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WCA Recommendations for the Long-Term Treatment of Panic Disorder

Published online by Cambridge University Press:  07 November 2014

Mark H. Pollack ,
Christer Allgulander ,
Borwin Bandelow ,
Giovanni B. Cassano ,
John H. Greist ,
Eric Hollander ,
David J. Nutt ,
Ahmed Okasha  and
Richard P. Swinson
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Abstract

What are the symptoms of panic disorder and how is the disorder most effectively treated? One of the most commonly encountered anxiety disorders in the primary care setting, panic disorder is a chronic and debilitating illness. The core symptoms are recurrent panic attacks coupled with anticipatory anxiety and phobic avoidance, which together impair the patient's professional, social, and familial functioning. Patients with panic disorder have medically unexplained symptoms that lead to overutilization of healthcare services. Panic disorder is often comorbid with agoraphobia and major depression, and patients may be at increased risk of cardiovascular disease and, possibly, suicide. Research into the optimal treatment of this disorder has been undertaken in the past 2 decades, and numerous randomized, controlled trials have been published. Selective serotonin reuptake inhibitors have emerged as the most favorable treatment, as they have a beneficial side-effect profile, are relatively safe (even if taken in overdose), and do not produce physical dependency. High-potency benzodiazepines, reversible monoamine oxidase inhibitors, and tricyclic antidepressants, have also shown antipardc efficacy. In addition, cognitive-behavioral therapy has demonstrated efficacy in the acute and long-term treatment of panic disorder. A n integrated treatment approach that combines pharmacotherapy with cognitive-behavioral therapy may provide the best treatment. Long-term efficacy and ease of use are important considerations in treatment selection, as maintenance treatment is recommended for at least 12–24 months, and in some cases, indefinitely.

Type
Academic Supplement
Information
CNS Spectrums , Volume 8 , supplement S1: Recommendations for the Long-Term Treatment of Anxiety Disorders , August 2003 , pp. 17 - 30
Copyright
Copyright © Cambridge University Press 2003

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References

REFERENCES

1.Diagnostic and Statistical Manual of Mental Disorders. 3rd ed. Washington, DC: American Psychiatric Association; 1980.Google Scholar
2.Pollack, MH, Marzol, PC. Panic: course, complications and treatment of panic disorder. J Psychopharmacol. 2000;14:S25–S30.CrossRefGoogle ScholarPubMed
3.Regier, DA, Narrow, WE, Rae, DS. The epidemiology of anxiety disorders: the Epidemiologic Catchment Area (ECA) experience. J Psychiatr Res. 1990;24(suppl 2):3–14.CrossRefGoogle ScholarPubMed
4.Shear, MK, Clark, D, Feske, U. The road to recovery in panic disorder: response, remission, and relapse. J Gin Psychiatry. 1998;59(suppl 8):4–8.Google ScholarPubMed
5.Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.Google Scholar
6.Carr, RE. Panic disorder and asthma. J Asthma. 1999;36:143–152.CrossRefGoogle ScholarPubMed
7.Gorman, JM, Kent, JM, Sullivan, GM, et al.Neuroanatomical hypothesis of panic disorder, revised. Am J Psychiatry. 2000;157:493–505.CrossRefGoogle ScholarPubMed
8.Fava, GA, Mangelli, L. Subclinical symptoms of panic disorder: new insights into pathophysiology and treatment. Psychother Psychosom. 1999;68:281–289.CrossRefGoogle ScholarPubMed
9.Katschnig, H, Amering, M. The long-term course of panic disorder and its predictors. J Clin Psychopharmacol. 1998;18:6S–11S.CrossRefGoogle ScholarPubMed
10.Weissman, MM, Bland, RC, Canino, GJ, et al.The cross-national epidemiology of panic disorder. Arch Gen Psychiatry. 1997;54:305–309.CrossRefGoogle ScholarPubMed
11.Cross-National Collaborative Panic Study SPI. Drug treatment of panic disorder. Comparative efficacy of alprazolam, imipramine, and placebo. Br J Psychiatry. 1992;160:191–202.CrossRefGoogle Scholar
12.Katon, WJ, Von Korff, M, Lin, E. Panic disorder: relationship to high medical utilization. Am J Med. 1992;92:7S–11S.CrossRefGoogle ScholarPubMed
13.Kennedy, BL, Schwab, JJ. Utilization of medical specialists by anxiety disorder patients. Psychosomatics. 1997;38:109–112.CrossRefGoogle ScholarPubMed
14.Fleet, R, Lavoie, K, Beitman, BD. Is panic disorder associated with coronary artery disease? A critical review of the literature. J Psychosom Res. 2000;48:347–356.CrossRefGoogle ScholarPubMed
15.Mukerji, V, Beitman, BD, Alpert, MA. Chest pain and angiographically normal coronary arteries. Implications for treatment. Tex Heart Inst J. 1993;20:170–179.Google ScholarPubMed
16.Coryell, W, Noyes, R, Clancy, J. Excess mortality in panic disorder. A comparison with primary unipolar depression. Arch Gen Psychiatry. 1982;39:701–703.CrossRefGoogle ScholarPubMed
17.Weissman, MM, Markowitz, JS, Ouellette, R, et al.Panic disorder and cardiovascular/cerebrovascular problems: results from a community survey. Am J Psychiatry. 1990;147:1504–1508.Google ScholarPubMed
18.Davies, SJ, Ghahramani, P, Jackson, PR, et al.Association of panic disorder and panic attacks with hypertension. Am J Med. 1999;107:310–316.CrossRefGoogle ScholarPubMed
19.Carr, RE, Lehrer, PM, Rausch, LL, et al.Anxiety sensitivity and panic attacks in an asthmatic population. Behav Res Ther. 1994;32:411–418.CrossRefGoogle Scholar
20.Eaton, WW, Kessler, RC, Wittchen, HU, et al.Panic and panic disorder in the United States. Am J Psychiatry. 1994;151:413–420.Google ScholarPubMed
21.Lecmbier, Y, Ustun, TB. Panic and depression: a worldwide primary care perspective. Int Clin Psychopharmacol. 1998;13(suppl 4):S7–S11.CrossRefGoogle Scholar
22.Johnson, J, Weissman, MM, Klerman, GL. Panic disorder, comorbidity, and suicide attempts. Arch Gen Psychiatry. 1990;47:805–808.CrossRefGoogle ScholarPubMed
23.Klerman, GL, Weissman, MM, Ouellette, R, et al.Panic attacks in the community. Social morbidity and health care utilization. JAMA. 1991;265:742–746.CrossRefGoogle ScholarPubMed
24.Kessler, RC, McGonagle, KA, Zhao, S, et al.Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch Gen Psychiatry. 1994;51:8–19.CrossRefGoogle ScholarPubMed
25.Wittchen, HU, Essau, CA, von Zerssen, D, et al.Lifetime and six-month prevalence of mental disorders in the Munich Follow-Up Study. Eur Arch Psychiatry Clin Neurosd. 1992;241:247–258.CrossRefGoogle ScholarPubMed
26.Katschnig, H, Amering, M, Stolk, JM, et al.Long-term follow-up after a drug trial for panic disorder. Br J Psychiatry. 1995;167:487–494.CrossRefGoogle ScholarPubMed
