The Treatment of Panic Disorder

Jean-Marc Cloos

Disclosures

Curr Opin Psychiatry. 2005;18(1):45-50. 

In This Article

Abstract and Introduction

Abstract

Purpose of Review: The aim of this article is to provide an updated review of studies and recommendations published from August 2003 to August 2004 on the treatment of panic disorder.
Recent Findings: Cognitive-behavioral psychotherapy remains the treatment of choice for panic disorder. Recent studies confirm selective serotonin reuptake inhibitors as the first-choice drugs in treating panic disorder. Recommendations for (adjunctive) high-potency benzodiazepines have been published. Psychoeducation and combined pharmacotherapy/psychotherapy improve treatment response. Optimal long-term treatment of panic disorder involves adequate medication and duration of treatment, since relapse is frequent.
Summary: Recent studies confirm that cognitive-behavioral therapy, alone or in combination with drug therapy, remains the treatment of choice for panic disorder. Long-term treatment is often necessary due to the chronicity of the illness.

Introduction

Panic disorder is a chronic and debilitating illness characterized by recurrent, unexpected panic attacks coupled with anticipatory anxiety. Agoraphobia is a frequent complication of panic disorder. Panic disorder is often comorbid with major depressive disorder (MDD) and mitral valve prolapse (MVP) frequently accompanies the disorder.

Swoboda et al.[1] showed that embarrassability and fear of negative evaluation are significantly higher in patients with agoraphobic avoidance than in patients with uncomplicated panic disorder and controls. Furthermore, women generally showed higher embarrassability scores than men. The authors concluded that heightened embarrassability is an important characteristic of patients suffering from panic disorder with agoraphobia (PDA).

Anxiety disorders such as panic disorder are risk factors for the first onset of MDD, severe impairment being the strongest predictor of MDD, as recently confirmed in a study by Bittner et al..[2]

In a 15-year follow-up study of 55 outpatients with panic disorder published by Andersch and Hetta,[3] complete recovery (no panic attacks and no longer on medication during the last 10 years) was seen in 18% of patients, and an additional 13% recovered but were still on medication. Fifty-one percent experienced recurrent anxiety attacks whereas 18% still met diagnostic criteria for panic disorder. The incidence of agoraphobia decreased from 69% to 20%. Patients with agoraphobia at admission tended to have a poorer long-term outcome according to daily functioning compared with patients without agoraphobia at admission, although both groups reported improved daily functioning at follow-up. Maintenance medication was common. No benzodiazepine abuse was reported. The authors concluded that panic disorder has a favourable outcome in a substantial proportion of patients. However, the illness is chronic and needs treatment.

Finally, Culpepper[4] proposed a review on the identification of panic disorder in primary care.

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