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Chapter 29. Panic Disorder

Murray B. Stein, M.D., M.P.H.; Laura Campbell-Sills, Ph.D.
DOI: 10.1176/appi.books.9781585622986.258062

Sections

Excerpt

In this chapter we review current treatments for panic disorder with or without agoraphobia. The first section covers pharmacotherapeutic approaches, and the second section covers psychotherapeutic approaches and discusses combining these strategies. The treatment recommendations stem from a combination of practice guidelines (e.g., American Psychiatric Association Work Group on Panic Disorder 1998; Bandelow et al. 2002), the published scientific literature, and the authors' clinical experience. For the most part, we will reference seminal reports stemming from double-blind, randomized controlled trials (RCTs) and authoritative review papers and will limit citing of uncontrolled case reports or open-label treatment series to areas (e.g., psychodynamic psychotherapy) where no other literature exists. We will also avoid providing specific dosing recommendations for particular drugs, as this information is better obtained from other sources that are frequently updated (e.g., manufacturers' Web sites). We will not discuss the treatment of panic disorder in special populations (e.g., older adults, children, pregnant women), thereby acknowledging that these topics require additional consideration that cannot be accomplished in the space allotted to us.

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References

American Psychiatric Association Work Group on Panic Disorder: Practice guidelines for the treatment of patients with panic disorder. Am J Psychiatry 155:1–34, 1998
 
Asnis GM, Hameedi FA, Goddard AW, et al: Fluvoxamine in the treatment of panic disorder: a multi-center, double-blind, placebo-controlled study in outpatients. Psychiatry Res 103:1–14, 2001
[PubMed]
 
Ballenger JC, Wheadon DE, Steiner M, et al: Double-blind, fixed-dose, placebo-controlled study of paroxetine in the treatment of panic disorder. Am J Psychiatry 155:36–42, 1998
[PubMed]
 
Bandelow B, Zohar J, Hollander E, et al: World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the pharmacological treatment of anxiety, obsessive-compulsive and posttraumatic stress disorders. World J Biol Psychiatry 3:171–199, 2002
[PubMed]
 
Bandelow B, Behnke K, Lenoir S, et al: Sertraline versus paroxetine in the treatment of panic disorder: an acute, double-blind noninferiority comparison. J Clin Psychiatry 65:405–413, 2004
[PubMed]
 
Barlow DH, Craske MG, Cerny JA, et al: Behavioral treatment of panic disorder. Behavior Therapy 20:261–282, 1989
 
Barlow DH, Gorman JM, Shear MK, et al: Cognitive-behavioral therapy, imipramine, or their combination for panic disorder: a randomized controlled trial. JAMA 283:2529–2536, 2000
[PubMed]
 
Bienvenu OJ, Onyike CU, Stein MB, et al: Agoraphobia in adults: incidence and longitudinal relationship with panic. Br J Psychiatry 188:432–438, 2006
[PubMed]
 
Bouton ME, Mineka S, Barlow DH: A modern learning theory perspective on the etiology of panic disorder. Psychological Review 108:4–32, 2001
[PubMed]
 
Bradwejn J, Ahokas A, Stein DJ, et al: Venlafaxine extended-release capsules in panic disorder: flexible-dose, double-blind, placebo-controlled study. Br J Psychiatry 187:352–359, 2005
[PubMed]
 
Bruce SE, Vasile RG, Goisman RM, et al: Are benzodiazepines still the medication of choice for patients with panic disorder with or without agoraphobia? Am J Psychiatry 160:1432–1438, 2003
[PubMed]
 
Bruce TJ, Spiegel D, Hegel M: Cognitive-behavioral therapy helps prevent relapse and recurrence of panic disorder following alprazolam discontinuation: a long-term follow-up of the Peoria and Dartmouth studies. J Consult Clin Psychol 67:151–156, 1999
[PubMed]
 
Calbring P, Westling BE, Ljungstrand P, et al: Treatment of panic disorder via the Internet: a randomized trial of a self-help program. Behavior Therapy 32:751–764, 2001
 
Clark DM: A cognitive approach to panic disorder. Behav Res Ther 24:461–470, 1986
[PubMed]
 
Clark DM, Salkovskis PM, Hackmann A, et al: A comparison of cognitive therapy, applied relaxation and imipramine in the treatment of panic disorder. Br J Psychiatry 164:759–769, 1994
[PubMed]
 
Clark DM, Salkovskis PM, Hackmann A, et al: Brief cognitive therapy for panic disorder: a randomized controlled trial. J Consult Clin Psychol 67:583–589, 1999
[PubMed]
 
Craske MG, Brown TA, Barlow DH: Behavioral treatment of panic disorder: a two-year follow-up. Behavior Therapy 22:289–304, 1991
 
Craske MG, Maidenberg E, Bystritsky A: A brief cognitive-behavioral versus nondirective therapy for panic disorder. J Behav Ther Exp Psychiatry 26:113–120, 1995
[PubMed]
 
Febbraro GAR, Clum GA, Roodman AA, et al: The limits of bibliotherapy: a study of differential effectiveness of self-administered interventions in individuals with panic attacks. Behavior Therapy 30:209–222, 1999
 
