MHPG and heart rate as correlates of nonresponse to drug therapy in panic disorder patients - A preliminary report

Little is known about biological predictors of treatment response in panic disorder (PD). In the present study heart rate, blood pressure, plasma cortisol and plasma MHPG were investigated at baseline in a sample of 44 PD patients as possible predictors for nonresponse to treatment. We used a strict definition of nonresponse to find patients who did not respond at all after 12 weeks of treatment with brofaromine or fluvoxamine. Patients were considered nonresponders when they fulfilled two criteria: they did not show a 50% reduction of agoraphobic avoidance and they still experienced panic attacks at endpoint. The variables that differed significantly between the groups were used to predict nonresponse to drug therapy. Using this strict definition of nonresponse, 15 patients (32.6%) were considered nonresponders. These patients were characterised by a higher plasma MHPG concentration and a higher heart rate at baseline. These variables were subsequently used to predict nonresponse

The prediction of nonresponse to pharmacotherapy in panic disorder:A review

Several effective pharmacotherapeutic treatments exist for panic disorder; however, not all patients respond to treatment. between 20 % to 40 % are nonresponders. Recent studies have reported several predictors of nonresponse to pharmacotherapy. In this review two questions are addressed: is there consensus with respect to predictors of nonresponse and are there any differences between short-term and long-term predictors? In this review both short-term and long-term outcome studies are discussed. Studies were included if at least DSM-III criteria were used and baseline variables were investigated as possible predictor of response, or nonresponse, to pharmacotherapy. Of each clinical predictor, tallies were made of the particular predictors employed and of those predictors that predicted nonresponse. It appears that a long duration of illness and severe agoraphobic avoidance are robust predictors of nonresponse, particularly in long-term studies. Personality disorders, or even personality traits, are possibly the most robust predictors of nonresponse. Several factors appear to be robust predictors of nonresponse: factors that are present before treatment and exert their influence on short-term and long-term treatment outcome. Prospective studies are needed to further investigate these factors and to test whether it is viable to intervene in an attempt to increase treatment response. (C) 2001 Wiley-Liss, Inc

Review of current treatment in panic disorder

The ideal properties for an antipanic agent include the ability to provide complete recovery from panic attacks, resolution of associated anxiety and avoidance behavior, relapse prevention, good tolerability, and efficacy in comorbid conditions including depression. We compared the properties of currently available treatment options for panic attacks, including the benzodiazepines, tricyclic antidepressants, monoamine oxidase inhibitors and selective serotonin reuptake inhibitors (SSRIs), with this ideal. Experimental approaches in the development of therapeutic agents of potential use against panic disorder were also examined. It is clear that SSRIs, such as paroxetine, are an effective treatment for panic disorder, and their antidepressant activity also allows concurrent treatment of comorbid depressive disorders, for which patients with panic disorder are at high risk. However, despite the availability of effective antipanic agents, some patients do not respond to treatment. (C) 1998 Lippincott-Raven Publishers

MHPG and heart rate as correlates of nonresponse to drug therapy in panic disorder patients - A preliminary report

Little is known about biological predictors of treatment response in panic disorder (PD). In the present study heart rate, blood pressure, plasma cortisol and plasma MHPG were investigated at baseline in a sample of 44 PD patients as possible predictors for nonresponse to treatment. We used a strict definition of nonresponse to find patients who did not respond at all after 12 weeks of treatment with brofaromine or fluvoxamine. Patients were considered nonresponders when they fulfilled two criteria: they did not show a 50% reduction of agoraphobic avoidance and they still experienced panic attacks at endpoint. The variables that differed significantly between the groups were used to predict nonresponse to drug therapy. Using this strict definition of nonresponse, 15 patients (32.6%) were considered nonresponders. These patients were characterised by a higher plasma MHPG concentration and a higher heart rate at baseline. These variables were subsequently used to predict nonresponse