PANIC DISORDER - EFFICACY OF CURRENT TREATMENTS

As has been demonstrated in the numerous studies cited in this report, there are multiple effective treatments for panic disorder (PD), both pharmacological and psychosocial. Available evidence documents that at least 75 percent of patients will have a good response to three classes of medications (tricyclic antidepressants, monoamine oxidase inhibitors, benzodiazepines) which are all approximately equal in efficacy and side effects. Medications may be even more effective when combined with cognitive and behavioral techniques. Several of the psychosocial treatments are also quite effective and appear to have certain advantages, including a low relapse rate. Currently a cognitive treatment specific for panic disorder is under active study and appears especially promising. It is clear that both pharmacological and cognitive-behavioral treatments for panic disorder are effective and can reduce or eliminate the multiple symptoms (panic attacks, phobic avoidance, depression, etc.) and the secondary disability in occupational and social and family roles associated with panic disorder. Untreated, panic disorder patients appear to generally remain chronically ill and worsen over time. What is less clear are issues of length of treatment, outcome after treatment is discontinued, relationship of pharmacological and nonpharmacological treatments, effect of comorbid disorders and presence of subclinical symptoms, and patient characteristics which predict a positive response. The relatively recent finding that panic disorder is a common condition, occurring in about 1-2 percent of the population within any 6-month period (Weissman 1990) has stimulated clinical interest in the development of effective interventions. Until the early 1980s available treatments were generally ineffective, leaving approximately 75 percent of patients unimproved (Doctor 1982). However, excellent pharmacological and nonpharmacological treatments are now available and provide significant improvement with complete resolution of symptoms and disability in the majority of patients. The advances in the knowledge base about panic disorder were underscored in the National Institutes of Health Consensus Development Conference held September 25-27, 1991 at the National Institutes of Health in Bethesda, MD. These conferences are convened periodically by the National Institutes of Health to evaluate available scientific evidence, resolve issues of both safety and treatment efficacy, and make these advances known to the public. One of the primary conclusions from this conference is that ''Panic disorder is a distinct condition with a specific presentation, course, and positive family history and for which there are effective pharmacological and cognitive-behavioral treatments'' (Panic Consensus Statement 1991). This paper will review the clinical evidence which clearly demonstrates the effectiveness of first pharmacological and then nonpharmacological treatments and the extent to which they are able to reduce the symptoms and disability associated with this condition. Recent advances in the field will be described, closing with a summary that outlines research and clinical issues requiring further study.