Treatment of Panic Disorder

Abstract

In 1981, panic disorder was officially recognized as a separate illness and not merely a component of generalized anxiety disorder. Panic disorder is characterized by panic attacks or unpredictable episodes of sudden and overwhelming feelings of fear or terror. The disorder has a lifetime prevalence rate of 1.6% to 2%, being more common in women than men; many patients do not seek treatment. The majority of patients who have panic disorder develop severe anxiety and agoraphobia; comorbidity with depression occurs in approximately 33%. Panic disorder seems to be chronic with significant morbidity and mortality, including suicide, in patients who are untreated. Fortunately, panic disorder can be successfully treated using several drugs, including antidepressants, imipramine and phenelzine, and the benzodiazepine, alprazolam. It is anticipated that the Federal Food and Drug Administration (FDA) will soon approve the first antipanic drug, alprazolam (Xanax, Upjohn, Kalamazoo, MI). The drug of choice for panic disorder is determined by careful evaluation of several drug and patient characteristics. Although alprazolam has some distinct advantages over the antidepressants, including faster onset of therapeutic response and greater patient acceptance, the major problem is drug dependence and withdrawal, especially after high-dose, long-term use. Alprazolam should never be abruptly discontinued, but slowly tapered according to individual response. The pharmacist can play a valuable role in educating patients regarding the efficacy of drug treatment, risks and benefits of individual therapeutic agents, as well as the risks of untreated panic disorder.