27.Keller, MB, Yonkers, KA, Warshaw, MG, et al.Rernjssion and relapse in subjects with panic disorder and panic with agoraphobia: a prospective short-interval naturalistic follow-up. J Nerv Ment Dis. 1994;182:290–296.CrossRefGoogle ScholarPubMed
28.Stein, MB, Tancer, ME, Uhde, TW. Major depression in patients with panic disorder: factors associated with course and recurrence. J Affect Disord. 1990;19:287–296.CrossRefGoogle ScholarPubMed
29.Segui, J, Marquez, M, Garcia, L, et al.Differential clinical features of early-onset panic disorder. J Affect Disord. 1999;54:109–117.CrossRefGoogle ScholarPubMed
30.Yonkers, KA, Zlotnick, C, Allsworth, J, et al.Is the course of panic disorder the same in women and men? Am J Psychiatry. 1998; 155:596–602.CrossRefGoogle ScholarPubMed
31.Keller, MB, Baker, LA. The clinical course of panic disorder and depression. J Clin Psychiatry. 1992;53(suppl):5–8.Google ScholarPubMed
32.Warshaw, MG, Massion, AO, Shea, MT, et al.Predictors of remission in patients with panic with and without agoraphobia: prospective 5-year follow-up data. J New Ment Dis. 1997;185:517–519.CrossRefGoogle ScholarPubMed
33.Markowitz, JS, Weissman, MM, Ouellette, R, et al.Quality of life in panic disorder. Arch Gen Psychiatry. 1989;46:984–992.CrossRefGoogle ScholarPubMed
34.Ettigi, P, Meyerhoff, AS, Chirban, JT, et al.The quality of life and employment in panic disorder. J Nerv Ment Dis. 1997;185:368–372.CrossRefGoogle ScholarPubMed
35.Swinson, RP, Cox, BJ, Woszczyna, CB. Use of medical services and treatment for panic disorder with agoraphobia and for social phobia. CMAJ. 1992;147: 878–883Google ScholarPubMed
36.Weissman, MM, Klerman, GL, Markowitz, JS, et al.Suicidal ideation and suicide attempts in panic disorder and attacks. N Engl J Med. 1989;321:1209–1214.CrossRefGoogle ScholarPubMed
37.Cox, BJ, Direnfeld, DM, Swinson, RP, et al.Suicidal ideation and suicide attempts in panic disorder and social phobia. Am J Psychiatry. 1994;151:882–887.Google ScholarPubMed
38.Henriksson, MM, Isometsa, ET, Kuoppasalmi, KI, et al.Panic disorder in completed suicide. J Clin Psychiatry. 1996;57:275–281.Google ScholarPubMed
39.Lepine, JP, Chignon, JM, Teherani, M. Suicide attempts in patients with panic disorder. Arch Gen Psychiatry. 1993;50:144–149.CrossRefGoogle ScholarPubMed
40.Cowley, DS, Flick, SN, Roy-Byrne, PP. Long-term course and outcome in panic disorder: a naturalistic follow-up study. Anxiety. 1996;2:13–21.3.0.CO;2-E>CrossRefGoogle ScholarPubMed
41.Ball, SG, Otto, MW, Pollack, MH, et al.Predicting prospective episodes of depression in patients with panic disorder: a longitudinal study. J Consult Clin Psychol. 1994;62:359–365.CrossRefGoogle ScholarPubMed
42.McElroy, SL, Altshuler, LL, Suppes, T, et al.Axis I psychiatric comorbidity and its relationship to historical illness variables in 288 patients with bipolar disorder. Am J Psychiatry. 2001;158:420–426.CrossRefGoogle ScholarPubMed
43.Stein, MB, Tancer, ME, Gelemter, CS, et al.Major depression in patients with social phobia. Am J Psychiatry. 1990;147:637–639.Google ScholarPubMed
44.Aronson, TA, Craig, TJ. Cocaine precipitation of panic disorder. Am J Psychiatry. 1986;143:643–645.Google ScholarPubMed
