quetiapine-fumarate and Panic-Disorder

A role for second-generation antipsychotics (SGAs) in the treatment of panic disorders (PD) has been proposed, but the actual usefulness of SGAs in this disorder is unclear. According to the PRISMA guidelines, we undertook an updated systematic review of all of the studies that have examined, in randomized controlled trials, the efficacy and tolerability of SGAs (as either monotherapy or augmentation) in the treatment of PD, with or without other comorbid psychiatric disorders. Studies until 31 December 2015 were identified through PubMed, PsycINFO, Embase, Cochrane Library and Clinical trials.gov. Among 210 studies, five were included (two involving patients with a principal diagnosis of PD and three involving patients with bipolar disorder with comorbid PD or generalized anxiety disorder). All were eight-week trials and involved treatments with quetiapine extended release, risperidone and ziprasidone. Overall, a general lack of efficacy of SGAs on panic symptoms was observed. Some preliminary indications of the antipanic effectiveness of risperidone are insufficient to support its use in PD, primarily due to major limitations of the study. However, several methodological limitations may have negatively affected all of these studies, decreasing the validity of the results and making it difficult to draw reliable conclusions. Except for ziprasidone, SGAs were well tolerated in these short-term trials.

Topics: Antipsychotic Agents; Bipolar Disorder; Humans; Panic Disorder; Piperazines; Quetiapine Fumarate; Risperidone; Thiazoles

Anxiety disorders complicate the treatment of bipolar disorder but are seldom the focus of bipolar treatment studies.. The anxiolytic effect of quetiapine XR 50-300 mg/day compared to divalproex ER (500-3000 mg/day) was tested in an 8-week, double-blind, placebo-controlled, randomized clinical trial in 149 patients with bipolar disorder and a co-occurring panic disorder or GAD. The primary efficacy measure was the Clinician Global Improvement-21 Anxiety Scale (CGI-21). Secondary measures included the Hamilton Anxiety Scale (HAM-A) and Sheehan Panic Disorder Scale (SPS).. Repeated measures last-observation-carried-forward (LOCF) analyses of variance demonstrated significant treatment-by-time interaction effects on 3 of the 4 anxiety measures. Quetiapine XR at a mean endpoint dose of 186 mg/day produced rapid sustained improvements relative to baseline, divalproex ER and placebo on anxiety. Mean baseline-to-endpoint improvement was significantly greater for quetiapine XR compared to divalproex ER and placebo on the HAM-A and SPS. Both active medications were well tolerated, but weight gain was higher on quetiapine XR.. The study was limited to 8 weeks and to patients with bipolar disorder and comorbid panic disorder or GAD. The results may not be applicable to quetiapine XR as an add-on treatment to mood stabilizers or to bipolar disorder comorbid with other anxiety disorders.. Quetiapine XR in a dose range of 50-300 mg/day appears to reduce anxiety in bipolar patients with comorbid panic disorder or GAD treated for 8 weeks. The efficacy of other second-generation antipsychotics and mood stabilizers in patients with bipolar disorder and a co-occurring anxiety disorder should be investigated in double-blind, placebo-controlled studies.

Topics: Adult; Antipsychotic Agents; Bipolar Disorder; Delayed-Action Preparations; Dibenzothiazepines; Double-Blind Method; Female; Humans; Male; Middle Aged; Panic Disorder; Quetiapine Fumarate; Treatment Outcome; Valproic Acid; Weight Gain

Topics: Adult; Agoraphobia; Antibodies, Monoclonal, Humanized; Antidepressive Agents; Antimanic Agents; Benzodiazepines; Bipolar Disorder; Depressive Disorder; Depressive Disorder, Major; Female; Humans; Lithium Carbonate; Male; Mental Disorders; Middle Aged; Nordazepam; Panic Disorder; Paroxetine; Psoriasis; Quetiapine Fumarate; Severity of Illness Index; Treatment Outcome; Valproic Acid

