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Panic Disorder—a Condition for Life? Treatment Issues

✍ Scribed by H. G. M. WESTENBERG

Publisher
John Wiley and Sons
Year
1997
Tongue
English
Weight
101 KB
Volume
12
Category
Article
ISSN
0885-6222

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✦ Synopsis

Panic disorder is a readily diagnosed, chronic condition which has received substantial attention since its recognition as a distinct condition in the Diagnostic and Statistical Manual of Mental Disorders (DSM)-III (American Psychiatric Association, 1980). Eective anti-panic therapy should show ecacy in reducing the frequency of panic attacks and associated symptomology, and be well tolerated. Benzodiazepines have a rapid onset of action, but have disadvantages of dependence and withdrawal problems and are thus less suitable for long-term use. Since depression occurs as a comorbid condition in 60 per cent of patients with panic disorder, the use of antidepressants is a logical choice. The ®rst-generation monoamine oxidase inhibitors are little used in panic disorder, since they present a major problem of a potential hypertensive crisis, particularly when ingested with tyramine. Tricyclic antidepressants (TCAs), such as imipramine and clomipramine, are widely used and are eective but they are not well tolerated. The TCAs appear to exert their anti-panic eect via the serotonin reuptake pathway. Selective serotonin reuptake inhibitors (SSRIs) do not have anti-cholinergic eects or act on the noradrenergic system, thus there is a clear pharmacological rationale for believing that SSRIs should be as eective as TCAs in panic disorder and be better tolerated. Indeed, the SSRI paroxetine is as eective as clomipramine in panic disorder but has an improved tolerability pro®le; paroxetine is the only agent of its class licensed as a treatment for panic disorder. # 1997 by

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