Based on the DSM-IV, a panic attack is defined as paroxysmal episodes of fear and discomfort accompanied by somatic symptoms and cognitive disturbances that arise in normal circumstances where there is no disruption or the threat of a real environment. Various studies prove neurobiology that the roles of serotonergic and noradrenergic neurotransmitter systems in a panic attack.

SSRIs (Selective serotonin reuptake inhibitors) are used widely for a panic attack. Paroxetine as one of the SSRI class drugs through clinical trials RCT (randomized clinical trial) is considered effective for the treatment of panic disorder and also reduce the symptoms of panic attacks.

Since 1993, risperidone has been approved by the FDA as a drug for the treatment of psychosis and schizophrenia. Risperidone had a working mechanism to inhibit the activity of dopamine D2 and serotonin receptors that are regarded as having anxiolytic effects. Various clinical trials show anxiolytic effects of risperidone in patients with anxiety disorders, depression with co morbid anxiety disorders, anxiety disorders are resistant to various therapies in geriatrics, comprehensive anxiety disorder, obsessive compulsive disorder and post traumatic stress disorder (post-traumatic stress disorder) found at lower doses compared with doses used for psychosis.

A clinical trial to the comparison between low-dose risperidone therapy with paroxetine for the treatment of panic attacks. The design of this clinical trial is a randomized, single blind, the control drug (in this case paroxetine used as a control) for 8 weeks in duration. Subjects included in this study were 56 patients with panic attacks who were randomized to receive low-dose risperidone therapy (n = 33) and paroxetine (n = 23). Intervention procedures is provided to risperidone therapy is initiated with a dose of 0.25 mg / day, increased to 0.5 mg / day on day 3 for patients who had remission of panic symptoms and reduced to 0.125 mg / day on day 3 for patients undergoing sedation side effects. Paroxetine therapy begins with a dose of 30 mg / day and the dose was increased if no remission of symptoms. The maximum dose allowed for risperidone is 16 mg / day for paroxetine was 60 mg / day.

During the duration of eight weeks, follow-up is done as much as 10 times that on the first day before the intervention, the third day, seventh day and thereafter once a week for two weeks to up to eight. The measurement objective is to score by HAM-D-17 (score assessed by the physician to assess symptoms of depression), HAM-A score (a score that is considered by doctors to assess symptoms of anxiety), PDSS score (a score that is considered by doctors to assess symptoms of panic attacks), the SPAS-P scores (scores assessed by patients to assess symptoms of anxiety) and CGI scores (a score that assessed by doctors to assess the overall condition of the patient).

Results from this study is to score PDSS, HAM-A and HAM-D, both therapy groups showed a significant decrease for the final score. At the end of the study, there was no significant difference between groups of low-dose risperidone therapy and paroxetine. To score the SPAS-P, risperidone therapy group have an average total score is lower compared with paroxetine therapy group but the difference was not significant.

There was no significant difference between the two groups of therapy PDSS score improvement assessment, HAM-A, HAM-D and CGI. Side effects were found on risperidone and paroxetine treatment groups did not significant. The conclusion of this study is the low-dose risperidone has the same effectiveness with paroxetine for the treatment of panic attacks.

From the session discussions of the research some of the interesting things are, the average dose of risperidone in clinical trials is 0.53 mg / day and no patients who received risperidone therapy at a dose above 1 mg / day. When compared with the dose for the treatment of psychosis, then the above dose is less than half. So, with this low dose can reduce the incidence of side effects.

The weakness of this study is, the study was done in a short duration only 8 weeks so it does not provide data on the effectiveness and long-term safety of risperidone on the use of panic attacks. In addition the number of samples that are still relatively small.

Conclusion

1. Panic attacks are paroxysmal episodes of fear and discomfort accompanied by somatic symptoms and cognitive disturbances that arise in normal circumstances where there is no disruption or the threat of a real environment.
2. Paroxetine as one of the SSRI class drugs through clinical trials RCT (randomized clinical trial) is considered effective for the treatment of panic disorder and also reduce the symptoms of panic attacks.
3. Has the effect of low dose risperidone anxiolytic.
4. Research shows that low-dose risperidone therapy in patients with panic attacks who did not have significantly different efficacy with paroxetine with minimal side effects.