The effects of tianeptine or paroxetine on 35% CO2 provoked panic in panic disorder

J Psychopharmacol. 2004 Dec;18(4):553-8. doi: 10.1177/0269881104047283.


Antidepressants that inhibit the reuptake of serotonin (5-HT) are particularly effective in the treatment of panic disorder. Evidence suggests that increased 5-HT availability is important for the anti-panic effect of serotonergic drugs and in maintaining the response to selective serotonin reuptake inhibitors (SSRIs). Tianeptine is an antidepressant with 5-HT reuptake enhancing properties (i.e. the opposite pharmacological profile to that of SSRIs). Therefore, no effect would be expected in panic disorder. The aim of the present study was to compare the effect of tianeptine with that of paroxetine, a selective 5-HT reuptake inhibitor with demonstrated efficacy in panic disorder, on the vulnerability to a laboratory panic challenge in panic disorder patients. Twenty panic disorder patients were treated with either tianeptine or paroxetine for a period of 6 weeks, in a randomized, double-blind, separate group design. The reaction to a 35% CO(2) panic challenge was assessed at baseline and after treatment. Improvement on several clinical scales was also monitored. Tianeptine, as well as paroxetine, showed a significant reduction in vulnerability to the 35% CO(2) panic challenge. In spite of their opposite influence on 5-HT uptake, both tianeptine and paroxetine appeared to reduce the reaction to the panic challenge. These results raise questions about the necessity of 5-HT uptake for the therapeutic efficacy of anti-panic drugs.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Agoraphobia / chemically induced
  • Agoraphobia / psychology
  • Antidepressive Agents, Second-Generation / therapeutic use*
  • Antidepressive Agents, Tricyclic / therapeutic use*
  • Carbon Dioxide*
  • Comorbidity
  • Double-Blind Method
  • Female
  • Humans
  • Male
  • Middle Aged
  • Panic Disorder / chemically induced*
  • Panic Disorder / drug therapy*
  • Panic Disorder / psychology
  • Paroxetine / therapeutic use*
  • Patient Compliance
  • Thiazepines / therapeutic use*


  • Antidepressive Agents, Second-Generation
  • Antidepressive Agents, Tricyclic
  • Thiazepines
  • tianeptine
  • Carbon Dioxide
  • Paroxetine