45.Nutt, DJ. Antidepressants in panic disorder: clinical and preclinical mechanisms. J Clin Psychiatry. 1998;59(suppl 8):24–28.Google ScholarPubMed
46.Bradwejn, J, Koszycki, D, Shriqui, C. Enhanced sensitivity to cholecystokinin tetrapeptide in panic disorder. Clinical and behavioral findings. Arch Gen Psychiatry. 1991;48:603–610.CrossRefGoogle ScholarPubMed
47.Klein, E, Zohar, J, Geraci, MF, et al.Anxiogenic effects of m-CPP in patients with panic disorder: comparison to caffeine's anxiogenic effects. Biol Psychiatry. 1991;30:973–984.CrossRefGoogle ScholarPubMed
48.den Boer, JA, Westenberg, HG. Effect of a serotonin and noradrenaline uptake inhibitor in panic disorder; a double-blind comparative study with fluvoxamine and maprotiline. Int Clin Psychopharmacol. 1988;3:59–74.CrossRefGoogle ScholarPubMed
49.Norman, TR, Gregory, MS, Judd, FK, et al.Platelet serotonin uptake in panic disorder: comparison with normal controls and the effect of treatment. Aust N Z J Psychiatry. 1988;22:390–395.CrossRefGoogle ScholarPubMed
50.Charney, DS, Heninger, GR, Jatlow, PI. Increased anxiogenic effects of caffeine in panic disorders. Arch Gen Psychiatry. 1985;42:233–243.CrossRefGoogle ScholarPubMed
51.Guy, W. ECDEU Assessment Manual for Psychopharmacology. US Dept Health, Education and Welfare publication (ADM) 76–338. Rockville, Md: National Institute of Mental Health; 1976;218–222.Google Scholar
52.Hamilton, M. Diagnosis and rating of anxiety. Br J Psychiatry. 1969;3:76–79.Google Scholar
53.Hamilton, M. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960;23:56–62.CrossRefGoogle ScholarPubMed
54.Sheehan, DV. The Anxiety Disease. New York, NY: Bantam Books. 1983.Google Scholar
55.Argyle, N, Deltito, J, Allerup, P, et al.The Panic-Associated Symptom Scale: measuring the severity of panic disorder. Acta Psychiatr Scand. 1991;83:20–26.CrossRefGoogle ScholarPubMed
56.Bandelow, B, Broocks, A, Pekrun, G, et al.The use of the Panic and Agoraphobia Scale (P & A) in a controlled clinical trial. Pharmacopsychiatry. 2000;33:174–181.CrossRefGoogle Scholar
57.Klein, DF, Fink, M. Psychiatric reaction patterns to imipramine. Am J Psychiatry. 1962;119:432–438.CrossRefGoogle ScholarPubMed
58.Bakish, D, Hooper, CL, Filteau, MJ, et al.A double-blind placebo-controlled trial comparing fluvoxamine and imipramine in the treatment of panic disorder with or without agoraphobia. Psychopharmacol Bull. 1996;32:135–141.Google ScholarPubMed
59.Rizley, R, Kahn, RJ, McNair, DM, et al.A comparison of alprazolam and imipramine in the treatment of agoraphobia and panic disorder. Psychopharmacol Bull. 1986;22:167–172.Google ScholarPubMed
60.Taylor, CB, Hayward, C, King, R, et al.Cardiovascular and symptomatic reduction effects of alprazolam and imipramine in patients with panic disorder: results of a double-blind, placebo-controlled trial. J Clin Psychopharmacol. 1990;10:112–118.CrossRefGoogle ScholarPubMed
61.Schweizer, E, Rickels, K, Weiss, S, et al.Maintenance drug treatment of panic disorder. I. Results of a prospective, placebo-controlled comparison of alprazolam and imipramine. Arch Gen Psychiatry. 1993;50:51–60.CrossRefGoogle ScholarPubMed
62.Andersch, S, Rosenberg, NK, Kullingsjo, H, et al.Efficacy and safety of alprazolam, imipramine and placebo in treating panic disorder. A Scandinavian multicenter study. Acta Psychiatr Scand Suppl. 1991;365:18–27.CrossRefGoogle ScholarPubMed
