- Patients with panic disorder who are on antidepressants report more side-effects compared to patients suffering from depression only.
- This is because patients with panic disorder are hypersensitive to changes in their body and are constantly vigilant.
- The depressive symptoms among patients with panic disorder who have multiple side-effects worsens over the course of time.
Patients who take medication for depression report more side effects if they also suffer from panic disorder.
The new study was led by researchers from the University of Illinois at Chicago and published in the Journal of Clinical Psychiatry
‘Before switching doses or medication, therapists should carefully assess the side effects to differentiate an actual side-effect from symptoms of panic disorder, so that the appropriate treatment can be decided.’
According to a report released by the National Center for Health Statistics (NCHS) in 2011, the rate of antidepressant use in U.S among people aged 12 years and older have increased by almost 400% between 1988-1994 and 2005-2008.
- Women are 2― times more likely to be taking an antidepressant than men
- 23% of women in their 40s and 50s take antidepressants
- 14% of non-Hispanic white people take antidepressants compared with just 4% of non-Hispanic blacks and 3% of Mexican Americans
As part of the Research Evaluating the Value of Augmenting Medication with Psychotherapy (REVAMP) trial, the researchers studied data of 808 patients with chronic depression who were given antidepressants. The 12 week trial ran from 2002-2006
Among these patients, 85 had been diagnosed with panic disorder as well.
The side-effects of antidepressants were categorized as : gastrointestinal, cardiovascular, dermatological, neurological, genitourinary, sleep, or sexual functioning.
The side-effects of antidepressants were assessed every two weeks.
The researchers found that more side effects with antidepressant use were reported by patients with both depression and panic disorder compared to patients with depression only.
88% of the participants reported at least one side effect.
Patients with depression and panic disorder self-reported more:
- gastrointestinal side effects at 47% compared to 32% among depressed only patients
- cardiovascular side effects at 26% compared to 14% among depressed only patints
- neurological side effects at 59% compared to 33% among depressed only patients
- genital/urinary side effects at 24% compared to. 8% among depressed only patients
Co-occurring panic disorder was not associated with eye or ear issues or dermatological, sleep or sexual functioning side effects compared to participants without panic disorder.
Why Patients With Panic Disorder Experience More Side Effects?
"People with panic disorder are especially sensitive to changes in their bodies," said Stewart Shankman, professor of psychology and psychiatry at UIC and corresponding author on the paper. "It's called 'interoceptive awareness.'
Patients with panic disorder experience panic attacks, which are sudden, out-of-nowhere symptoms that include heart racing, shortness of breath, and feeling of imminent death.
Since they experience panic attacks, they are acutely sensitive to changes in their bodies that may signal another panic attack coming on. As a result, these vigilant patients report more physiological side effects with antidepressant treatment.
Different people respond differently to side effects of antidepressants. Many patients who experience side effects switch medication or change dosage. Some discontinue therapy altogether.
Among participants with panic disorder, those who experienced multiple side effects, were more likely to report a worsening of their depressive symptoms over the 12 weeks.
"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 cautions that physicians and therapists 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 and identify what might be a symptom of panic disorder, or a side effect and if it is worth switching doses or medications.
- Stewart A. Shankman et al. Side Effects to Antidepressant Treatment in Patients With Depression and Comorbid Panic Disorder. Journal of Clinical Psychiatry; (2017)
- Astounding increase in antidepressant use by Americans - (http://www.health.harvard.edu/blog/astounding-increase-in-antidepressant-use-by-americans-201110203624)