piperidines and Agoraphobia

Factors that predict nonresponse to drug therapy (brofaromine or fluvoxamine) were investigated in a sample of 44 panic disorder patients. We used a strict definition of nonresponse to find patients who did not respond at all after 12 weeks of treatment. Using this definition, 15 patients (32.6%) were considered nonresponders. Nonresponders had a higher score on the Blood-Injury subscore of the Fear Questionnaire (FQ) and more often had high scores on several FQ subscores, indicative of comorbid phobic symptoms. These variables were subsequently used to predict nonresponse.

Topics: Adult; Agoraphobia; Double-Blind Method; Female; Fluvoxamine; Humans; Male; Middle Aged; Monoamine Oxidase Inhibitors; Panic; Panic Disorder; Personality Inventory; Phobic Disorders; Piperidines; Prognosis; Treatment Outcome

Topics: Adult; Agoraphobia; Humans; Male; Monoamine Oxidase Inhibitors; Panic Disorder; Phobic Disorders; Piperidines

There is considerable evidence that antidepressants, particularly serotonin uptake inhibitors, are effective in the treatment of panic disorder (PD). Monoamine oxidase inhibitors (MAOI) may also have beneficial effects in PD. In this study 30 patients with PD with or without agoraphobia (DSM-III-R) were treated with the selective and reversible MAO-A inhibitor brofaromine (150 mg daily) in a 12-week double-blind placebo controlled design. A clinical relevant improvement was found in more than 70% of the patients treated with brofaromine, whereas no significant improvement was observed on placebo. After an increase in anxiety in the first week, a clinically relevant improvement in anxiety symptoms was found, followed by a subsequent reduction in agoraphobic avoidance in patients treated with brofaromine. A similar improvement was observed on distress scores related to panic attacks, although there was no significant reduction in the number of panic attacks. The most prominent side-effects were middle sleep disturbance and nausea. No increase in blood pressure was observed. During a follow-up period of another 12 weeks a further improvement was found in patients treated with brofaromine.

Topics: Adult; Agoraphobia; Double-Blind Method; Fear; Female; Follow-Up Studies; Humans; Male; Middle Aged; Monoamine Oxidase Inhibitors; Panic Disorder; Piperidines; Psychiatric Status Rating Scales

Monoamine oxidase (MAO) inhibitors are known to be effective in panic disorder, but a high incidence of adverse reactions have limited their use. The new, selective, and reversible MAO-A inhibitors exemplified by brofaromine and moclobemide do not require dietary restrictions, have fewer drug interactions, and are better tolerated. This paper reports a randomized, double-blind, 8-week trial in which the efficacy and safety of brofaromine was compared to clomipramine in patients with panic disorder with or without agoraphobia. Both treatments achieved a significant and comparable reduction in the number of panic attacks, and were equally effective in all the parameters measured. Side effects were typical of the drug class. Further trials are required to evaluate this promising new treatment.

Topics: Agoraphobia; Clomipramine; Double-Blind Method; Humans; Monoamine Oxidase; Monoamine Oxidase Inhibitors; Panic Disorder; Piperidines; Psychiatric Status Rating Scales

Clinical and preclinical data suggest a link between serotonin [5-hydroxytryptamine (5-HT)] function and certain psychopathologic dimensions of anxiety disorders. Antidepressants consistently have been found to exert a favorable effect in anxiety disorders, particularly panic disorders. Clinical studies with 5-HT-selective drugs have shown that 5-HT neurons may comprise the site at which anxiolytic drugs exert a significant proportion of their action. Thus, fluvoxamine, a selective 5-HT uptake inhibitor, but not maprotiline, a selective noradrenaline uptake inhibitor, was found to be efficacious in panic disorder. The clinical effect of fluvoxamine revealed a noteworthy time course. After an initial increase in anxiety, improvement was attained gradually. On the basis of this finding, we tentatively hypothesized that stimulation of the 5-HT receptors, resulting from uptake inhibition, would worsen the condition of the patient, while down-regulation of the 5-HT receptors, resulting from chronic treatment, would account for the clinical efficacy. Thus, we performed a study in which ritanserin, a putative 5-HT2 antagonist, was compared with fluvoxamine. Ritanserin was found to be ineffective in the treatment of panic disorder symptoms, suggesting that 5-HT2 receptors may not be critically involved in the mechanism underlying the anxiolytic activity of 5-HT uptake inhibitors. It would seem, therefore, that other 5-HT-receptor subtypes, e.g., 5-HT1, may be implicated in this effect. Recent studies with selective 5-HT1 agonists support this hypothesis.

Topics: Adolescent; Adult; Aged; Agoraphobia; Brain; Clinical Trials as Topic; Fear; Female; Fluvoxamine; Humans; Male; Middle Aged; Oximes; Panic; Phobic Disorders; Piperidines; Psychological Tests; Random Allocation; Receptors, Serotonin; Ritanserin

The therapeutic efficacy of brofaromine--a new reversible and short acting MAO-A inhibitor--was evaluated in 14 inpatients with a panic disorder. In an open trial, the patients were treated with placebo during the first week and with 150 mg brofaromine per day during the following four weeks. In all patients a distinct improvement in both anxiety and depressive symptoms was observed under the active drug. Treatment outcome was the same in patients with and without a concomitant major depressive episode. No side-effects of any note were reported. Our findings suggest that the MAO-A inhibitor brofaromine is an effective drug in the treatment of anxiety disorders.

Topics: Adult; Agoraphobia; Female; Humans; Male; Monoamine Oxidase; Monoamine Oxidase Inhibitors; Panic Disorder; Piperidines; Psychiatric Status Rating Scales

Eleven patients with panic disorder were administered ritanserin, a post-synaptic serotonin S2 antagonist, during a 4 week period at a daily dose of 10-20 mg. The treatment resulted in a decrease in the number of panic attacks, and a diminution of agoraphobic avoidance. The possible practical and theoretical signification of these findings is discussed.

Topics: Adult; Agoraphobia; Escape Reaction; Fear; Female; Humans; Male; Panic; Phobic Disorders; Piperidines; Ritanserin; Serotonin Antagonists