Ham P, Waters DB, Oliver MN: Treatment of panic disorder. Am Fam Physician 2005; 71(4):733-40.
Patients with panic disorder present complicated and time-consuming issues to the primary care provider. This review article concisely presents diagnostic criteria and evidence-based options for therapy. Patients with panic disorder usually have a sudden onset of an attack, which includes intense fear and some combination of somatic symptoms such as chest pain, sweating, palpitations, nausea, dizziness, paresthesias, or shortness of breath. Panic attacks, which usually last more than 10 minutes, may account for nearly one-fourth of patients who present to emergency departments with chest pain. Antidepressant drug therapy alone is highly effective in reducing panic severity and number of attacks, and tricyclic antidepressants and selective serotonin re-uptake inhibitors show equal effectiveness. Choice of drug is based on side effect profile, patient preference and cost. Drug therapy should be continued for 6 months after the patient is symptom-free before considering medication withdrawal with monthly monitoring for relapse. Cognitive behavior therapy, which includes cognitive restructuring, exposure in vivo and through imagery, and relaxation and breathing retraining, improves panic symptoms and overall disability. Providers may choose to refer patients to an experienced cognitive behavior therapist. Self-help videotapes or reading materials are effective, but less so than cognitive behavior therapy.