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Table 14 Strength of evidence for pharmacotherapy for panic disorder

From: Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders

Agent Level of evidence Agent Level of evidence
Antidepressants
SSRIs   TCAs  
Citalopram [198200] 1 Clomipramine [199, 211, 213, 232, 233] 1
Fluoxetine [201204] 1 Imipramine [207, 224, 233240] 1
Fluvoxamine [195, 205210] 1 MAOIs and RIMAs  
Paroxetine [211219] 1 Phenelzine [240] 2
Sertraline [183, 220224] 1 Moclobemide [204, 232, 241, 242] 1*
Escitalopram [198] 2 Tranylcypromine [243] 3
Paroxetine CR [225] 2 Other antidepressants  
SNRIs   Reboxetine [200, 219, 244] 1
Venlafaxine XR [215, 216, 227229] 1 Mirtazapine [203, 245, 246] 2
Duloxetine [230] 3 Bupropion SR [247, 248] 3*
Milnacipran [231] 3   
Other therapies
Anxiolytics   Atypical antipsychotics  
    Benzodiazepines   Risperidone [217, 267] 2
      Alprazolam [234, 249254] 1 Olanzapine [268] 3
      Clonazepam [218, 250, 255258] 1 Quetiapine [267] 3
      Lorazepam [251, 259, 260] 1 Adjunctive aripiprazole [269] 3
      Diazepam [261263] 1 Adjunctive olanzapine [270] 3
      Adjunctive clonazepam [264, 265] 1 Adjunctive risperidone [271] 3
      Adjunctive alprazolam ODT [266] 3 Anticonvulsants  
Other treatments   Divalproex [272275] 3
Buspirone [254, 282] 1 (-ve) Levetiracetam [276] 3
Trazodone [283] 2 (-ve) Gabapentin [277] 2 (-ve)
Propranolol [262, 284, 285] 2 (-ve) Tiagabine [278, 279] 2 (-ve)
Adjunctive pindolol [286] 2 Carbamazepine [280] 3 (-ve)
   Adjunctive divalproex [281] 3
  1. *Conflicting data. No significant superiority over placebo in overall population, but significant benefits in subgroup of more severely ill patients. CR = controlled release; MAOI = monoamine oxidase inhibitor; ODT = orally disintegrating tablets; RIMA = reversible inhibitor of monoamine oxidase A; SNRI = serotonin–norepinephrine reuptake inhibitor; SR = sustained release; SSRI = selective serotonin reuptake inhibitor; TCA = tricyclic antidepressant; XR = extended release; (-ve) = negative.