Evidence-based pharmacotherapy of panic disorder

Introduction Panic disorder is a common mental disorder that is associated with significant morbidity. Fortunately, effective treatments for panic disorder are available, and include both medication and cognitive–behavioral therapy (CBT). Ongoing research on the pharmacotherapy of panic disorder makes it timely to update an evidence-based approach to the pharmacotherapy of panic disorder (Bakker et al., 2005). Here we briefly emphasize the importance of adequate care before reviewing the available pharmacological evidence on treating panic disorder, focusing in particular on (1) the optimal first-line pharmacotherapy of panic disorder, (2) the optimal duration of maintenance therapy, and (3) the optimal approach to pharmacotherapy in the treatment-refractory patient. To reveal relevant research conducted since the publication of Bakker et al. (2005), a MEDLINE search (2003–2010) using the terms “panic’ and “treatment’ was undertaken. Importance of adequate care, Panic disorder is a common mental disorder, with a 12-month prevalence rate of 1.8% (Goodwin et al., 2005). Only a minority of those affected receive adequate care. The main reason is that not all patients seek help. It may take years before individuals with panic disorder seek help; only about one third of those affected seek help within the year of onset (Wang et al., 2005a). The gap between those affected and those seeking help for panic disorder is about 50% (Kohn et al., 2004; Wang et al., 2005b).