The effect of sertraline with or without propranolol on panic attacks in women: a controlled clinical trial

The use of propranolol in the treatment of panic attacks has historically been widespread. However, there is insufficient precise evidence regarding the combination of propranolol with sertraline in this context. Panic attacks are a common health issue among women, significantly affecting their personal and social lives. Therefore, this study aimed to determine the effect of sertraline, with or without propranolol, on the severity of panic attack symptoms and depressive symptoms.

This randomized controlled clinical trial included 60 women who attended a specialized university clinic in Tabriz. Participants were randomly assigned to either the sertraline with propranolol group (n = 30) or the sertraline with propranolol placebo group (n = 30) using block randomization method. Both groups received drugs for four weeks. Data were collected using the Panic Disorder Severity Scale- Self-Report (PDSS-SR) and the Beck Depression Inventory-Short Form (BDI-13). The Mann-Whitney U test was employed to compare outcomes between the two groups, and Wilcoxon tests were used for within-group comparisons.

Samples were enrolled from July 22, 2024, to February 11, 2025. The two groups exhibited no statistically significant differences in sociodemographic characteristics (p > 0.05). After the intervention, the mean score for the severity of panic attack symptoms in the sertraline with propranolol group was 6.6 (SD: 4.4), compared to 13.1 (SD: 5.4) in the sertraline with propranolol placebo group, indicating a statistically significant difference (P < 0.001). Additionally, the mean (SD) post-intervention depression score was 8.9 (4.8) in the sertraline with propranolol group and 15.5 (7.2) in the sertraline with propranolol placebo group, with the sertraline with propranolol group demonstrating a significantly lower mean depression score according to the Mann-Whitney U test (p = 0.001). Within-group comparisons also revealed a significant reduction in the severity scores for both panic attack symptoms and depression in the sertraline with propranolol group (P < 0.001).

Based on the results of this trial, using propranolol alongside sertraline reduces the severity of panic attacks. Given these promising results, further studies in various settings are recommended to provide high-certainty evidence in this field.

Iranian Registry of Clinical Trials (IRCT): IRCT20120718010324N70. Date of registration: 2022-08-31; URL: https://irct.behdasht.gov.ir/user/trial/65033/view .