63.Leon, CA, De Arango, MV, Arevalo, W, et al.Comparison of the effect of alprazolam, imipramine and placebo in the treatment of panic disorders in Cali, Colombia. Acta Psiquiatr Psicol Am hat. 1990;36:59–72.Google ScholarPubMed
64.Barlow, DH, German, JM, Shear, MK, et al.Cognitive-behavioral therapy, imipramine, or their combination for panic disorder: a randomized controlled trial. JAMA. 2000;283:2529–2536.CrossRefGoogle ScholarPubMed
65.Johnston, DG, Troyer, IE, Whitsett, SF. Clomipramine treatment of agoraphobic women. An eight-week controlled trial. Arch Gen Psychiatry. 1988;45:453–459.CrossRefGoogle ScholarPubMed
66.Fahy, TJ, O'Rourke, D, Brophy, J, et al.The Galway Study of Panic Disorder. I: clomipramine and lofepramine in DSM III-R panic disorder: a placebo controlled trial. J Affect Disord. 1992;2563–2575.Google ScholarPubMed
67.Hoffart, A, Due-Madsen, J, Lande, B, et al.Clomipramine in the treatment of agoraphobic inpatients resistant to behavioral therapy. J Clin Psychiatry. 1993;54:481–487.Google ScholarPubMed
68.Lecrubier, Y, Bakker, A, Dunbar, G, et al.A comparison of paroxetine, clomipramine and placebo in the treatment of panic disorder. Collaborative Paroxetine Panic Study Investigators. Acta Psychiatr Scand. 1997;95:145–152.CrossRefGoogle ScholarPubMed
69.Bakker, A, van Dyck, R, Spinhoven, P, et al.Paroxetine, clomipramine, and cognitive therapy in the treatment of panic disorder. J Clin Psychiatry. 1999;60:831–838.CrossRefGoogle ScholarPubMed
70.Wade, AG, Lepola, U, Koponen, HJ, et al.The effect of citalopram in panic disorder. Br J Psychiatry. 1997;170:549–553.CrossRefGoogle ScholarPubMed
71.Broocks, A, Bandelow, B, Pekrun, G, et al.Comparison of aerobic exercise, clomipramine, and placebo in the treatment of panic disorder. Am J Psychiatry. 1998;155:603–609.CrossRefGoogle ScholarPubMed
72.Modigh, K, Westberg, P, Eriksson, E. Superiority of clomipramine over imipramine in the treatment of panic disorder: a placebo-controlled trial. J Clin Psychopharmacol. 1992;12:251–261.CrossRefGoogle ScholarPubMed
73.Diagnostic and Statistical Manual of Mental Disorders. 3rd ed rev. Washington, DC: American Psychiatric Association; 1987.Google Scholar
74.Cassano, GB, Petracca, A, Perugi, G, et al.Clomipramine for panic disorder: I. The first 10 weeks of a long-term comparison with imipramine. J Affect Disord. 1988;14:123–127.CrossRefGoogle ScholarPubMed
75.Sheehan, DV. Current concepts in the treatment of panic disorder. J Clin Psychiatry. 1999;60(suppl 18):16–21.Google ScholarPubMed
76.Ballenger, JC, Davidson, JR, Lecrubier, Y, et al.Consensus statement on panic disorder from the International Consensus Group on Depression and Anxiety. J Clin Psychiatry. 1998;59(suppl 8):47–54.Google Scholar
77.Davidson, JR. The long-term treatment of panic disorder. J Clin Psychiatry. 1998;59(suppl 8):17–21.Google ScholarPubMed
78.Ballenger, JC, Wheadon, DE, Steiner, M, et al.Double-blind, fixed-dose, placebo-controlled study of paroxetine in the treatment of panic disorder. Am J Psychiatry. 1998;155:36–42.CrossRefGoogle ScholarPubMed
79.Oehrberg, S, Christiansen, PE, Behnke, K, et al.Paroxetine in the treatment of panic disorder. A randomised, double-blind, placebo-controlled study. Br J Psychiatry. 1995;167:374–379.CrossRefGoogle ScholarPubMed
