Clinical issues in the long-term treatment of panic disorder.
Longitudinal studies in naturalistic settings have shed new light on the course and value of therapeutic interventions in panic disorder and agoraphobia. Patients, their families, and clinicians need additional information about the natural course of the disorders and the factors that predispose patients to sustained illness, recovery, and relapse during treatment and upon treatment discontinuation. Clinical experience and controlled studies confirm the efficacy of pharmacologic and cognitive-behavioral therapy (CBT). Newer antidepressants, especially the serotonin selective reuptake inhibitors, represent a significant advance in effective pharmacologic intervention. However, despite the availability of effective treatment options, panic disorder often remains a chronic condition characterized by intermittent remissions and relapses over many years. Depression and comorbid anxiety disorders are associated with increased disease severity, treatment refractoriness, and relapse. The role of CBT as both a primary intervention and as an aid in the discontinuation of pharmacotherapy is reviewed.
Department of Psychiatry, Massachusetts General Hospital, Boston 02114, USA.
J F
JF
Rosenbaum
M H
MH
Pollack
R A
RA
Pollock
D000367:Age Factors; D000379:Agoraphobia / Q000188:drug therapy / Q000453:epidemiology / Q000628:therapy; D000525:Alprazolam / Q000627:therapeutic use; D014151:Anti-Anxiety Agents / Q000627:therapeutic use*; D000928:Antidepressive Agents / Q000627:therapeutic use*; D002648:Child; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D015897:Comorbidity; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D007099:Imipramine / Q000627:therapeutic use; D008137:Longitudinal Studies; D016584:Panic Disorder / Q000188:drug therapy / Q000453:epidemiology / Q000628:therapy*; D012008:Recurrence; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000525:Alprazolam; D014151:Anti-Anxiety Agents; D000928:Antidepressive Agents; D007099:Imipramine; D017367:Selective Serotonin Reuptake Inhibitors