Topics: Adult; Antidepressive Agents; Antipsychotic Agents; Dibenzothiazepines; Drug Therapy, Combination; Female; Humans; Panic Disorder; Quetiapine Fumarate; Treatment Outcome; Young Adult

This is a complex case of post-traumatic stress disorder (PTSD) with comorbid panic disorder occurring in a woman in her mid-60s, with a family history of neurotic illness. PTSD arose in the context of treatment for terminal lung cancer. This patient who had been close to her father watched him die of cancer, when he was about her age. Her diagnosis and treatment prompted traumatic recollections of her father's illness and death that resulted in her voluntary withdrawal from cancer treatment. The goals of treatment were to promptly reduce anxiety, minimise use of sedating pharmacotherapy, promote lucidity and prolong anxiety-free state thereby allowing time for important family interactions. Prompt, sustained relief of severe anxiety was necessary to achieve comfort at the end of life. Skilled additions of psychological therapies (eye movement desensitisation reprocessing, clinical hypnosis and breathing exercises) with combined pharmacotherapy (mirtazepine and quetiapine) led to control of anxiety and reduction of post-traumatic stress.

Topics: Anti-Anxiety Agents; Anxiety; Breathing Exercises; Comorbidity; Death; Dibenzothiazepines; Eye Movement Desensitization Reprocessing; Female; Humans; Hypnosis; Lung Neoplasms; Mianserin; Middle Aged; Mirtazapine; Palliative Care; Panic Disorder; Quetiapine Fumarate; Stress Disorders, Post-Traumatic; Terminal Care

This study analyzed and defined specific factors that account for attrition in clinical research for patients with bipolar and substance-related disorders.. Data were analyzed from two completed studies: an open-label trial of lamotrigine in patients with bipolar disorder (BPD) and cocaine-related disorder, and a placebo-controlled trial of quetiapine in patients with BPD and alcohol-related disorders. Correlations and Independent sample t-tests were performed to assess the impact of baseline characteristics including on length of study participation. Significance was set at the p=0.05 level.. In the lamotrigine-treated patients, the presence of an amphetamine-related disorder, in addition to cocaine-related disorders, was associated with a shorter time in the study. In the quetiapine-treated patients higher scores on the Addiction Severity Index Legal subscale were associated with shorter length in the study. The presence of panic disorder was associated with shorter time in both studies.. Although the data were taken from the two largest clinical trials, to date, in patients with BPD and substance-related disorders, the sample sizes were relatively modest. In addition, the baseline assessments were somewhat different in the two studies limiting our ability to make conclusions on differences between patients with BPD and cocaine use versus alcohol use.. This study adds to an emerging literature on the significance of panic disorder in patients with BPD.

Topics: Adult; Alcohol-Related Disorders; Amphetamine-Related Disorders; Anticonvulsants; Antipsychotic Agents; Bipolar Disorder; Clinical Trials as Topic; Cocaine-Related Disorders; Comorbidity; Diagnosis, Dual (Psychiatry); Dibenzothiazepines; Female; Humans; Lamotrigine; Male; Panic Disorder; Patient Dropouts; Psychiatric Status Rating Scales; Quetiapine Fumarate; Randomized Controlled Trials as Topic; Severity of Illness Index; Substance-Related Disorders; Time Factors; Triazines

Topics: Adult; Antipsychotic Agents; Brain; Brain Mapping; Depersonalization; Dibenzothiazepines; Emotions; Humans; Magnetic Resonance Imaging; Male; Panic Disorder; Quetiapine Fumarate; Self Disclosure; Treatment Outcome

The authors describe three schizophrenic patients who suffered from panic attacks and experienced marked improvement of these episodes after switching to quetiapine from their previous antipsychotics (haloperidol, bromperidol, and risperidone), which have high dopamine antagonistic properties such as haloperidol, bromperidol, and risperidone.

Topics: Adult; Antipsychotic Agents; Dibenzothiazepines; Female; Humans; Male; Panic Disorder; Quetiapine Fumarate; Schizophrenia