Feske U, Goldstein AJ: Eye movement desensitization and reprocessing treatment for panic disorder: a controlled outcome and partial dismantling study. J Consult Clin Psychol 65:1026–1035, 1997
[PubMed]
 
Goddard AW, Brouette T, Almai A, et al: Early co-administration of clonazepam with sertraline for panic disorder. Arch Gen Psychiatry 58:681–686, 2001
[PubMed]
 
Goddard AW, Mason GF, Appel M, et al: Impaired GABA neuronal response to acute benzodiazepine administration in panic disorder. Am J Psychiatry 161:2186–2193, 2004
[PubMed]
 
Goisman RM, Warshaw MG, Keller MB: Psychosocial treatment prescriptions for generalized anxiety disorder, panic disorder, and social phobia, 1991–1996. Am J Psychiatry 156:1819–1821, 1999
[PubMed]
 
Isbister GK, O'Regan L, Sibbritt D, et al: Alprazolam is relatively more toxic than other benzodiazepines in overdose. Br J Clin Pharmacol 58:88–95, 2004
[PubMed]
 
Kessler RC, Berglund P, Demler O, et al: Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 62:593–602, 2005a
 
Kessler RC, Chiu WT, Demler O, et al: Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 62:617–627, 2005b
 
Klein DF: Delineation of two drug-responsive anxiety syndromes. Psychopharmacology 5:397–408, 1964
[PubMed]
 
Loerch B, Graf-Morgenstern M, Hautzinger M, et al: Randomised placebo-controlled trial of moclobemide, cognitive-behavioural therapy and their combination in panic disorder with agoraphobia. Br J Psychiatry 174:205–212, 1999
[PubMed]
 
Londborg PD, Wolkow R, Smith WT, et al: Sertraline in the treatment of panic disorder. Br J Psychiatry 173:54–60, 1998
[PubMed]
 
Markowitz JS, Weissman MM, Ouellette R, et al: Quality of life in panic disorder. Arch Gen Psychiatry 46:984–992, 1989
[PubMed]
 
Mendlowicz MV, Stein MB: Quality of life in individuals with anxiety disorders. Am J Psychiatry 157:669–682, 2000
[PubMed]
 
Michelson D, Allgulander C, Dantendorfer K, et al: Efficacy of usual antidepressant dosing regimens of fluoxetine in panic disorder: randomised, placebo-controlled trial. Br J Psychiatry 179:514–518, 2001
[PubMed]
 
Milrod B, Busch F, Leon AC, et al: A pilot open trial of brief psychodynamic psychotherapy for panic disorder. J Psychother Pract Res 10:239–245, 2001
[PubMed]
 
Nagy LM, Krystal JH, Woods SW, et al: Clinical and medication outcome after short-term alprazolam and behavioral group treatment in panic disorder: 2.5 year naturalistic follow-up study. Arch Gen Psychiatry 46:993–999, 1989
[PubMed]
 
Neumeister A, Bain E, Nugent AC, et al: Reduced serotonin type 1A receptor binding in panic disorder. J Neurosci 24:589–591, 2004
[PubMed]
 
Newman MG, Erickson T, Przeworski A, et al: Self-help and minimal-contact therapies for anxiety disorders: is human contact necessary for therapeutic efficacy? J Clin Psychol 59:251–274, 2003
[PubMed]
 
Otto MW, Pollack MH, Sachs GS, et al: Discontinuation of benzodiazepine treatment: efficacy of cognitive-behavioral therapy for patients with panic disorder. Am J Psychiatry 150:1485–1490, 1993
[PubMed]
 
Pande AC, Pollack MH, Crockatt J, et al: Placebo-controlled study of gabapentin treatment of panic disorder. J Clin Psychopharmacol 20:467–471, 2000
[PubMed]
 
Pecknold J, Luthe L, Munjack D, et al: A double-blind, placebo-controlled, multicenter study with alprazolam and extended-release alprazolam in the treatment of panic disorder. J Clin Psychopharmacol 14:314–321, 1994
[PubMed]
 
Pohl RB, Wolkow RM, Clary CM: Sertraline in the treatment of panic disorder: a double-blind multicenter trial. Am J Psychiatry 155:1189–1195, 1998
[PubMed]
 
Pollack MH: The pharmacotherapy of panic disorder. J Clin Psychiatry 66 (suppl 4):23–27, 2005
 
Pollack MH, Doyle AC: Treatment of panic disorder: focus on paroxetine. Psychopharmacol Bull 37 (suppl 1):53–63, 2003
 
Pollack MH, Otto MW, Worthington JJ, et al: Sertraline in the treatment of panic disorder: a flexible-dose multicenter trial. Arch Gen Psychiatry 55:1010–1016, 1998
[PubMed]
 
Pollack MH, Simon NM, Worthington JJ, et al: Combined paroxetine and clonazepam treatment strategies compared to paroxetine monotherapy for panic disorder. J Psychopharmacol 17:276–282, 2003
[PubMed]
 