80.Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.Google Scholar
81.Stein, MB, Ron, NG, Walker, JR, et al.Do selective serotonin re-uptake inhibitors enhance the efficacy of very brief cognitive behavioral therapy for panic disorder? A pilot study. Psychiatry Res. 2000;94:191–200.CrossRefGoogle ScholarPubMed
82.Londborg, PD, Wolkow, R, Smith, WT, et al.Sertraline in the treatment of panic disorder. A multi-site, double-blind, placebo-controlled, fixed-dose investigation. Br J Psychiatry. 1998;173:54–60.CrossRefGoogle ScholarPubMed
83.Pohl, RB, Wolkow, RM, Clary, CM. Sertraline in the treatment of panic disorder: a double-blind multicenter trial. Am J Psychiatry. 1998;155:1189–1195.CrossRefGoogle ScholarPubMed
84.Pollack, MH, Otto, MW, Worthington, JJ, et al.Sertraline in the treatment of panic disorder: a flexible-dose multicenter trial. Arch Gen Psychiatry. 1998;55:1010–1016.CrossRefGoogle ScholarPubMed
85.Pollack, MH, Rapaport, MH, Clary, CM, Mardekian, J, Wolkow, R. Sertraline treatment of panic disorder: response in patients at risk for poor outcome. J Clin Psychiatry. 2000;61:922–927.CrossRefGoogle ScholarPubMed
86.Hoehn-Saric, R, McLeod, DR, Hipsley, PA. Effect of fluvoxamine on panic disorder. J Clin Psychopharmacol. 1993;13:321–326.CrossRefGoogle ScholarPubMed
87.Black, DW, Wesner, R, Bowers, W, et al.A comparison of fluvoxamine, cognitive therapy, and placebo in the treatment of panic disorder. Arch Gen Psychiatry. 1993;50:44–50.CrossRefGoogle ScholarPubMed
88.Sharp, DM, Power, KG, Simpson, RJ, et al.Global measures of outcome in a controlled comparison of pharmacological and psychological treatment of panic disorder and agoraphobia in primary care. Br J Gen Pract. 1997;47:150–155.Google Scholar
89.de Beurs, E, van Balkom, AJ, Lange, A, et al.Treatment of panic disorder with agoraphobia: comparison of fluvoxamine, placebo, and psychological panic management combined with exposure and of exposure in vivo alone. Am J Psychiatry. 1995;152:683–691.Google ScholarPubMed
90.Michelson, D, Lydiard, RB, Pollack, MH, et al.Outcome assessment and clinical improvement in panic disorder: evidence from a randomized controlled trial of fluoxetine and placebo. The Fluoxetine Panic Disorder Study Group. Am J Psychiatry. 1998;155:1570–1577.CrossRefGoogle ScholarPubMed
91.Hirschtnann, S, Dannon, PN, Iancu, I, et al.Pindolol augmentation in patients with treatment-resistant panic disorder: a double-blind, placebo-controlled trial. J Clin Psychopharmacol. 2000;20:556–559CrossRefGoogle Scholar
92.Rickels, K, Schweizer, E, Weiss, S, et al.Maintenance drug treatment for panic disorder. II. Short- and long-term outcome after drug taper. Arch Gen Psychiatry. 1993;50:61–68.CrossRefGoogle Scholar
93.den Boer, JA. Pharmacotherapy of panic disorder: differential efficacy from a clinical viewpoint. J Clin Psychiatry. 1998;59(suppl 8):30–36.Google ScholarPubMed
94.Ballenger, JC, Burrows, GD, DuPont, RL, et al.Alprazolam in panic disorder and agoraphobia: results from a multicenter trial. I. Efficacy in short-term treatment. Arch Gen Psychiatry. 1988;45:413–422.CrossRefGoogle ScholarPubMed
95.Pecknold, JC, Swinson, RP, Kuch, K, et al.Alprazolam in panic disorder and agoraphobia: results from a multicenter trial. III. Discontinuation effects. Arch Gen Psychiatry. 1988;45:429–436.CrossRefGoogle ScholarPubMed
