Hostname: page-component-cd9895bd7-q99xh Total loading time: 0 Render date: 2025-01-05T12:54:13.845Z Has data issue: false hasContentIssue false
  • English
  • Français

Pharmacologic Treatment of Panic Disorder

Published online by Cambridge University Press:  07 November 2014

Julie C. Stevens  and
Mark H. Pollack
Julie C. Stevens
Affiliation:
Ms. Stevens is a clinical research coordinator in the Department of Psychiatry at Massachusetts General Hospital in Boston. Dr. Pollack is associate professor of psychiatry in the Department of Psychiatry at Harvard Medical School in Boston, Massachusetts
Get access Rights & Permissions [Opens in a new window]

Abstract

Panic disorder, frequently complicated by agoraphobia in the clinical setting, is a relatively common disorder that is associated with significant morbid burden and dysfunction in affected individuals. PD treatment is focused on the reduction of panic attacks, avoidance behavior, and anticipatory anxiety, as well as the resolution of comorbid conditions, with the goal of normalizing function and improving overall quality of life. Antidepressants, including the selective serotonin reuptake inhibitors and serotonin norepinephrine reuptake inhibitors, as well as benzodiazepines, are commonly used as primary pharmacotherapies for the treatment of PD, with a variety of other novel interventions potentially useful as well, to optimize treatment outcome.

Type
Research Article
Information
CNS Spectrums , Volume 10 , Issue S12 , September 2005 , pp. 25 - 31
Copyright
Copyright © Cambridge University Press 2005

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.Google Scholar
2.Kessler, RC, McGonagle, KA, Zhao, S, et al.Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch Gen Psychiatry. 1994;51:8–19.Google Scholar
3.Katon, W. Panic disorder: relationship to high medical utilization, unexplained physical symptoms, and medical costs. J Clin Psychiatry. 1996;57(suppl 10):11–18; discussion 19-22.Google ScholarPubMed
4.Sartorius, N, Ustun, TB, Costa e Silva, JA, et al.An international study of psychological problems in primary care. Preliminary report from the World Health Organization Collaborative Project on ‘Psychological Problems in General Health Care’. Arch Gen Psychiatry. 1993;50:819–824.CrossRefGoogle Scholar
5.Rubin, HC, Rapaport, MH, Levine, B, et al.Quality of well being in panic disorder: the assessment of psychiatric and general disability. J Affect Disord. 2000;57:217–221.CrossRefGoogle ScholarPubMed
6.Cramer, V, Torgersen, S, Kringlen, E. Quality of life and anxiety disorders: a population study. J Nerv Ment Dis. 2005;193:196–202.CrossRefGoogle ScholarPubMed
7.Pollack, MH. The pharmacotherapy of panic disorder. J Clin Psychiatry. 2005;66(suppl 4):23–27.Google Scholar
8.Michelson, D, Lydiard, RB, Pollack, MH, et al.Outcome assessment and clinical improvement in panic disorder: evidence from a randomized controlled trial of fluoxetine and placebo. The Fluoxetine Panic Disorder Study Group. Am J Psychiatry. 1998;155:1570–1577.Google Scholar
9.Shear, MK, Rucci, P, Williams, J, et al.Reliability and validity of the Panic Disorder Severity Scale: replication and extension. J Psychiatr Res. 2001;35:293–296.Google Scholar
10.Rosenbaum, JF, Pollack, MH, Fredman, SJ. The pharmacotherapy of panic disorder. In: Rosenbaum, JF, Pollack, MH, eds. Panic Disorder and Its Treatment. New York, NY: Marcel Dekker, Inc; 1998:153–180.Google Scholar
11.Practice guideline for the treatment of patients with panic disorder. Work Group on Panic Disorder. American Psychiatric Association. Am J Psychiatry. 1998;155:1–34.Google Scholar
12.Ballenger, JC, Wheadon, DE, Steiner, M, Bushnell, W, Gergel, IP. Double-blind, fixed-dose, placebo-controlled study of paroxetine in the treatment of panic disorder. Am J Psychiatry. 1998;155:36–42.CrossRefGoogle ScholarPubMed
13.Dannon, PN, Iancu, I, Cohen, A, Lowengrub, K, Grunhaus, L, Kotler, M. Three year naturalistic outcome study of panic disorder patients treated with paroxetine. BMC Psychiatry. 2004;4:16.Google Scholar
14.Modell, JG, Katholi, CR, Modell, JD, DePalma, RL. Comparative sexual side effects of bupropion, fluoxetine, paroxetine, and sertraline. Clin Pharmacol Ther. 1997;61:476–487.CrossRefGoogle ScholarPubMed
15.Lecrubier, Y, Judge, R. Long-term evaluation of paroxetine, clomipramine and placebo in panic disorder. Collaborative Paroxetine Panic Study Investigators. Acta Psychiatr Scand. 1997;95:153–160.Google Scholar
16.Lecrubier, Y, Bakker, A, Dunbar, G, Judge, R. A comparison of paroxetine, clomipramine and placebo in the treatment of panic disorder. Collaborative Paroxetine Panic Study Investigators. Acta Psychiatr Scand. 1997;95:145–152.CrossRefGoogle ScholarPubMed
17.Oehrberg, S, Christiansen, PE, Behnke, K, et al.Paroxetine in the treatment of panic disorder. A randomised, double-blind, placebo-controlled study. Br J Psychiatry. 1995;167:374–379.Google Scholar
18.Sheehan, DV, Burnham, DB, Iyengar, MK, Perera, P. Efficacy and tolerability of controlled-release paroxetine in the treatment of panic disorder. J Clin Psychiatry. 2005;66:34–40.Google Scholar
19.Pollack, MH, Otto, MW, Worthington, JJ, Manfro, GG, Wolkow, R. Sertraline in the treatment of panic disorder: a flexible-dose multicenter trial. Arch Gen Psychiatry. 1998;55:1010–1016.CrossRefGoogle ScholarPubMed
20.Sheikh, JI, Londborg, P, Clary, CM, Fayyad, R. The efficacy of sertraline in panic disorder: combined results from two fixed-dose studies. Int Clin Psychopharmacol. 2000;15:335–342.CrossRefGoogle ScholarPubMed
21.Pollack, MH, Rapaport, MH, Clary, CM, Mardekian, J, Wolkow, R. Sertraline treatment of panic disorder: response in patients at risk for poor outcome. J Clin Psychiatry. 2000;61:922–927.CrossRefGoogle ScholarPubMed
22.Michelson, D, Pollack, M, Lydiard, RB, Tamura, R, Tepner, R, Tollefson, G. Continuing treatment of panic disorder after acute response: randomised, placebo-controlled trial with fluoxetine. The Fluoxetine Panic Disorder Study Group. Br J Psychiatry. 1999;174:213–218.Google Scholar
23.Michelson, D, Allgulander, C, Dantendorfer, K, et al.Efficacy of usual antidepressant dosing regimens of fluoxetine in panic disorder: randomised, placebo-controlled trial. Br J Psychiatry. 2001;179:514–518.Google Scholar
24.Asnis, GM, Hameedi, FA, Goddard, AW, et al.Fluvoxamine in the treatment of panic disorder: a multi-center, double-blind, placebo-controlled study in outpatients. Psychiatry Res. 2001;103:1–14.Google Scholar
25.Black, DW, Wesner, R, Bowers, W, Gabel, J. A comparison of fluvoxamine, cognitive therapy, and placebo in the treatment of panic disorder. Arch Gen Psychiatry. 1993;50:44–50.Google Scholar
26.Palatnik, A, Frolov, K, Fux, M, Benjamin, J. Double-blind, controlled, crossover trial of inositol versus fluvoxamine for the treatment of panic disorder. J Clin Psychopharmacol. 2001;21:335–339.CrossRefGoogle ScholarPubMed
27.Lepola, UM, Wade, AG, Leinonen, EV, et al.A controlled, prospective, 1-year trial of citalopram in the treatment of panic disorder. J Clin Psychiatry. 1998;59:528–534.Google Scholar
28.Wade, AG, Lepola, U, Koponen, HJ, Pedersen, V, Pedersen, T. The effect of citalopram in panic disorder. Br J Psychiatry. 1997;170:549–553.CrossRefGoogle ScholarPubMed
29.Stahl, SM, Gergel, I, Li, D. Escitalopram in the treatment of panic disorder: a randomized, double-blind, placebo-controlled trial. J Clin Psychiatry. 2003;64:1322–1327.Google Scholar
30.Pollack, MH, Worthington, JJ 3rd, Otto, MW, et al.Venlafaxine for panic disorder: results from a double-blind, placebo-controlled study. Psychopharmacol Bull. 1996;32:667–670.Google Scholar
31.Pollack, M, Emilien, G, Tzanis, E, Whitaker, T. Venlafaxine XR and paroxetine in the short-term treatment of panic disorder. Poster presented at: the World Federation for the Societies of Biological Psychiatry; February 9-13, 2004; Sydney, Australia.Google Scholar
32.Pollack, M, Mangano, R, Entsuah, R, Tzanis, E. Short-term treatment of panic disorder: Venlafaxine XR vs paroxetine or placebo. Poster presented at: 158th Annual Meeting of the American Psychiatric Association; May 21-26, 2005; Atlanta, Ga.Google ScholarPubMed
33.Kienke, AS, Rosenbaum, JF. Efficacy of venlafaxine in the treatment of severe depression. Depress Anxiety. 2000;12(suppl 1):50–54.Google Scholar
34.Roseboom, PH, Kalin, NH. Neuropharmacology of venlafaxine. Depress Anxiety. 2000;12(suppl 1):20–29.Google Scholar
35.van den Broek, WW, Birkenhager, TK, Mulder, PG, Bruijn, JA, Moleman, P. A double-blind randomized study comparing imipramine with fluvoxamine in depressed inpatients. Psychopharmacology (Berl). 2004;175:481–486.CrossRefGoogle ScholarPubMed
36.Cowley, DS, Ha, EH, Roy-Byrne, PP. Determinants of pharmacologic treatment failure in panic disorder. J Clin Psychiatry. 1997;58:555–5561.Google Scholar
37.Bakker, A, van Dyck, R, Spinhoven, P, van Balkom, AJ. Paroxetine, clomipramine, and cognitive therapy in the treatment of panic disorder. J Clin Psychiatry. 1999;60:831–838.Google Scholar
38.den Boer, JA, Westenberg, HG, Kamerbeek, WD, Verhoeven, WM, Kahn, RS. Effect of serotonin uptake inhibitors in anxiety disorders; a double-blind comparison of clomipramine and fluvoxamine. Int Clin Psychopharmacol. 1987;2:21–32.Google Scholar
39.Sheehan, DV, Ballenger, J, Jacobsen, G. Treatment of endogenous anxiety with phobic, hysterical, and hypochondriacal symptoms. Arch Gen Psychiatry. 1980;37:51–59.Google Scholar
40.Livingston, MG, Livingston, HM. Monoamine oxidase inhibitors. An update on drug interactions. Drug Saf. 1996;14:219–227.Google Scholar
41.Lippman, SB, Nash, K. Monoamine oxidase inhibitor update. Potential adverse food and drug interactions. Drug Saf. 1990;5:195–204.Google Scholar
42.Bruce, SE, Vasile, RG, Goisman, RM, et al.Are benzodiazepines still the medication of choice for patients with panic disorder with or without agoraphobia? Am J Psychiatry. 2003;160:1432–1438.Google Scholar
43.Noyes, R Jr, Burrows, GD, Reich, JH, et al.Diazepam versus alprazolam for the treatment of panic disorder. J Clin Psychiatry. 1996;57:349–355.Google Scholar
44.Tesar, GE, Rosenbaum, JF, Pollack, MH, et al.Double-blind, placebo-controlled comparison of clonazepam and alprazolam for panic disorder. J Clin Psychiatry. 1991;52:69–76.Google ScholarPubMed
45.Soumerai, SB, Simoni-Wastila, L, Singer, C, et al.Lack of relationship between long-term use of benzodiazepines and escalation to high dosages. Psychiatr Serv. 2003;54:1006–1011.Google Scholar
46.Pecknold, JC, Swinson, RP, Kuch, K, Lewis, CP. Alprazolam in panic disorder and agoraphobia: results from a multicenter trial. III. Discontinuation effects. Arch Gen Psychiatry. 1988;45:429–436.CrossRefGoogle ScholarPubMed
47.Gaudreault, P, Guay, J, Thivierge, RL, Verdy, I. Benzodiazepine poisoning. Clinical and pharmacological considerations and treatment. Drug Saf. 1991;6:247–265.Google Scholar
48.Kan, CC, Hilberink, SR, Breteler, MH. Determination of the main risk factors for benzodiazepine dependence using a multivariate and multidimensional approach. Compr Psychiatry. 2004;45:88–94.Google Scholar
49.Greenblatt, DJ, Shader, RI, Abernethy, DR. Drug therapy. Current status of benzodiazepines. N Engl J Med. 1983;309:354–358.Google Scholar
50.Goddard, AW, Brouette, T, Almai, A, Jetty, P, Woods, SW, Charney, D. Early coadministration of clonazepam with sertraline for panic disorder. Arch Gen Psychiatry. 2001;58:681–686.CrossRefGoogle ScholarPubMed
51.Pollack, MH, Simon, NM, Worthington, JJ, et al.Combined paroxetine and clonazepam treatment strategies compared to paroxetine monotherapy for panic disorder. J Psychopharmacol. 2003;17:276–282.Google Scholar
52.Sheehan, DV, Davidson, J, Manschreck, T, Van Wyck Fleet, J. Lack of efficacy of a new antidepressant (bupropion) in the treatment of panic disorder with phobias. J Clin Psychopharmacol. 1983;3:28–31.CrossRefGoogle ScholarPubMed
53.Simon, NM, Emmanuel, N, Ballenger, J, et al.Bupropion sustained release for panic disorder. Psychopharmacol Bull. 2003;37:66–72.Google Scholar
54.Messer, T, Schmauss, M, Lambert-Baumann, J. Efficacy and tolerability of reboxetine in depressive patients treated in routine clinical practice. CNS Drugs. 2005;19:43–54.CrossRefGoogle ScholarPubMed
55.Versiani, M, Cassano, G, Perugi, G, et al.Reboxetine, a selective norepinephrine reuptake inhibitor, is an effective and well-tolerated treatment for panic disorder. J Clin Psychiatry. 2002;63:31–37.Google Scholar
56.Dannon, PN, Iancu, I, Grunhaus, L. The efficacy of reboxetine in the treatment-refractory patients with panic disorder: an open label study. Hum Psychopharmacol. 2002;17:329–333.Google Scholar
57.Seedat, S, van Rheede van Oudtshoorn, E, Muller, JE, Mohr, N, Stein, DJ. Reboxetine and citalopram in panic disorder: a single-blind, cross-over, flexible-dose pilot study. Int Clin Psychopharmacol. 2003;18:279–284.Google Scholar
