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Bandelow 2004 Sertraline versus paroxetine in the treatment of panic disorder


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Even withdrawal over three weeks could not remedy exacerbation of panic in about a fifth of the previously responding patients treated with paroxetine. The authors attributed this difference to the more severe withdrawal syndrome from paroxetine.


J Clin Psychiatry. 2004 Mar;65(3):405-13.

Sertraline versus paroxetine in the treatment of panic disorder: an acute, double-blind noninferiority comparison.

Bandelow B, Behnke K, Lenoir S, Hendriks GJ, Alkin T, Goebel C, Clary CM.




Department of Psychiatry and Psychotherapy, University of Göttingen, von-Siebold-Strasse 5, D-37505 Göttingen, Germany. bbandel@gwdg.de


Abstract at http://www.ncbi.nlm.nih.gov/pubmed/15096081 Please upload full text if you have it.




Several classes of medications have demonstrated efficacy in panic disorder, but direct comparison of 2 proven treatments is still uncommon. The purpose of this study was to compare sertraline and paroxetine in the acute treatment of panic disorder.




Adult outpatients with panic disorder with or without agoraphobia (DSM-IV and ICD-10 criteria) were randomly assigned in double-blind fashion to 12 weeks of treatment with flexible doses of sertraline (titrated up to 50-150 mg/day; N = 112) or paroxetine (titrated up to 40-60 mg/day; N = 113). Patients were then tapered off medication over 3 weeks. The primary analysis was a noninferiority analysis of Panic and Agoraphobia Scale (PAS) scores. Secondary measures included panic attack frequency and the Clinical Global Impressions-Improvement scale (CGI-I) (with responders defined as those with a CGI-I score < or = 2). Data were collected from January 2000 to June 2001.




Sertraline and paroxetine were associated with equivalent levels of improvement on the PAS total score, as well as on all secondary outcome measures. Eighty-two percent of patients taking sertraline versus 78% of those taking paroxetine were CGI-I responders at endpoint. Numerically more patients on paroxetine treatment compared with sertraline treatment discontinued due to adverse events (18% vs. 12%; NS), and a significantly higher proportion of paroxetine patients showed > or = 7% weight gain (7% vs. < 1%; p <.05). During the taper period, the proportion of panic-free patients increased by 4% with sertraline but decreased by 11% with paroxetine (p <.05).




Received Aug. 18, 2003; accepted Jan. 5, 2004. From the Department of Psychiatry and Psychotherapy, University of Göttingen, Göttingen, Germany (Dr. Bandelow); private psychiatry practice, Frederiksberg, Denmark (Dr. Behnke); private psychiatry practice, St. Gallen, Switzerland (Dr. Lenoir); Department of Psychiatry, Anxiety Disorders Outpatient Unit, Nijmegen, the Netherlands (Dr. Hendriks); the Department of Psychiatry, Dokuz Eylül University, Izmir, Turkey (Dr. Alkin); Clinical Research, Pfizer GmbH, Karlsruhe, Germany (Dr. Goebel); and Pfizer Inc, New York, N.Y. (Dr. Clary).


Funded by Pfizer Inc, New York, N.Y.


Dr. Bandelow has received grant/research support from GlaxoSmithKline; has been a member of the scientific advisory boards of AstraZeneca, Bayer AG, Bristol-Myers Squibb, Fujisawa, Lilly, GlaxoSmithKline, Lundbeck, Parke-Davis, Pfizer, Sanofi-Synthelabo, and Wyeth; and has participated in speakers bureaus for Aventis, AstraZeneca, Bayer AG, Boehringer-Ingelheim GmbH, Bristol-Myers Squibb, Lilly, GlaxoSmithKline, Janssen-Cilag, Lundbeck, Meiji-Seiko Pharmaceuticals, Novartis, Organon, Parke-Davis, Pfizer, Pharmacia, Roche, Sanofi-Synthelabo, Solvay, and Wyeth. Dr. Alkin has received honoraria from Pfizer. Dr. Goebel is an employee of Pfizer. Dr. Clary is an employee of and major shareholder in Pfizer.


Corresponding author and reprints: Prof. Dr. Borwin Bandelow, Department of Psychiatry and Psychotherapy, University of Göttingen, von-Siebold-Str. 5, D-37075 Göttingen, Germany (e-mail: bbandel@gwdg.de).

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