Australian and New Zealand clinical practice guidelines for the treatment of panic disorder and agoraphobia.
BACKGROUND
The Royal Australian and New Zealand College of Psychiatrists is co-ordinating the development of clinical practice guidelines (CPGs) in psychiatry, funded under the National Mental Health Strategy (Australia) and the New Zealand Health Funding Authority.


METHODS
For these guidelines, the CPG team reviewed the treatment outcome literature, consulted with practitioners and patients and conducted a meta-analysis of recent outcome research.


CONCLUSIONS
Education for the patient and significant others covering: (i) the nature and course of panic disorder and agoraphobia; (ii) an explanation of the psychopathology of anxiety, panic and agoraphobia; (iii) rationale for the treatment, likelihood of a positive response, and expected time frame. Cognitive behaviour therapy (CBT) is more effective and more cost-effective than medication. Tricyclic antidepressants (TCAs) and serotonin selective reuptake inhibitors are equal in efficacy and both are to be preferred to benzodiazepines. Treatment choice depends on the skill of the clinician and the patient's circumstances. Drug treatment should be complemented by behaviour therapy. If the response to an adequate trial of a first-line treatment is poor, another evidence-based treatment should be used. A second opinion can be useful. The presence of severe agoraphobia is a negative prognostic indicator, whereas comorbid depression, if properly treated, has no consistent effect on outcome.
D000379:Agoraphobia / Q000188:drug therapy / Q000191:economics / Q000628:therapy*; D000929:Antidepressive Agents, Tricyclic / Q000191:economics / Q000627:therapeutic use; D001569:Benzodiazepines / Q000191:economics / Q000627:therapeutic use; D015928:Cognitive Behavioral Therapy / Q000191:economics / Q000379:methods*; D003362:Cost-Benefit Analysis; D006801:Humans; D016584:Panic Disorder / Q000188:drug therapy / Q000191:economics / Q000628:therapy*; D017367:Selective Serotonin Reuptake Inhibitors / Q000191:economics / Q000627:therapeutic use
D000929:Antidepressive Agents, Tricyclic; D001569:Benzodiazepines; D017367:Selective Serotonin Reuptake Inhibitors