能副作用一样，可能会带来麻烦，从而降低患者的依从性。新开发的作用方式更具特异性且副作用较轻的抗抑郁药的作用有待在对照试验中进行评估。
