Brazilian Psychiatric Association guidelines for the treatment of panic disorder: an overview of systematic reviews.

OBJECTIVE

To develop national, evidence-based treatment guidelines for panic disorder (PD) in Brazil through an overview of systematic reviews.

METHODS

We searched PubMed, SciELO, and Cochrane for systematic reviews (with or without metaanalyses) of randomized controlled trials on PD (with or without agoraphobia) from 2004 to 2024. We assessed review quality with A MeaSurement Tool to Assess Systematic Reviews, version 2 (AMSTAR 2), and graded the certainty of evidence for each outcome with the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Using the PICO framework, we extracted response, remission, and dropout rates.

RESULTS

We identified 202 records; 84 met eligibility criteria, and nine were included (AMSTAR 2: high). Response, remission, and dropout risk were classified with GRADE. Selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), monoamine oxidase inhibitors, cognitive-behavioral therapy (CBT), and behavior therapy showed the most favorable profiles for efficacy and tolerability. Combining psychotherapy with antidepressants was also effective. Benzodiazepines demonstrated short-term efficacy and tolerability but are not recommended as first-line treatment due to dependency and long-term risk concerns.

CONCLUSION

SSRIs, SNRIs, TCAs, and CBT can be recommended as first-line interventions for PD. Concomitant therapy may offer additional benefits. Future studies should prioritize long-term outcomes and strategies to minimize bias.