title: Treatment-resistant panic disorder: a systematic review.
abstract: BACKGROUND
  The prevalence of panic disorder (PD) in the population is high and these patients have work impairment, high unemployment rates, seek medical treatment more frequently and have more hospitalizations than people without panic symptoms. Despite the availability of pharmacological, psychological and combined treatments, approximately one-third of all PD patients have persistent panic attacks and other PD symptoms after treatment.
  
  
  METHODS
  MEDLINE/Pubmed, CENTRAL, PsycINFO and Web of Science databases were searched for clinical trials in treatment-resistant PD. Only studies published between 1980 and 2015, in English, with human subjects, considered "journal articles" and clinical trial were included. We included trials recruiting only adult subjects with treatment-resistant PD, consistent with criteria from DSM-III to DSM5. We included all prospective experimental studies. Case, case series, retrospective studies or studies with <10 PD subjects were not included.
  
  
  CONCLUSIONS
  Only 11 articles were included in this review. There were few quality studies, only two were randomized, controlled and double blind. Augmentation of the pharmacological treatment with cognitive-behavioral therapy demonstrated some short-term efficacy in treatment-resistant PD. There were also preliminary evidences of efficacy for monotherapy with reboxetine and olanzapine, and augmentation with pindolol, divalproex sodium, aripiprazole and olanzapine in short-term treatment.
authors.affiliation: a Laboratory of Panic and Respiration , Institute of Psychiatry, Federal University of Rio de Janeiro and National Institute for Translational Medicine (INCT-TM) , Rio de Janeiro , Brazil.
authors.forename: Rafael C
authors.initials: RC
authors.lastname: Freire
authors.affiliation: a Laboratory of Panic and Respiration , Institute of Psychiatry, Federal University of Rio de Janeiro and National Institute for Translational Medicine (INCT-TM) , Rio de Janeiro , Brazil.
authors.forename: Morena M
authors.initials: MM
authors.lastname: Zugliani
authors.affiliation: a Laboratory of Panic and Respiration , Institute of Psychiatry, Federal University of Rio de Janeiro and National Institute for Translational Medicine (INCT-TM) , Rio de Janeiro , Brazil.
authors.forename: Rafael F
authors.initials: RF
authors.lastname: Garcia
authors.affiliation: a Laboratory of Panic and Respiration , Institute of Psychiatry, Federal University of Rio de Janeiro and National Institute for Translational Medicine (INCT-TM) , Rio de Janeiro , Brazil.
authors.forename: Antonio E
authors.initials: AE
authors.lastname: Nardi
mesh_terms: D000928:Antidepressive Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D006801:Humans; D016584:Panic Disorder / Q000188:drug therapy* / Q000628:therapy; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D017211:Treatment Failure
chemical_list: D000928:Antidepressive Agents; D014150:Antipsychotic Agents
keywords: Agoraphobia; anxiety; clinical trial; cognitive-behavioral therapy; panic attack