96.Lydiard, RB, Lesser, IM, Ballenger, JC, et al.A fixed-dose study of alprazolam 2 mg, alprazolam 6 mg, and placebo in panic disorder. J Clin Psychopharmacol. 1992;12:96–103.CrossRefGoogle ScholarPubMed
97.Marks, IM, Swinson, RP, Basoglu, M, et al.Alprazolam and exposure alone and combined in panic disorder with agoraphobia. A controlled study in London and Toronto. Br J Psychiatry. 1993;162:776–787.CrossRefGoogle ScholarPubMed
98.Beauclair, L, Fontaine, R, Annable, L, et al.Clonazepam in the treatment of panic disorder: a double-blind, placebo-controlled trial investigating the correlation between clonazepam concentrations in plasma and clinical response. J Clin Psychopharmacol. 1994;14:111–118.CrossRefGoogle ScholarPubMed
99.Rosenbaum, JF, Moroz, G, Bowden, CL. Clonazepam in the treatment of panic disorder with or without agoraphobia: a dose-response study of efficacy, safety, and discontinuance. Clonazepam Panic Disorder Dose-Response Study Group. J Clin Psychopharmacol. 1997;17:390–400.CrossRefGoogle ScholarPubMed
100.Moroz, G, Rosenbaum, JF. Efficacy, safety, and gradual discontinuation of clonazepam in panic disorder: a placebo-controlled, multicenter study using optimized dosages. J Clin Psychiatry. 1999;60:604–612.CrossRefGoogle ScholarPubMed
101.Valenca, AM, Nardi, AE, Nascimento, I, et al.Double-blind clonazepam vs placebo in panic disorder treatment. Arq Neuropsiquiatr. 2000;58:1025–1029.CrossRefGoogle ScholarPubMed
102.Tesar, GE, Rosenbaum, JF, Pollack, MH, et al.Double-blind, placebo-controlled comparison of clonazepam and alprazolam for panic disorder. J Clin Psychiatry. 1991;52:69–76.Google ScholarPubMed
103.Noyes, R, Burrows, GD, Reich, JH, et al.Diazepam versus alprazolam for the treatment of panic disorder. J Clin Psychiatry. 1996;57:349–355.Google ScholarPubMed
104.Dunner, DL, Ishiki, D, Avery, DH, et al.Effect of alprazolam and diazepam on anxiety and panic attacks in panic disorder: a controlled study. J Clin Psychiatry 1986;47:458–460.Google ScholarPubMed
105.Charney, DS, Woods, SW. Benzodiazepine treatment of panic disorder: a comparison of alprazolam and lorazepam. J Clin Psychiatry. 1989;50:418–423.Google ScholarPubMed
106.Schweizer, E, Fox, I, Case, G, et al.Lorazepam vs. alprazolam in the treatment of panic disorder. Psychopharmacol Bull. 1988;24:224–227.Google ScholarPubMed
107.Schweizer, E, Pohl, R, Balon, R, et al.Lorazepam vs. alprazolam in the treatment of panic disorder. Pharmacopsychiatry. 1990;23:90–93.CrossRefGoogle ScholarPubMed
108.Sheehan, DV, Ballenger, J, Jacobsen, G. Treatment of endogenous anxiety with phobic, hysterical, and hypochondriacal symptoms. Arch Gen Psychiatry. 1980;37:51–59.CrossRefGoogle ScholarPubMed
109.van Vliet, IM, Westenberg, HG, den Boer, JA. MAO inhibitors in panic disorder: clinical effects of treatment with brofaromine. A double blind placebo controlled study. Psychopharmacology (Berl). 1993;112:483–489.CrossRefGoogle ScholarPubMed
110.van Vliet, IM, den Boer, JA, Westenberg, HG, et al.A double-blind comparative study of brofaromine and fluvoxamine in outpatients with panic disorder. J Clin Psychopharmacol. 1996;16:299–306.CrossRefGoogle ScholarPubMed
