Pharmacotherapy for panic disorder with or without agoraphobia in adults
- Peter P Roy-Byrne, MD
Peter P Roy-Byrne, MD
- Editor-in-Chief — Psychiatry
- Section Editor — Depressive Disorders
- Professor of Psychiatry and Behavioral Sciences
- University of Washington School of Medicine
Panic disorder is a chronic illness characterized by recurrent panic attacks, at least some of which are unexpected, accompanied either by anxiety about having future attacks or about the implications of attacks (eg, undiscovered medical illness, possible sudden death or insanity), or by a change in behavior due to attacks (eg, avoidance of certain situations, recurrent requests for medical tests) .
While up to a third of the population will have a panic attack in their lifetime, only about 10 percent of this group (about 3 percent of the population) will go on to develop panic disorder . Clinical trials have found that both pharmacologic and psychotherapeutic approaches are efficacious for panic disorder. With the revision of DSM-IV to DSM-5, agoraphobia is diagnosed independently of panic disorder . Agoraphobia frequently but not always accompanies panic disorder.
Pharmacotherapy for panic disorder is discussed here. The epidemiology, pathogenesis, clinical manifestations, course, and diagnosis of panic disorder are discussed separately. Psychotherapy for panic disorder and for agoraphobia are also reviewed separately. (See "Panic disorder in adults: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis" and "Psychotherapy for panic disorder with or without agoraphobia in adults".)
APPROACH TO TREATMENT
Our approach to selecting among treatments for panic disorder, including the use of pharmacotherapy and psychotherapy, is discussed separately. (See "Approach to treating panic disorder with or without agoraphobia in adults".)
Several classes of medication have shown efficacy for symptoms of panic disorder (attack frequency, anticipatory anxiety, and phobic avoidance): selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCADs), monoamine oxidase inhibitors (MAOIs), and benzodiazepines. These drugs differ in the extent of supporting evidence, side effect profile, and in the case of benzodiazepines, their potential for abuse [3-6].
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- APPROACH TO TREATMENT
- - Selective serotonin reuptake inhibitors
- Side effects
- - Serotonin-norepinephrine reuptake inhibitors
- Side effects
- - Tricyclic antidepressants
- Side effects
- - Monoamine oxidase inhibitors
- - Mirtazapine
- - Efficacy
- - Dosing
- - Side effects
- Risk of addiction
- Other medications
- DURATION OF TREATMENT
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS