Ten patients suffernig from panic disorder according to DSMIV criteria, who were poor responders to standard therapy/ SSRI or SNRI AD/ were examined.The most common symptoms were fear of going crazy, losing control, dying, fainting with vegetative symptoms as palpitation, trembling, sweating, vertigo.Olanzapine, quetiapine or risperidon were added.

Objective global assessment measured by HAMA, CGI and Quality of Life Scale made before, two and four months after beginning of trial.Mild to significant improvement were recorded in seven patients related to reduced severity and number of attacks.Quetiapin then olanzapin showed best results.

Recommended treatment approaches include cognitive-behavioural as well as pharmacotherapy. Disorder have significant implications on global functioning, quality of life, suicidal risk.Limitation of our study is small number of participants, but there is a sense to try addition atypical antipsychotic in refractory cases.