Serotonergic compounds in panic disorder, obsessive-compulsive disorder and anxious depression: A concise review

The recognition that antidepressants are effective in panic and anxiety disorders had led to the evaluation of drugs selective for serotonin uptake in an attempt to dissect the neurotransmitters responsible for panic disorder. Fluvoxamine is the best studied of the selective serotonin reuptake inhibitors (SSRIs) and recent double-blind studies have confirmed earlier findings showing a reduced number and duration of panic attacks. In addition, fluvoxamine attenuates the 'accessory symptoms' of panic disorder such as depression and anxiety. Fluoxetine has only been evaluated in open trials, although these results are generally positive. Paroxetine has shown similar efficacy to clomipramine in a large, controlled study, although the other SSRIs have seldom been investigated. Fluvoxamine lacks the activating properties possessed by some SSRIs and this also makes it a useful candidate for the treatment of anxious depression. The efficacy of fluvoxamine in obsessive-compulsive disorder has been established in several double-blind, placebo-controlled trials. In clinical terms, fluvoxamine is approximately as effective as clomipramine, but with a decidedly better adverse event profile. Fluoxetine has also proved effective in obsessive-compulsive disorder, although a recent meta-analysis suggests that fluvoxamine may be somewhat more effective. The other SSRIs have not been sufficiently well studied to justify conclusive statements.