58.Bertani, A, Perna, G, Migliarese, G, et al.Comparison of the treatment with paroxetine and reboxetine in panic disorder: a randomized, single-blind study. Pharmacopsychiatry. 2004;37:206–210.Google Scholar
59.Sheehan, DV, Raj, AB, Sheehan, KH, Soto, S. Is buspirone effective for panic disorder? J Clin Psychopharmacol. 1990;10:3–11.Google Scholar
60.Sheehan, DV, Raj, AB, Harnett-Sheehan, K, Soto, S, Knapp, E. The relative efficacy of high-dose buspirone and alprazolam in the treatment of panic disorder: a double-blind placebo-controlled study. Acta Psychiatr Scand. 1993;88:1–11.Google Scholar
61.Gastfriend, DR, Rosenbaum, JF. Adjunctive buspirone in benzodiazepine treatment of four patients with panic disorder. Am J Psychiatry. 1989;146:914–916.Google Scholar
62.Bouvard, M, Mollard, E, Guerin, J, Cottraux, J. Study and course of the psychological profile in 77 patients expressing panic disorder with agoraphobia after cognitive behaviour therapy with or without buspirone. Psychother Psychosom. 1997;66:27–32.Google Scholar
63.Hirschmann, S, Dannon, PN, Iancu, I, Dolberg, OT, Zohar, J, Grunhaus, L. Pindolol augmentation in patients with treatment-resistant panic disorder: A double-blind, placebo-controlled trial. J Clin Psychopharmacol. 2000;20:556–559.Google Scholar
64.Hollifield, M, Thompson, PM, Ruiz, JE, Uhlenhuth, EH. Potential effectiveness and safety of olanzapine in refractory panic disorder. Depress Anxiety. 2005;21:33–40.Google Scholar
65.Worthington, JJ 3rd, Kinrys, G, Wygant, LE, Pollack, MH. Aripiprazole as an augmentor of selective serotonin reuptake inhibitors in depression and anxiety disorder patients. Int Clin Psychopharmacol. 2005;20:9–11.Google Scholar
66.Woodman, CL, Noyes, R Jr.Panic disorder: treatment with valproate. J Clin Psychiatry. 1994;55:134–136.Google Scholar
67.Lum, M, Fontaine, R, Elie, R. Divalproex sodium’s antipanic effect in panic disorder: a placebo-controlled study. Biol Psychiatry. 1990;27(suppl 1):164A–165A.Google Scholar
68.Uhde, TW, Stein, MB, Post, RM. Lack of efficacy of carbamazepine in the treatment of panic disorder. Am J Psychiatry. 1988;145:1104–1109.Google Scholar
69.Pande, AC, Pollack, MH, Crockatt, J, et al.Placebo-controlled study of gabapentin treatment of panic disorder. J Clin Psychopharmacol. 2000;20:467–471.Google Scholar
70.Rosenthal, M. Tiagabine for the treatment of generalized anxiety disorder: a randomized, open-label, clinical trial with paroxetine as a positive control. J Clin Psychiatry. 2003;64:1245–1249.CrossRefGoogle ScholarPubMed
71.Pande, AC, Feltner, DE, Jefferson, JW, et al.Efficacy of the novel anxiolytic pregabalin in social anxiety disorder: a placebo-controlled, multicenter study. J Clin Psychopharmacol. 2004;24:141–149.CrossRefGoogle ScholarPubMed
72.Simon, NM, Worthington, JJ, Doyle, AC, et al.An open-label study of levetiracetam for the treatment of social anxiety disorder. J Clin Psychiatry. 2004;65:1219–1222.Google Scholar
73.Dording, CM, Mischoulon, D, Petersen, TJ, et al.The pharmacologic management of SSRI-induced side effects: a survey of psychiatrists. Ann Clin Psychiatry. 2002;14:143–147.Google Scholar
74.Otto, MW, Powers, M, Smits, JAJA. Adding cognitive-behavioral therapy to pharmacotherapy for panic disorder: issues and strteiges. CNS Spectr. 2005;9(suppl 12):32–39.Google Scholar