Bell C J, Nutt D J
Psychopharmacology Unit, University of Bristol.
Br J Psychiatry. 1998 Jun;172:465-71. doi: 10.1192/bjp.172.6.465.
Tricyclic (TCA) and monoamine oxidase inhibitor (MAOI) antidepressants are effective in the treatment of panic disorder. Two selective serotonin reuptake inhibitors (SSRIs) have also been licensed in the UK for this indication and studies with three other SSRIs have recently been completed. These provide further evidence for the role of serotonin in panic.
Review of clinical, animal and laboratory studies.
SSRIs have been shown to be effective in the treatment of panic disorder. The reported rates of improvement of 60-70% of patients taking SSRIs are similar to those seen with TCAs and greater than placebo. Other serotonergic agents do not appear to be effective. Animal work and human studies including measures of 5-HT in plasma, cerebrospinal fluid and platelets, challenge paradigms and tryptophan depletion show that the relationship between 5-HT and anxiety is complex.
Clinical trials have shown that of all the serotonergic agents only the SSRIs are effective in panic disorder. They are as beneficial as the TCAs and seem to be better tolerated which may be particularly significant in view of the chronic nature of the condition. Serotonin plays a role in panic disorder and serotonergic dysfunction, however the results and evidence do not fit one theory alone. It is also likely that different brain regions and 5-HT receptors are involved in specific ways.
三环类抗抑郁药（TCA）和单胺氧化酶抑制剂（MAOI）在恐慌症治疗中有效。两种选择性5-羟色胺再摄取抑制剂（SSRI）在英国也已获批用于此适应症，并且最近已完成另外三种SSRI的研究。这些研究为血清素在恐慌症中的作用提供了进一步证据。
对临床、动物和实验室研究进行综述。
已证明SSRI在恐慌症治疗中有效。服用SSRI的患者报告的改善率为60%-70%，与三环类抗抑郁药相似且高于安慰剂。其他血清素能药物似乎无效。动物实验和人体研究，包括对血浆、脑脊液和血小板中5-羟色胺的测量、激发试验和色氨酸耗竭试验表明，5-羟色胺与焦虑之间的关系很复杂。
临床试验表明，在所有血清素能药物中，只有SSRI在恐慌症中有效。它们与三环类抗抑郁药一样有益，而且耐受性似乎更好，鉴于该病的慢性性质，这一点可能尤为重要。血清素在恐慌症和血清素能功能障碍中起作用，然而结果和证据并不只符合一种理论。不同的脑区和5-羟色胺受体也可能以特定方式参与其中。
