{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,13]],"date-time":"2026-11-13T01:26:56Z","timestamp":1794533216977,"version":"4.9.1"},"reference-count":38,"publisher":"BMJ","license":[{"start":{"date-parts":[[2022,1,19]],"date-time":"2022-01-19T00:00:00Z","timestamp":1642550400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ"],"accepted":{"date-parts":[[2021,11,25]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To identify drug classes and individual selective serotonin reuptake inhibitors (SSRIs) with high rates of remission and low risk of adverse events in the treatment of panic disorder with or without agoraphobia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Systematic review and network meta-analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data sources<\/jats:title>\n                    <jats:p>Embase, Medline, and ClinicalTrials.gov from inception to 17 June 2021.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Eligibility criteria for study selection<\/jats:title>\n                    <jats:p>Randomised controlled trials that included adults aged \u226518 years with a diagnosis of panic disorder, compared drugs used to treat the panic disorder, and measured the outcomes of interest, including remissions, dropouts, and adverse events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Risk of bias in the included studies was assessed using the revised Cochrane risk of bias tool for randomised trials. Direct meta-analyses were performed using random effects models. A two stage network meta-analysis with surface under the cumulative ranking curve (SUCRA) was used to estimate the comparative efficacy of drug classes and individual SSRIs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>87 studies including a total of 12\u2009800 participants and 12 drug classes were eligible for inclusion. Almost all the studies (86\/87) had some concern or were at high risk of bias. Network meta-analysis of remission with consistent results indicated that tricyclic antidepressants, benzodiazepines, monoamine oxidase inhibitors, SSRIs, and serotonin-noradrenaline reuptake inhibitors (SNRIs) were associated with significantly higher remission rates than placebo, with risk ratios of 1.39 (95% confidence interval 1.26 to 1.54), 1.47 (1.36 to 1.60), 1.30 (1.00 to 1.69), 1.38 (1.26 to 1.50), and 1.27 (1.12 to 1.45), respectively. SUCRAs identified benzodiazepines (84.5%, mean rank=2.4), tricyclic antidepressants (68.7%, 3.8), and SSRIs (66.4%, 4.0) as the top three best treatments for remission. However, tricyclic antidepressants, benzodiazepines, and SSRIs were also significantly associated with increased risk of adverse events compared with placebo, with risk ratios of 1.79 (1.47 to 2.19), 1.76 (1.50 to 2.06), and 1.19 (1.01 to 1.41), respectively. Consistency assumption of adverse events was upheld but could still be present on removal of studies with high percentages of women participants and those with agoraphobia. A SUCRA cluster ranking plot considering both remission and adverse events among all drug classes indicated that SSRIs were associated with high remission and low risk of adverse events. Among individual SSRIs, sertraline and escitalopram provided high remission with an acceptable risk of adverse events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The findings suggest that SSRIs provide high rates of remission with low risk of adverse events for the treatment of panic disorder. Among SSRIs, sertraline and escitalopram were associated with high remission and low risk of adverse events. The findings were, however, based on studies of moderate to very low certainty levels of evidence, mostly as a result of within study bias, inconsistency, and imprecision of the findings reported.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic review registration<\/jats:title>\n                    <jats:p>PROSPERO CRD42020180638.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmj-2021-066084","type":"journal-article","created":{"date-parts":[[2022,1,19]],"date-time":"2022-01-19T06:55:16Z","timestamp":1642575316000},"page":"e066084","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":69,"title":["Drug treatment for panic disorder with or without agoraphobia: systematic review and network meta-analysis of randomised controlled trials"],"prefix":"10.1136","volume":"376","author":[{"given":"Natasha","family":"Chawla","sequence":"first","affiliation":[{"name":"Department of Family Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1002-8536","authenticated-orcid":false,"given":"Thunyarat","family":"Anothaisintawee","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand"},{"name":"Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kridsada","family":"Charoenrungrueangchai","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Papan","family":"Thaipisuttikul","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gareth J","family":"McKay","sequence":"additional","affiliation":[{"name":"Centre for Public Health, School of Medicine, Dentistry, and Biomedical Sciences, Queen\u2019s University Belfast, Belfast, Ireland, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Attia","sequence":"additional","affiliation":[{"name":"School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ammarin","family":"Thakkinstian","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,1,19]]},"reference":[{"key":"2025110101363267000_376.jan19_3.e066084.1","doi-asserted-by":"publisher","DOI":"10.31887\/DCNS.2015.17.3\/bbandelow"},{"key":"2025110101363267000_376.jan19_3.e066084.2","doi-asserted-by":"publisher","DOI":"10.1002\/da.22572"},{"key":"2025110101363267000_376.jan19_3.e066084.3","doi-asserted-by":"publisher","DOI":"10.1177\/070674371005500107"},{"key":"2025110101363267000_376.jan19_3.e066084.4","doi-asserted-by":"publisher","DOI":"10.1097\/01.psy.0000174169.14227.1f"},{"key":"2025110101363267000_376.jan19_3.e066084.5","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291710000176"},{"key":"2025110101363267000_376.jan19_3.e066084.6","unstructured":"National