19 As a flexible-dose study, with a dosing range for sertraline hydrochloride of 50 to 200 mg/d and an initial 25-mg/d titration dose during the first week of treatment, the results provide useful information regarding the efficacy of doses typically used in clinical practice.  With 176 patients, this is one of the largest clinical trials with an SSRI for the treatment of panic disorder reported to date. This study assessed the effectiveness and safety of sertraline in a 10-center, random-assignment, flexible-dose, placebo-controlled study in patients with panic disorder, with and without agoraphobia. 17 The lack of major anticholinergic, О±-adrenergic, or cardiotoxic effects and the absence of marked induction of physiological dependence represents a potential therapeutic advantage for SSRIs such as sertraline 18 over the tricyclic antidepressants or benzodiazepines used to treat panic disorder. 14 Sertraline is a potent SSRI that has established efficacy in the treatment of depression, 15 obsessive-compulsive disorder, 16 and the prevention of depression relapse. In addition, results from a multicenter, fixed-dose study demonstrated a significant reduction in panic frequency for sertraline hydrochloride relative to placebo. 8 To date, this clinical opinion has been supported by results of double-blind trials demonstrating the effectiveness of paroxetine 9, 10 and fluvoxamine maleate 11 - 13 for panic disorder. 5, 6 Increasing clinical experience, as well as a consensus of expert clinical researchers, 7 has encouraged the use of serotonin selective reuptake inhibitors (SSRIs) as first-line treatments for panic disorder because of a generally favorable side-effect profile and broad spectrum of efficacy. 1 - 4 A number of psychopharmacological agents, as well as cognitive-behavioral therapies, have demonstrated efficacy for the treatment of patients with panic disorder. PANIC DISORDER is a common illness with a typically chronic course and substantial attendant morbidity and disability. Adverse events, generally characterized as either mild or moderate, were not significantly different in overall incidence between the sertraline and placebo groups.Д¬onclusion Results support the safety and efficacy of sertraline for the short-term treatment of patients with panic disorder. Significant differences between groups were also evident for clinician and patient assessments of improvement as measured by the Clinical Global Impression Improvement ( P=.01) and Severity ( P=.009) Scales, Panic Disorder Severity Scale ratings ( P=.03), high end-state function assessment ( P=.03), Patient Global Evaluation rating ( P=.01), and quality of life scores ( P=.003). Results Sertraline-treated patients exhibited significantly greater improvement ( P=.01) at end point than did patients treated with placebo for the primary outcome variable, panic attack frequency. After 2 weeks of single-blind placebo, patients were randomly assigned to 10 weeks of double-blind, flexible-dose treatment with either sertraline hydrochloride (50-200 mg/d) or placebo. Methods One hundred seventy-six nondepressed outpatients with panic disorder, with or without agoraphobia, from 10 sites followed identical protocols that used a flexible-dose design. We examined the efficacy and safety of the serotonin selective reuptake inhibitor sertraline hydrochloride in patients with panic disorder. Shared Decision Making and CommunicationД«ackground The serotonin selective reuptake inhibitors are increasingly being used for the treatment of panic disorder.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.

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