Current Pharmacological and Non-Pharmacological Treatments of Panic Disorder/Agoraphobia

Anxiety disorders represent the most prevalent psychiatric disorders, however, many patients who might benefit from treatment are not diagnosed or treated. This may partly be due to lack of awareness of the anxiety disorders by primary care practitioners and by the sufferers themselves. In addition, the stigma still associated with psychiatric disorders and lack of confidence in psychiatric treatments are factors leading to no/under recognition and treatment, or the use of unnecessary or inappropriate treatments. This paper aims to provide a comprehensive review of the pharmacological treatment of panic disorders (PD). The first-line treatments include selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). Tricyclic antidepressants (TCAs) are similarly effective, but are less well tolerated than the SSRIs/SNRIs. In treatment-resistant cases, benzodiazepines like alprazolam may be used in patients with no history of dependency and tolerance. Other treatment options include irreversible and reversible monoamine-oxidase inhibitors, hydroxyzine, and others. Atypical antipsychotics may also be effective in resistant cases. Besides pharmacological treatments, some psychological strategies have been shown to be effective, in particular, cognitive behavior therapy (CBT) and other variants of behavior therapy have been sufficiently investigated in controlled studies, and, therefore, will be reviewed herein.