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Reboxetine and Citalopram Similar in Efficacy in Treatment of Panic Disorder

The selective serotonin reuptake inhibitor (SSRI) citalopram and the selective noradrenergic reuptake inhibitor (NRI) reboxetine are comparably effective and tolerable treatments for panic disorder, according to a preliminary South African study.

Noradrenergic and serotonergic neurotransmitters are both involved in the pathophysiology of panic disorder. Therapeutic inhibitors of these pathways, known as the NRIs and SSRIs, respectively, are available and have shown promising results for the treatment of panic disorder. The comparative efficacy of these drugs, however, has had little study. It is also not known whether some patients respond better to one treatment as opposed to the other.

Soraya Seedat and colleagues at the University of Stellenbosch, Cape Town, South Africa, conducted a pilot study to compare the safety and efficacy of reboxetine and citalopram in the treatment of patients with panic disorder.

The single-blind, cross-over design study included 19 patients (8 men and 11 women, average age 36) with panic disorder. Patients were randomised to receive either reboxetine (4-10 mg/day) or citalopram (10 to 60 mg/day) for 8 weeks. Patients subsequently underwent a 2-week washout period and were then switched to the other drug regimen. Efficacy was assessed every 2 weeks throughout the course of the study.

At end of 18 week study, 54% of patients responded to reboxetine and 82% responded to citalopram. Furthermore, one citalopram non-responder showed response to reboxetine; and conversely, 3 reboxetine non-responders showed response to citalopram. Notably, only 9 patients completed the entire study, yet 17 gave sufficient data for inclusion in analysis. Discontinuation was primarily due to transport and work-related problems.

Overall, similar efficacy in general anxiety symptoms and disability were measured with both treatments. Significant improvement in panic attack severity was observed with both reboxetine and citalopram treatment. However, the study did find that patients showed a greater reduction in depressive symptoms while receiving citalopram.

Regarding adverse events, citalopram was more often associated with nausea, decreased libido, increased yawning and loss of appetite; while patients undergoing reboxetine treatment reported a higher incidence of insomnia, sweating, constipation, dizziness/fainting, headache, and hot flashes. The most common side effect reported in both groups was dry mouth (58% with citalopram and 46% with reboxetine treatment).

The authors conclude that "although SSRIs are viewed as a first-line treatment for panic disorder, these results suggest that a NA agent such as reboxetine may also have a role." They add that "these data also suggest an advantage for citalopram in treating comorbid depressive symptoms, although some patients may respond preferentially to an SSRI and other patients to an NRI."

They also note "the findings of this study should be interpreted with caution in view of the small sample and the high non-completer rate."


Int Clin Psychopharmacol 2003 Sep;18:5:279-84. "Reboxetine and citalopram in panic disorder: a single-blind, cross-over, flexible-dose pilot study"

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