Category Archives: Panic Disorder

Pharmacotherapy for Panic Disorder

The goal of pharmacological treatment of panic disorder is to reduce the severity and intensity of the panic attacks, avoidance, fearful anticipation, cognitive distortions, and any additional psychiatric disorder. The effectiveness of pharmacotherapy for panic disorder has been unequivocally established in well-controlled scientific studies. Although no unifying hypothesis explains the etiology of panic disorder, basic… Read More »

Pharmacotherapy for Panic Disorder: General Principles

As noted earlier, the effectiveness of several different classes of antipanic medication treatments has been firmly established via scientific investigation. Several types of medication treatments are now available, but the clinician suggesting a specific medication treatment for an individual panic disorder patient must consider a variety of factors. Even after considering the relevant clinical variables… Read More »

Pharmacotherapeutic Treatments for Panic Disorder

Selective Serotonin Reuptake Inhibitors The selective serotonin reuptake inhibitors have become the mainstay of pharmacological treatment for mood and anxiety disorders. Selective serotonin reuptake inhibitors were considered the first-line treatment by a group of experts in anxiety for years before controlled studies appeared, and a meta-analysis of the controlled studies up to 1995 that included… Read More »

Benzodiazepines in the Treatment of Panic Disorder

Benzodiazepines were not generally thought to be useful antipanic agents until the late 1980s. The triazolobenzodiazepine alprazolam was demonstrated to be superior to placebo in treating patients with panic disorder (or agoraphobia with panic attacks). Alprazolam was the first drug approved by the U.S. Food and Drug Administration (FDA) to treat panic disorder. Because of… Read More »

Tricyclic Antidepressants in the Treatment of Panic Disorder

The majority of the information for the efficacy of traditional tricyclic antidepressants in panic disorder is from studies using imipramine and clomipramine. In almost all of these studies, imipramine and clomipramine have been found to be superior to placebo; one study reported that clomipramine was more effective than imipramine. Clomipramine is usually prescribed at dosages… Read More »

Long-Term Treatment Issues of Panic Disorder

Among the effective treatments, the response rates range from 50% to 70%. Long-term observations (1.5-6 years after initial treatment) show that 50%-80% of patients have residual panic-related anxiety, 40% have panic attacks, and 20% remain unimproved and seriously ill. Factors that appear to contribute to persistent symptoms include coexisting depression, other anxiety disorders, concomitant personality… Read More »

Panic Disorder Treatment Considerations in Pregnancy and Lactation

A significant percentage of the individuals who have panic disorder are women of childbearing potential who will face, along with the clinician, the dilemma of whether to continue pharmacological treatment of panic disorder in unplanned or planned pregnancy. Data on the course of panic disorder during pregnancy are inconclusive. There appears to be greater consensus… Read More »

Long-Term Treatment of Panic Disorder

As might be suggested by the treatment outcome studies referred to above, anxiety disorders such as panic disorder have a chronic clinical course. A retrospective survey that reviewed literature on the course of depression and anxiety disorder before effective treatment became available showed that a high proportion of patients had little or no improvement in… Read More »

SSRIs in Panic Disorder

Over the past 35 years, there has been continuous evolution in the psychological and pharmacological treatments for panic disorder. Initially, pharmacotherapies involved imipramine (Tofranil) and many of the tricyclic antidepressants (TCAs), phenelzine and the monoamine oxidase inhibitor (MAOI) antidepressants, and the high-potency benzodiazepines (BZs), particularly alprazolam and clonazepam. These three classes were found to be… Read More »

SSRI Treatment Of Panic Disorder

With the introduction of the serotonergic tricyclic clomipramine, medications with principal actions on the serotonin neuron became available for use in Europe about 35 years ago. Zimelidine was available in the early 1980s in Europe and was shown to be effective in panic disorder, but it was taken off the market because of adverse side… Read More »