Institute for Health and Care Excellence. Generalised anxiety disorder and panic disorder in adults: management Clinical guideline. [CG113] NICE, 2011. www.nice.org.uk\/guidance\/cg113"},{"key":"2025110101363267000_376.jan19_3.e066084.7","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD011567.pub2"},{"key":"2025110101363267000_376.jan19_3.e066084.8","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD010677.pub2"},{"key":"2025110101363267000_376.jan19_3.e066084.9","unstructured":"American Psychiatric Association . Practice Guideline for the Treatment of Patients with Panic Disorder. 2nd ed. APA, 2009."},{"key":"2025110101363267000_376.jan19_3.e066084.10","doi-asserted-by":"publisher","DOI":"10.1177\/0269881114525674"},{"key":"2025110101363267000_376.jan19_3.e066084.11","doi-asserted-by":"publisher","DOI":"10.7326\/M14-2385"},{"key":"2025110101363267000_376.jan19_3.e066084.12","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-151-4-200908180-00135"},{"key":"2025110101363267000_376.jan19_3.e066084.13","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.1972.01750190059011"},{"key":"2025110101363267000_376.jan19_3.e066084.14","doi-asserted-by":"publisher","DOI":"10.1016\/0165-0327(88)90072-9"},{"key":"2025110101363267000_376.jan19_3.e066084.15","doi-asserted-by":"publisher","DOI":"10.1016\/S0165-0327(02)00120-9"},{"key":"2025110101363267000_376.jan19_3.e066084.16","doi-asserted-by":"publisher","DOI":"10.1037\/1040-3590.7.4.472"},{"key":"2025110101363267000_376.jan19_3.e066084.17","doi-asserted-by":"publisher","DOI":"10.1177\/0013164489491016"},{"key":"2025110101363267000_376.jan19_3.e066084.18","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l4898"},{"key":"2025110101363267000_376.jan19_3.e066084.19","unstructured":"West SL Gartlehner G Mansfield AJ . Table 7 Summary of common statistical approaches to test for heterogeneity. Comparative Effectiveness Review Methods: Clinical Heterogeneity. Agency for Healthcare Research and Quality, 2010."},{"key":"2025110101363267000_376.jan19_3.e066084.20","doi-asserted-by":"publisher","DOI":"10.1002\/lary.25688"},{"key":"2025110101363267000_376.jan19_3.e066084.21","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehu424"},{"key":"2025110101363267000_376.jan19_3.e066084.22","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dys041"},{"key":"2025110101363267000_376.jan19_3.e066084.23","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2021.02.012"},{"key":"2025110101363267000_376.jan19_3.e066084.24","doi-asserted-by":"publisher","DOI":"10.1002\/jrsm.1188"},{"key":"2025110101363267000_376.jan19_3.e066084.25","doi-asserted-by":"publisher","DOI":"10.1002\/jrsm.1044"},{"key":"2025110101363267000_376.jan19_3.e066084.26","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0076654"},{"key":"2025110101363267000_376.jan19_3.e066084.27","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1003082"},{"key":"2025110101363267000_376.jan19_3.e066084.28","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD010676.pub2"},{"key":"2025110101363267000_376.jan19_3.e066084.29","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.160.8.1432"},{"key":"2025110101363267000_376.jan19_3.e066084.30","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.v59n0201"},{"key":"2025110101363267000_376.jan19_3.e066084.31","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD010676.pub2"},{"key":"2025110101363267000_376.jan19_3.e066084.32","unstructured":"American Psychiatric Association . Practice Guideline for the Treatment of Patients with Panic Disorder. 3rd ed. APA, 2009."},{"key":"2025110101363267000_376.jan19_3.e066084.33","unstructured":"American Psychiatric Association . Practice Guideline for the Treatment of Patients with Major Depressive Disorder. 3rd ed. APA; 2010."},{"key":"2025110101363267000_376.jan19_3.e066084.34","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.v64n1107"},{"key":"2025110101363267000_376.jan19_3.e066084.35","doi-asserted-by":"publisher","DOI":"10.1503\/jpn.120256"},{"key":"2025110101363267000_376.jan19_3.e066084.36","doi-asserted-by":"publisher","DOI":"10.1503\/jpn.130055"},{"key":"2025110101363267000_376.jan19_3.e066084.37","unstructured":"Sub Laban T, Saadabadi A. Monoamine Oxidase Inhibitors (MAOI): StatePearls Publishing; 2020. www.ncbi.nlm.nih.gov\/books\/NBK539848\/."},{"key":"2025110101363267000_376.jan19_3.e066084.38","doi-asserted-by":"publisher","DOI":"10.1590\/S0100-879X2001001000010"}],"container-title":["BMJ"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/data.bmj.org\/tdm\/10.1136\/bmj-2021-066084","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmj-2021-066084","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T08:36:40Z","timestamp":1761986200000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.bmj.com\/lookup\/doi\/10.1136\/bmj-2021-066084"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,19]]},"references-count":38,"alternative-id":["10.1136\/bmj-2021-066084"],"URL":"https:\/\/doi.org\/10.1136\/bmj-2021-066084","relation":{},"ISSN":["1756-1833"],"issn-type":[{"value":"1756-1833","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1,19]]}}}