A Comparison of Citalopram and Paroxetine in the Treatment of Panic Disorder: A Randomized, Single-Blind Study
Abstract
BACKGROUND: Serotonin Selective Re-uptake Inhibitors (SSRIs) are the drugs of choice for treating panic disorder (PD). In vitro studies have shown different pharmacodynamic profiles for SSRIs, but their clinical relevance is still unknown. Paroxetine, the SSRI with the strongest serotonergic effect, also shows significant cholinergic and noradrenergic activities. In this class of drugs, citalopram is the most selective for serotonin. We compared these two drugs and their effectiveness and tolerability in a sample of patients with PD in a two-month treatment course. METHOD: Fifty-eight patients with PD were randomly assigned to either the paroxetine or the citalopram treatment group in a single-blind, randomized design. Each patient was assessed at days 0, 7 and 60 by the Panic Associated Symptoms Scale (PASS), the Sheehan Disability Scale (SDS) and the Fear Questionnaire (FQ). Primary outcome measures were the percentage of patients free of panic attacks, anticipatory anxiety and phobic avoidance in the last week of the trial and the percentage of good responders, as defined by a reduction of at least 50% from baseline of both PASS and SDS global scores at day 60. RESULTS: At day 60, 86% of patients receiving citalopram and 84% of those receiving paroxetine responded well to treatment. No significant differences between the two drugs were found. Both were well tolerated, although sexual side effects and weight gain were frequent. Anticipatory anxiety decreased significantly after the first week of treatment, and no initial worsening in the panic attacks was observed. CONCLUSION: Paroxetine and citalopram show similar anti-panic properties and a good tolerability profile. Our results support evidence that the serotonergic system plays a significant role in the anti-panic properties of these two SSRIs.
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A comparison of paroxetine and citalopram in a small sample of panic disorder patients showed a higher percentage of patients without panic attacks after 8 weeks of paroxetine treatment (50%) than citalopram (24%).
“A comparison of paroxetine and citalopram in a small sample of patients with PD showed a higher percentage of patients without PAs after 8 weeks of paroxetine treatment (50%) than citalopram (24%).”
From Management of Treatment-Resistant Panic Disorder (2017) · cites this paper as [52]
Although there was a statistical trend only, this finding suggests higher anti-panic efficacy of paroxetine, possibly related to its adjunctive anticholinergic properties.
“Although there was a statistical trend only, this finding suggests higher anti-panic efficacy of paroxetine, possibly related to its adjunctive anticholinergic properties [52].”
From Management of Treatment-Resistant Panic Disorder (2017) · cites this paper as [52]
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“Some comparisons among the SSRIs did not reveal differences with regard to efficacy (Bandelow et al. 2004; Perna et al. 2001), while escitalopram showed evidence of superiority over citalopram on some outcome measures (Bandelow et al.”
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- Authors
- Perna, G., Bertani, A., Caldirola, D., Smeraldi, E., & Bellodi, L.
- Affiliations
- IRCCS Ospedale San Raffaele (IT)
- Vita-Salute San Raffaele University (IT)
- Venue
- Pharmacopsychiatry
- Publisher
- Georg Thieme Verlag KG
- Published
- 2001-05
- Volume
- 34
- Issue
- 3
- Pages
- 85-90
- ISSN
- 0176-3679 (ISSN-L)
- 1439-0795
- OpenAlex
- W2029947432
- Cited by
- 64
- References
- 0
- Citations by year
- 2026: 2 · 2024: 1 · 2023: 1 · 2022: 2 · 2021: 2 · 2020: 1 · 2019: 2 · 2018: 1 · 2017: 1 · 2016: 2 · 2015: 1 · 2014: 2 · 2013: 1 · 2012: 3
- FWCI
- 9.27
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Pharmacopsychiatry (publishedVersion)
- PubMed (publishedVersion)
- Archivio Istituzionale della Ricerca - Università Vita-Salute San Raffaele (submittedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Keywords
- panic disorder, citalopram, paroxetine, selective serotonin reuptake inhibitors, serotonergic system, anticipatory anxiety, phobic avoidance, treatment response, drug tolerability, sexual side effects, weight gain
- MeSH terms
- Adult, Fear, Female, Humans, Male, Psychiatric Status Rating Scales, Surveys and Questionnaires, Citalopram, Single-Blind Method, Panic Disorder, Treatment Outcome, Paroxetine, Antidepressive Agents, Second-Generation
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