Pull CB: Current status of virtual reality exposure therapy in anxiety disorders. Curr Opin Psychiatry 18:7–14, 2005
[PubMed]
 
Raffa SD, White KS, Barlow DH: Feared consequences of panic attacks in panic disorder: a qualitative and quantitative analysis. Cogn Behav Ther 33:199–207, 2004
[PubMed]
 
Rapaport MH, Clary C, Fayyad R, et al: Quality-of-life impairment in depressive and anxiety disorders. Am J Psychiatry 162:1171–1178, 2005
[PubMed]
 
Ribeiro L, Busnello JV, Kauer-Sant'Anna M, et al: Mirtazapine versus fluoxetine in the treatment of panic disorder. Braz J Med Biol Res 34:1303–1307, 2001
[PubMed]
 
Rosenbaum JF, Moroz G, Bowden CL: Clonazepam in the treatment of panic disorder with or without agoraphobia: a dose-response study of efficacy, safety, and discontinuance. J Clin Psychopharmacol 17:390–400, 1997
[PubMed]
 
Roy-Byrne PP, Craske MG, Stein MB, et al: A randomized effectiveness trial of cognitive-behavioral therapy and medication for primary care panic disorder. Arch Gen Psychiatry 62:290–298, 2005
[PubMed]
 
Schmidt NB, Woolaway-Bickel K, Trakowski J, et al: Dismantling cognitive-behavioral treatment for panic disorder: questioning the utility of breathing retraining. J Consult Clin Psychol 68:417–424, 2000
[PubMed]
 
Schmidt NB, Woolaway-Bickel K, Trakowski JH, et al: Antidepressant discontinuation in the context of cognitive behavioral treatment for panic disorder. Behav Res Ther 40:67–73, 2002
[PubMed]
 
Shear MK, Houck P, Greeno C, et al: Emotion-focused psychotherapy for patients with panic disorder. Am J Psychiatry 158:1993–1998, 2001
[PubMed]
 
Sheehan DV, Burnham DB, Iyengar MK, et al: Efficacy and tolerability of controlled-release paroxetine in the treatment of panic disorder. J Clin Psychiatry 66:34–40, 2005
[PubMed]
 
Sheehan DV, Raj AB, Sheehan KH, et al: Is buspirone effective for panic disorder? J Clin Psychopharmacol 10:3–11, 1990
[PubMed]
 
Sheehan DV, Raj AB, Harnett-Sheehan K, et al: The relative efficacy of high-dose buspirone and alprazolam in the treatment of panic disorder: a double-blind placebo-controlled study. Acta Psychiatr Scand 88:1–11, 1993
[PubMed]
 
Sherbourne CD, Wells KB, Judd LL: Functioning and well-being of patients with panic disorder. Am J Psychiatry 153:213–218, 1996
[PubMed]
 
Spiegel DA, Bruce TJ, Gregg SF, et al: Does cognitive behavior therapy assist slow-taper alprazolam discontinuation in panic disorder? Am J Psychiatry 151:876–881, 1994
[PubMed]
 
Stahl SM, Gergel I, Li D: Escitalopram in the treatment of panic disorder: a randomized, double-blind, placebo-controlled trial. J Clin Psychiatry 64:1322–1327, 2003
[PubMed]
 
Stein MB, Roy-Byrne PP, Craske MG, et al: Functional impact and health utility of anxiety disorders in primary care outpatients. Medical Care 43:1164–1170, 2005
[PubMed]
 
Stirman SW, Crits-Christoph P, DeRubeis RJ: Achieving successful dissemination of empirically supported psychotherapies: a synthesis of dissemination theory. Clinical Psychology: Science and Practice 11:343–359, 2004
 
Telch MJ, Lucas JA, Schmidt NB, et al: Group cognitive-behavioral treatment of panic disorder. Behav Res Ther 31:279–287, 1993
[PubMed]
 
Van Ameringen M, Mancini C, Pipe B, et al: Antiepileptic drugs in the treatment of anxiety disorders: role in therapy. Drugs 64:2199–2220, 2004
 
Wade AG, Lepola U, Koponen HJ, et al: The effect of citalopram in panic disorder. Br J Psychiatry 170:549–553, 1997
[PubMed]
 
Wade WA, Treat TA, Stuart GL: Transporting an empirically supported treatment for panic disorder to a service clinic setting: a benchmark strategy. J Consult Clin Psychol 66:231–239, 1998
[PubMed]
 
Whittal ML, Otto MW, Hong JJ: Cognitive-behavior therapy for discontinuation of SSRI treatment of panic disorder: a case series. Behav Res Ther 39:939–945, 2001
[PubMed]
 
Wiborg IM, Dahl AA: Does brief dynamic psychotherapy reduce the relapse rate of panic disorder? Arch Gen Psychiatry 53:689–694, 1996
[PubMed]
 
Worthington JJ III, Pollack MH, Otto MW, et al: Long-term experience with clonazepam in patients with a primary diagnosis of panic disorder. Psychopharmacol Bull 34:199–205, 1998
[PubMed]
 
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