Panic disorder (PD) being one of the most intensively investigated anxiety disorders is considered a heterogeneous psychiatric disease which has difficulties with early diagnosis. The disorder is recurrent and usually associated with low remission rates and high rates of relapse which may exacerbated social and quality of life, causes unnecessary cost and increased risk for complication and suicide. Current pharmacotherapy for PD are available but these drugs have slow therapeutic onset, several side effects and most patients do not fully respond to these standard pharmacological treatments. Ongoing investigations indicate the need for new and promising agents for the treatment of PD. This article will cover the importance of immediate and proper treatment, the gap in the current management of PD with special emphasis on pharmacotherapy, and evidence regarding the novel anti-panic drugs including the drugs in developments such as metabotropic glutamate (mGlu 2/3) agonist and levetiracetam. Preliminary results suggest the anti-panic properties and the efficacy of duloxetine, reboxetine, mirtazapine, nefazodone, risperidone and inositol as a monotherapy drug. Apart for their effectiveness, the aforementioned compounds were generally well tolerated compared to the standard available pharmacotherapy drugs, indicating their potential therapeutic usefulness for ambivalent and hypervigilance patient. Further strong clinical trials will provide an ample support to these novel compounds as an alternative monotherapy for PD treatment-resistant patient.
Objective: This systematic review is aimed to quantitatively summarise the
prevalence of sexual dysfunction among non-SSRI second generation
antidepressants namely agomelatine, bupropion, duloxetine, venlafaxine, and
mirtazapine.
Methods: Relevant studies published from inception till
December 2012 were identified by searching PubMed, OVID and Embase.
We included all literatures encompassing randomized controlled, cohort,
case-controlled and cross-sectional studies, which contained quantitative data
for prevalence on all aspects of sexual dysfunction in depressive patients who
were older than 18 years of age. Heterogeneity, publication bias and odds
ratio were assessed thoroughly.
Results: In the non-SSRI second generation
antidepressant group which consisted of 17,316 subjects, various studies
showed the range of sexual dysfunction prevalence between 0% and 67%.
Sexual dysfunction in patients who took non-SSRI second generation
antidepressants constituted a meta-analytical pooled prevalence of 15%, and
36% in those who took SSRIs. The combined relative risk of sexual
dysfunction in the non-SSRI second generation antidepressant group when
compared with SSRI was 0.57.
Conclusions: The pooled prevalence of sexual
dysfunction in non-SSRI second generation antidepressant is lower than in
SSRI antidepressants.