Open-label support for duloxetine for the treatment of panic disorder

Abstract

Panic disorder with or without agoraphobia is a common, often chronic and refractory anxiety disorder. Although a number of pharmacotherapies are now indicated for panic disorder, many patients do not respond to available interventions. We hypothesized that duloxetine, a serotonin-norepinephrine reuptake inhibitor (SNRI) that has greater initial noradrenergic effects than venlafaxine, would have broad efficacy for individuals with panic disorder. Fifteen individuals with panic disorder with or without agoraphobia received 8 weeks of open label duloxetine flexibly dosed from 60 to 120 mg per day. Duloxetine treatment resulted in significant anxiolysis as measured by the primary outcome measure, the Panic Disorder Severity Scale (PDSS) (paired t(df) = 4.02(14), P= 0.0013), as well as measures of generalized anxiety, depression and quality of life (all P < 0.05). Although definitive conclusions are limited due to its small open-label nature, this first prospective study provides preliminary support for the efficacy of duloxetine for panic disorder and suggests larger randomized controlled study is warranted.

Conflict of interest statement

Naomi M. Simon: Research Support: Astra Zeneca, Bristol‐Myers Squibb, Cephalon, Forest Laboratories, Glaxo SmithKline, Janssen, Lilly, NARSAD, NIMH, Pfizer, UCB‐Pharma, Sepracor. Advisory/Consulting: American Foundation for Suicide Prevention, Paramount Biosciences, Pfizer, Sepracor, Solvay. Speaking: Forest Laboratories, MGH Psychiatry Academy, Janssen, Lilly, Pfizer, UCB‐Pharma. Equity Holdings: None Royalty/patent. Other income: None.

Rebecca Kaufman, Nannette N. Herlands, Maryann E. Owens. Authors declare no conflict of interest.

Elizabeth A. Hoge: Research Support: Clinical Investigator Training Program: Harvard‐MIT Health Sciences and Technology/Beth Israel Deaconess Medical Center, in collaboration with Pfizer Inc. and Merck and Company, Inc.; and Eli Lilly, Inc. Advisory/Consulting: None. Speaking: None. Equity Holdings: None. Royalty/patent, other income: None.

John J. Worthington: Research Support: Abbott Laboratories, Alkermes, Aspect Medical Systems, Astra‐Zeneca, Bristol‐Myers Squibb Company, Cephalon, Eli Lilly & Company, Forest Pharmaceuticals Inc., GlaxoSmithkline, J & J Pharmaceuticals, Lichtwer Pharma GmbH, Lorex Pharmaceuticals, Novartis, Organon Inc., PamLab, LLC, Pfizer Inc, Pharmavite, Roche, Sanofi‐Aventis, Sepracor, Solvay Pharmaceuticals, Inc., UCB Pharma and Wyeth‐Ayerst Laboratories. Speaking: Bristol‐Myers Squibb Company, Eli Lilly & Company, Forest Pharmaceuticals Inc., GlaxoSmithKline, Pfizer Inc., Sanofi‐Aventis and Wyeth‐Ayerst Laboratories.

Mark H. Pollack: Research Support: Astra‐Zeneca, Bristol Myers Squibb, Cephalon, Cyberonics, Forest Laboratories, GlaxoSmithKline, Janssen, Eli Lilly, NARSAD, NIDA, NIMH, Pfizer, Roche Laboratories, Sepracor, UCB Pharma, Wyeth.

Advisory/Consulting: AstraZeneca, Brain Cells Inc, Bristol Myers Squibb, Cephalon, Dov Pharmaceuticals, Forest Laboratories, GlaxoSmithKline, Janssen, Jazz Pharmaceuticals, Eli Lilly & Co, Medavante, Neurocrine, Neurogen, Novartis, Otsuka Pharmaceuticals, Pfizer, Predix, Roche, Laboratories, Sanofi, Sepracor, Solvay, Tikvah Therapeutics, Transcept Inc, UCB Pharma, Wyeth. Speaking: Bristol Myers Squibb, Forest Laboratories, GlaxoSmithKline, Janssen, Lilly, Pfizer, Solvay, Wyeth.

Equity Holdings: Medavante, Mensante Corporation. Royalty/patent, other income: Copyright royalties for the SIGH‐A, SAFER.

Figures

Figure 1

Baseline and Endpoint PDSS total scores for individual subjects (n= 15).