An open-label trial of nefazodone in high comorbidity panic disorder

Nefazodone is a recently marketed compound with demonstrated efficacy in major depression. This study was undertaken to assess the efficacy and safety of nefazodone in a sample of panic disorder patients with a high degree of depressive comorbidity.

Fourteen patients were screened for entry into an open 8-week trial of nefazodone clinically titrated between 200-600 mg. Patients fulfilled DSM-III-R criteria for panic disorder and were allowed to enter with concurrent diagnoses of major depression, dysthymia, generalized anxiety disorder, and depression NOS. Primary outcome measures included panic attack frequency and severity and the Clinical Global Impression scale.

At Week 8 of treatment, 10/14 patients (71%) were judged to be much or very much improved with study treatment. Panic attack frequency decreased from a mean of 5.4 at baseline to 2.1 at Week 8, reaching significance by Week 8 (p < .05) as did decreases in phobic anxiety. Improvement in panic attack severity, phobic avoidance, HAM-D, HAM-A, CGI-Severity, and Sheehan Disability Scale scores was significant by Week 4. Five of the 8 patients with comorbid major depression were responders, as were 3/5 patients with generalized anxiety disorder comorbidity. Five of 6 patients with pure panic or minor depressive symptoms responded to the study treatment. None of the patients withdrew because of side effects of nefazodone.

This report presents preliminary evidence for the efficacy and tolerability of nefazodone in panic disorder and panic with comorbid depression or depressive symptoms.