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 meta-analyses) of randomized controlled trials for panic disorder (with or without agoraphobia) from 2004 to 2024. Study methodology was assessed using AMSTAR 2 to assess articles and GRADE for the evidence of each outcome. The PICO framework was used to obtain response, remission, and dropout rates. PROSPERO CRD420251002430.

Results: 202 papers were identified, 84 were eligible, and 9 were included (AMSTAR 2 High). Response, remission, and chance of dropout were classified by GRADE. SSRIs, SNRIs, TCAs, MAIOs, CBT, and BT achieve the best response, remission, and tolerability. Combined psychotherapy and antidepressants work well together. Benzodiazepines demonstrated short-term efficacy and tolerability but are not recommended as first-line treatment due to concerns about dependency and long-term risks.

Conclusion: SSRIs, SNRIs, TCAs, and CBT can be endorsed as first-line interventions for panic disorder (PD). Concomitant therapy may provide supplementary advantages. Subsequent investigations ought to concentrate on enduring results and the reduction of bias.