Current concepts in the treatment of panic disorder.
Panic disorder is a prevalent psychiatric condition that often is chronic and rarely resolves without medical intervention. Many patients with panic disorder initially present with a variety of somatic symptoms, including chest pain, nausea, or dizziness, and patients frequently seek care in ambulatory care settings. Although panic disorder is classified as a single entity, it can have many dimensions and may be associated with significant morbidity. During the past 2 decades, there have been significant advances in the treatment of panic disorder, and a range of therapeutic choices is now available. Four classes of medications, including the selective serotonin reuptake inhibitors (SSRIs), high-potency benzodiazepines, tricyclic antidepressants, and monoamine oxidase inhibitors, may be considered for the management of patients with panic disorder. Emerging clinical data favor the SSRIs as first-line treatment for patients with panic disorder, and paroxetine and sertraline have been approved by the U.S. Food and Drug Administration for use in panic disorder. This article reviews the efficacy and safety of these treatments, as well as their relative merits and disadvantages, and assists the practicing clinician in choosing among the various pharmacotherapies to tailor therapy to each patient's individual needs.
Sheehan
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Department of Psychiatry, University of South Florida, USF Institute for Research in Psychiatry, Tampa 36613-4788, USA. dsheehan@com1.med.usf.edu
D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use; D001569:Benzodiazepines / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D005473:Fluoxetine / Q000627:therapeutic use; D016666:Fluvoxamine / Q000627:therapeutic use; D006801:Humans; D015201:Meta-Analysis as Topic; D008996:Monoamine Oxidase Inhibitors / Q000627:therapeutic use; D016584:Panic Disorder / Q000188:drug therapy* / Q000523:psychology; D017374:Paroxetine / Q000627:therapeutic use; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D020280:Sertraline / Q000627:therapeutic use; D016896:Treatment Outcome
D000929:Antidepressive Agents, Tricyclic; D001569:Benzodiazepines; D005473:Fluoxetine; D016666:Fluvoxamine; D008996:Monoamine Oxidase Inhibitors; D017374:Paroxetine; D017367:Selective Serotonin Reuptake Inhibitors; D020280:Sertraline