Treatment Options for Panic Disorder

Treatment Options for Panic Disorder including:
Psychological Treatments
During the past 10 years, there has been extensive evaluation of the psychological treatment of panic disorder, with and without extensive agoraphobic avoidance. This evaluation has overwhelmingly demonstrated that cognitive behavioral packages are extremely successful in managing panic disorder. In general, following treatment, around 80% of participants are free of panic attacks and 60–70% of those who exhibit severe avoidance behavior are markedly improved in their degree of avoidance.
In addition, relatively good results can also be obtained from very brief interventions (four sessions) and even from treatments offered in a self-help format. More importantly, treatment results continue for up to two years. However, there are still considerable improvements to be made. Despite the fact that cognitive behavioral treatments produce excellent results with respect to panic attacks and very good results with respect to agoraphobic avoidance, the overall individual picture is far from perfect. Recent longitudinal follow-up of individuals who completed a cognitive behavioral program for panic disorder has shown that more than 50% do not meet criteria for high end state functioning and/or continue to seek treatment during the following two years.
Several studies also demonstrated that cognitive behavioral treatment packages result in greater and longer lasting improvements than medication. One large study demonstrated that 90% of patients treated with cognitive therapy were free of panic attacks at the end of treatment (85% at 1 year follow-up) compared with 55% treated with imipramine (60% at followup). In a recent multicenter comparison, 56% of people treated with cognitive behavior therapy alone were considered ‘‘treatment responders’’ compared with 49% of those treated with imipramine alone and 67% of those treated with a combination of CBT and imipramine. At 12-month follow-up, these figures were 92%, 75%, and 63%, respectively, among those who completed treatment. The surprising tendency for those treated with a combination of cognitive behavior therapy and medication to show slightly worse outcome at follow-up has been demonstrated elsewhere and requires further investigation.
Pharmacological Treatment
In one of the earliest studies in this area, Klein and Fink found that imipramine, a tricyclic antidepressant, blocked ‘‘spontaneous’’ panic attacks but did not affect more chronic or anticipatory anxiety. Since that time, a number of studies have been conducted indicating the value of tricyclics and monoamine oxidase inhibitors (MAOIs) in reducing panic attacks. These results, together with the early work by Klein, led to the suggestion that panic attacks were specifically affected by the tricyclics and MAOIs, whereas the benzodiazepines were more effective for anticipatory anxiety. More recently, however, this simple formula has been challenged by the finding that many benzodiazepines are effective in reducing panic attacks when given in large enough doses.
Recent interest has begun to focus more closely on the selective serotonin re-uptake inhibitors as the treatment of choice for panic disorder. Controlled treatment outcome studies are currently still few, but preliminary data suggest that the effects are at least as good as the tricyclics and with fewer side effects.