Current Trend in the Pharmacotherapy of Panic Disorder

Kim, Chan Hyung

Abstract

Pharmacologic and cognitive-behaviral treatments are currently employed in the treatment of panic disorder. Several studies have found that a combination of the two treatment modalities may be superior to either treatment alone. Antidepressants has been considered as the first line of treatment for patients with panic disoreder since 1960s. Although tricyclic antidepressants (TCAs) such as imipramine and clomipramine are well established in treating panic disorder, today many clinicians choose selective serotonin reuptake inhibitors(SSRIs) as the first-line drug because of their efficacy, safely, and favorable side effect profile. While many clinicians have chosen the SSRIs as the antipanic drug of choice, research support for this preference is just starting to emerge. Since a substantial number of patients with panic disorder are quite sensitive to the unpleasent activating effects of antidepressants including TCAs and SSRIs, it is prudent to start the patients on a low dose. Monoamine oxidase inhibitors(MAOIs) have established efficacy as antipanic drugs. These medications may be particularly effective in treament-resistant patients. Also, it is expected that new antidepressants, such as nefazodone and venlafaxine, have antipanic properties. With the advent of high-potency benzodiazepines(e.g. alprazolam, clonazepam), these drugs have been major antipanic drugs. However, the major limitations related to benzodiazepine use are dependency and withdrawal symptoms. Generally, if a benzodiazepine is used for more than about 1 month of treatment, the drug should be discontinued at a slow rate and the patient should receive support for any distressing withdrawal symptoms.