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

Table 14 Strength of evidence for pharmacotherapy for panic disorder

Agent	Level of evidence	Agent	Level of evidence
Antidepressants
SSRIs		TCAs
Citalopram [198–200]	1	Clomipramine [199, 211, 213, 232, 233]	1
Fluoxetine [201–204]	1	Imipramine [207, 224, 233–240]	1
Fluvoxamine [195, 205–210]	1	MAOIs and RIMAs
Paroxetine [211–219]	1	Phenelzine [240]	2
Sertraline [183, 220–224]	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, 227–229]	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, 249–254]	1	Olanzapine [268]	3
Clonazepam [218, 250, 255–258]	1	Quetiapine [267]	3
Lorazepam [251, 259, 260]	1	Adjunctive aripiprazole [269]	3
Diazepam [261–263]	1	Adjunctive olanzapine [270]	3
Adjunctive clonazepam [264, 265]	1	Adjunctive risperidone [271]	3
Adjunctive alprazolam ODT [266]	3	Anticonvulsants
Other treatments		Divalproex [272–275]	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

*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.

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