Long-term management of panic disorder

Abstract

Many patients with panic disorder respond to pharmacologic treatment with benzodiazepines, monoamine oxidase inhibitors, tricyclic and tetracyclic antidepressants, and selective serotonin reuptake inhibitors. In these patients, the dose of antipanic medication can be gradually tapered off and the drug eventually withdrawn. Patients with a prolonged duration of illness, severe and frequent attacks, attacks while receiving medication, secondary psychopathology, or continued avoidant or other maladaptive behavior may require chronic or lifelong drug therapy. Controlled clinical studies have demonstrated the sustained effectiveness of the drugs used to treat panic disorder. The side effects associated with long-term treatment are similar both in type and frequency to those observed with acute therapy. Discontinuation of any drug that has been used for a prolonged period of time can cause withdrawal symptoms in patients with panic disorder. Gradual tapering of the drug dose usually is helpful in reducing the risk of withdrawal symptoms, but particularly intense symptoms have been reported in patients treated with benzodiazepines toward the end of the dose-tapering period. Logarithmically derived dose-reduction strategies and concomitant cognitive behavioral and supportive therapy are useful in preventing symptoms during the later phases of discontinuation.