For Panic Disorder, Escitalopram and Sertraline Provide Greatest Benefit with Fewest Risks

Meta-analyses suggest that, for managing panic disorder, tricyclic antidepressants (TCAs), benzodiazepines, and selective serotonin reuptake inhibitors (SSRIs) all are more effective than placebo, but TCAs and benzodiazepines are associated with higher risk for adverse effects than are SSRIs. Consequently, several guidelines recommend SSRIs as first-line treatment for panic disorder. But which SSRI is most effective and has the lowest risk for adverse effects?

Investigators conducted a network meta-analysis of 87 randomized trials in which drugs from any of 11 classes were compared against each other or against placebo (or no treatment) in 12,800 patients with panic disorder. Trial outcomes included remission (i.e., no panic attacks for 1 we…