The American Psychiatric Association Practice Guideline for the Treatment of Patients With Panic Disorder: Recommendations and Controversies

Fredric N. Busch, MD and Barbara L. Milrod, MD

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Choice of Treatment

Patient preferences, costs, and the risks and benefits of the various treatments must be considered in treatment choice. Medication presents a risk of teratogenicity in pregnant women, and psychotherapy should be strongly considered. As noted above, many panic patients prefer not to be treated with medication.[14] Although clearly favoring CBT and medication, the guideline notes that the clinician must treat the patient, and less well-studied treatments may be indicated when a personality disorder or extensive conflicts are prominent. It is unclear at this time when combined treatment is the best treatment. Psychodynamic psychotherapy is often useful in conjunction with medications on the basis of clinical consensus. If there is an urgent need for symptom reduction, benzodiazepines may be indicated. There is concern, however, that patients may attribute their response to benzodiazepines and lose the motivation to follow CBT steps, and that even after a relatively brief period on the medication, patients may experience withdrawal symptoms. The guideline therefore recommends that when benzodiazepines are combined with another treatment, patients be told that more definitive treatment will be initiated in a few weeks.

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