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APA: Venlafaxine XR and Paroxetine Combination Improves Physiological Symptoms of Panic Disorder and Social Anxiety Disorder

By Bruce Sylvester

SAN FRANCISCO, CA -- May 25, 2003 -- Venlafaxine XR and paroxetine in combination elicited significant improvements in the physical symptoms associated with panic disorder (PD) and social anxiety disorder (SAD), researchers reported May 22^nd here at the Annual Meeting of the American Psychiatric Association.

"We found that patients diagnosed with either of these disorders characteristically suffer from significant physiological distress, and it is often the reason they seek help in the first place," said lead investigator and presenter Rajiv Mallick, PhD, a researcher at Wyeth Research, in Collegeville, Pennsylvania. "It is heartening to note that as we address the primary symptoms of [these] disorders, we might also be able to simultaneously address some of the commonly experienced physical distress."

Dr. Mallick and his research team analysed pooled data on 958 subjects from two randomised, double-blind, placebo-controlled PD studies (one included a paroxetine control group) of venlafaxine XR 75 mg, 150 mg, or flexible dosages. The treatment phase lasted 10 to 12 weeks. All subjects met Diagnostic and Statistical Manual - Revision IV (DSM-IV) criteria for PD.

The patient-reported Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) assessed treatment-related changes in physical symptoms. This tool measures eight subscales: physical health/activities, as well as subjective feelings of well-being, work, household duties, school/course work, leisure time, social relations, and general well-being. The questionnaire also has two subscales on satisfaction with medication and overall life satisfaction.

Investigators measured response to treatment using a 5-point Likert scale, with increasing scores from baseline indicating improved physical functioning.

The researchers also analysed pooled data on 1,372 subjects from four randomised, double-blind, placebo-controlled SAD studies, including two paroxetine-controlled studies, of flexible-dose venlafaxine XR. The treatment phases of each study lasted 10 weeks. All subjects met the DSM-IV SAD criteria at baseline. Outcomes included the physiological-arousal subscale of the Social Phobia Inventory (SPIN) and the total SPIN score. The subscale includes four important symptoms of SAD patients: blushing, sweating, palpitations and shaking/trembling, as well as additional areas measuring non-somatic factors such as fear and avoidance.

The investigators reported that, "In PD, venlafaxine XR and paroxetine were associated with greater improvement versus placebo on the physical health/activities subscale [P<0.0001 and P=0.0004, respectively] and on most other subscales [venlafaxine XR 8 out of 9, paroxetine 5 out of 9]."

"In SAD, improvement on the physiological arousal sub-scale and total SPIN score [all P<0.0001] was greater with venlafaxine XR and paroxetine than with placebo." Dr. Mallick added. "We saw enough changes from baseline to end point in these studies to say that venlafaxine XR effectively ameliorates physiological symptoms in acute-term treatment in both PD and SAD, and that there are similar if slightly more modest results for paroxetine."

This study was supported by Wyeth Research.


[Study title: Improvement in Physical Symptoms in Select Anxiety Disorders. Abstract NR797]

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