77 Reboxetinc, a selective norepinephrine reuptake inhibitor was effective and well tolerated in an 8-week, placebo-controlled, double-blind trial,78 with a significant reduction in the mean number of panic attacks and phobic symptoms at doses of 6 to 8 mg/day. Other drugs Buspirone in PD failed to show any efficacy even at high doses (60 mg/day).79 Pagoclone, a cyclopyrrolone that is believed to act as a partial agonist, at the GABAA/BZ receptor provided some preliminary evidence in a crossover trial with placebo.80 β-Blockers Inhibitors,research,lifescience,medical provided conflicting
results, with some positive small crossover trials, but a negative double-blind trial of propranolol with alprazolam and placebo.81 Initial evidence suggested that gabapentin82 and sodium valproate may be effective in PD, while carbamazepine is not.83 Also Ca-channel blockers have shown mixed results.84 Social anxiety disorder Benzodiazepines There is a limited number of controlled studies testing BZs in the treatment of social anxiety disorder. Clonazepam was shown to be effective in one 10-week, double-blind trial Inhibitors,research,lifescience,medical versus placebo, with 78% of patients responding to an average dosage of 2.4 mg/day.85 Almost 85% of patients had
some response, with 50% having a marked response and 50% having a moderate one. There has been only one double-blind study of alprazolam, Inhibitors,research,lifescience,medical in which Gelernter et a!86 compared alprazolam (mean dose 4.2 mg/day) with phenelzine, cognitive behavioral group therapy, and placebo over a 12-week period. Only 38% of patients on alprazolam were considered Inhibitors,research,lifescience,medical responders at end point compared with 69% on phenelzine, 24% on cognitive behavioral group therapy, and 20% on placebo. Versiani ct al87 conducted a 12-weck, double-blind study to compare bromazepam (mean dose 21 mg/day) to placebo, with a response rate of 83% of patients on active drug versus 20% of patients
on placebo. Antidepressants Inhibitors,research,lifescience,medical Only anecdotal evidence supports the efficacy of TCAs for the treatment of social anxiety disorder,88 mainly due to early observations that, patients with atypical depression with marked interpersonal sensitivity and sociophobic features show a better response with MAOIs than TCAs.89 There were three early controlled trials86,90,91 in which BAY 73-4506 phenelzine (up to 90 mg/day) oxyclozanide was found to be quite effective, with 64% of patients obtaining clinically significant responses, which increased when treatment was extended to 4 months. These results were replicated by Heimbergetal92 in 1998. In a comparison between phenelzine and moclobemide, phenelzine appeared roughly equivalent, but appeared to work faster.91 By week 16, 91% of the phenelzine patients versus 82% of moclobemide patients were nearly asymptomatic, although moclobemide was better tolerated. In the Gelernter et al86 trial, phenelzine was also better than alprazolam in terms of efficacy. As mentioned above, RIMAs have also been studied.
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