Panic Disorder
- Panic Attack
- Panic Disorder
- Recurrent Panic Attacks
- Anticipatory Anxiety
- Agoraphobia
- Hypochondriasis
- Demoralisation
- Epidemiology
- Age of Onset
- Situation of Onset
- Stressful Life Events
- Early Life Events
- Maternal Over-Protection
- Separation Anxiety
- Short and Long-term Outcomes
- Comorbidity
- Panic Disorder: Pathogenesis
- Biological Findings
- Provocative Agents
- Neurotransmitter Systems
- Neuroanatomical Models
- Brain Imaging
- Psychological Models
- Psychodynamic Models
- Behavioural Models
- Cognitive Models
- Areas of Controversy and Debate
- The Evolutionary Perspective
- Panic Disorder: Treatment
- Pharmacotherapy
- Benzodiazepines
- Tricyclic Antidepressants
- Monoamine Oxidase Inhibitors
- Selective Serotonin Re-uptake Inhibitors
- Other Drugs
- Psychotherapy
Pharmacotherapy
Controlled clinical trials have established efficacy in the treatment of PD for two main classes of drugs: benzodiazepines (BDZs) and antidepressants (AD), including tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), and selective serotonin re-uptake inhibitors (SSRIs).
Comparative studies suggest that all these classes of compounds can be efficacious. Differences are apparent with respect to speed of onset, side-effect profiles, safety and complications of long-term therapy, such as the ease of discontinuing medication. The latter consideration is particularly important, since for the majority of patients PD is a continuous, chronic disorder requiring treatment for at least 6–8 months, and longer in most cases. The BDZs act rapidly (in minutes to hours), whereas the antidepressants work slower (over several weeks).
Concerns about dependence and withdrawal aspects of the BDZs have led to recommendations that their use be restricted to the short-term administration, ideally less than four weeks, which will then present problems in enduring conditions such as PD. Therefore, there is a general consensus that the pharmacological treatment of PD means antidepressants. Although MAOI (mainly fenelzine) has proven to be highly effective in all the trials, in practice, the choice is limited to TCAs and SSRIs because of the difficulties and limitations of MAOIs.
The general opinion is that SSRIs should be used as first-line treatment for PD as they are safer and better tolerated, having similar efficacy as TCAs. Their side-effect profile is relatively mild, especially when used in low doses at the start of treatment. Some authors, however, suggest that in some cases TCAs, especially clomipramine, should not be abandoned.