BACKGROUND: Tricyclic
antidepressants and selective serotonin reuptake inhibitors (SSRIs) as well
as benzodiazepines have been shown to be effective for the treatment of
panic disorder. The introduction of SSRIs has enabled a greater
understanding of the role of serotonin in the etiology of panic disorder;
however, the role of norepinephrine has been more challenging to ascertain.
The aim of this study was to determine the efficacy and tolerability of
reboxetine, a novel selective norepinephrine reuptake inhibitor, in patients
with panic disorder with and without agoraphobia.
METHOD: Eighty-two patients
(aged 18-65 years) with DSM-III-R panic disorder, with or without
agoraphobia, were randomly assigned to receive 6 to 8 mg/day of reboxetine
(42 patients) or placebo (40 patients) for 8 weeks in this
placebo-controlled, parallel-group, double-blind clinical trial.
RESULTS: Of the 82 patients
enrolled in the trial, 75 were considered in the analysis (37 patients in
the reboxetine group and 38 patients in the placebo group). At last
assessment, there was a significant reduction in the mean number of panic
attacks (range, 9.3-1.2) and phobic symptoms (range, 8.1-3.2) in the
reboxetine group compared with the placebo group (ranges, 8.5-5.8 and
7.7-5.2, respectively; p < .05). Improvement in Hamilton Rating Scale for
Depression, Hopkins Symptom Checklist-90, and Sheehan Disability Scale
scores were also greater in the reboxetine group compared with the placebo
group. Adverse events reported more frequently with reboxetine than placebo
included dry mouth (36% vs. 16%), constipation (27% vs. 22%), and insomnia
(26% vs. 22%).
CONCLUSION: Reboxetine was
effective and well tolerated in the treatment of panic disorder.