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Panic disorder increases reports of antidepressant side effects

Patients with panic disorder taking antidepressants for depression are more likely to report side effects, study finds

Ingrid Torjesen

Wednesday, 04 January 2017

Patients who take medication for depression report more side effects if they also suffer from panic disorder, according to a study published in the Journal of Clinical Psychiatry.

Researchers from the University of Illinois at Chicago looked at data from 808 patients with chronic depression who were given antidepressants as part of the Research Evaluating the Value of Augmenting Medication with Psychotherapy (REVAMP) trial. Of those patients, 85 also had diagnoses of panic disorder.

In total, 88% of patients reported at least one side effect during the 12-week trial, which ran between 2002 and 2006. Antidepressant side effects were assessed every two weeks, and categorized as gastrointestinal, cardiovascular, dermatological, neurological, genitourinary, sleep, or sexual functioning.

Patients with depression and panic disorder were more likely than those with only depression to self-report gastrointestinal (47% versus 32%), cardiovascular (26% versus 14%), neurological (59% versus 33%), and genital/urinary side effects (24% versus 8%). Co-occurring panic disorder was not associated with increased reports of eye or ear issues or dermatological, sleep or sexual functioning side effects.

Stewart Shankman, professor of psychology and psychiatry at University of Illinois at Chicago, said: "People with panic disorder are especially sensitive to changes in their bodies. It's called 'interoceptive awareness.'

"Because these patients experience panic attacks – which are sudden, out-of-nowhere symptoms that include heart racing, shortness of breath, and feeling like you're going to die – they are acutely attuned to changes in their bodies that may signal another panic attack coming on. So it does make sense that these tuned-in patients report more physiological side effects with antidepressant treatment."

Participants with co-occurring panic disorder were also more likely to report a worsening of their depressive symptoms over the 12 weeks if they reported multiple side effects.

"In patients with panic disorder, the more side effects they reported, the more depressed they got," said Shankman. "Whether the side effects are real or not doesn't matter, but what was real was that their depression worsened as a function of their side effects."

Shankman said that doctors should be aware that their patients with panic disorder may report more side effects, and they should "do a thorough assessment of these side effects to try to tease out what might be the result of hypersensitivity, or what might be a side effect worth switching doses or medications for".

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