111.Bakish, D, Saxena, BM, Bowen, R, et al.Reversible monoamine oxidase-A inhibitors in panic disorder. Clin Neuropharmacol. 1993;16(suppl 2):S77–S82Google ScholarPubMed
112.Loerch, B, Graf-Morgenstern, M, Hautzinger, M, et al.Randomised placebo-controlled trial of moclobemide, cognitive-behavioural therapy and their combination in panic disorder with agoraphobia. Br J Psychiatry. 1999;174:205–212.CrossRefGoogle ScholarPubMed
113.Tdler, JW, Bouwer, C, Behnke, K. Moclobemide and fluoxetine for panic disorder. International Panic Disorder Study Group. Eur Arch Psychiatry Clin Neurosci. 1999;249(suppl 1):S7–S10.Google Scholar
114.Lydiard, RB, Steiner, M, Burnham, D, et al.Efficacy studies of paroxetine in panic disorder. Psychopharmacol Bull. 1998;34:175–182.Google ScholarPubMed
115.Lecrubier, Y, Judge, R. Long-term evaluation of paroxetine, clomipramine and placebo in panic disorder. Collaborative Paroxetine Panic Study Investigators. Acta Psychiatr Scand. 1997;95:153–160.CrossRefGoogle ScholarPubMed
116.Rapaport, M, Walkow, R, Rubin, A, et al.Sertraline treatment of panic disorder: results of a long-term study. Acta Psychiatr Scand. 2001;104(4):289–98.CrossRefGoogle ScholarPubMed
117.Michelson, D, Pollack, M, Lydiard, RB, et al.Continuing treatment of panic disorder after acute response: randomised, placebo-controlled trial with fluoxetine. The Fluoxetine Panic Disorder Study Group. Br J Psychiatry. 1999;174:213–218.CrossRefGoogle ScholarPubMed
118.Lepola, UM, Wade, AG, Leinonen, EV, et al.A controlled, prospective, 1-year trial of citalopram in the treatment of panic disorder. J Clin Psychiatry. 1998;59:528–534.CrossRefGoogle ScholarPubMed
119.Mavissakalian, MR, Perel, JM. 2nd year maintenance and discontinuation of imipramine in panic disorder with agoraphobia. Ann Clin Psychiatry. 2001;13:63–67.CrossRefGoogle ScholarPubMed
120.Lepola, UM, Rimon, RH, Riekkinen, PJ. Three-year follow-up of patients with panic disorder after short-term treatment with alprazolam and imipramine. Int Clin Psychopharmacol. 1993;8:115–118.CrossRefGoogle ScholarPubMed
121.Lepola, U, Koponen, H, Leinonen, E. A naturalistic 6-year follow-up study of patients with panic disorder. Acta Psychiatr Scand. 1996;93:181–183.CrossRefGoogle ScholarPubMed
122.Curtis, GC, Massana, J, Udina, C, et al.Maintenance drug therapy of panic disorder. J Psychiatr Res. 1993;27(suppl 1):127–142.CrossRefGoogle ScholarPubMed
123.Clark, DM, Salkovskis, PM, Hackmann, A, et al.A comparison of cognitive therapy, applied relaxation and imipramine in the treatment of panic disorder. Br J Psychiatry. 1994;164:759–769.CrossRefGoogle ScholarPubMed
124.Lotufo-Neto, F, Bernik, M, Ramos, RT, et al.A dose-finding and continuation study of clomipramine in panic disorder. J Psychopharmacology. 2001;15:13–17.CrossRefGoogle ScholarPubMed
125.de Beurs, E, van Balkom, AJ, van Dyck, R, et al.Long-term outcome of pharmacological and psychological treatment for panic disorder with agoraphobia: a 2-year naturalistic follow-up. Acta Psychiatr Scand. 1999;99:59–67.CrossRefGoogle ScholarPubMed
126.Pohl, R, Holland, P, Chung, H, Clary, C. Effectiveness of sertraline in long-term treatment of panic disorder: treatment response, quality of life, and sexual functioning. Poster presented at: the American Psychiatric Association Annual Meeting, 2001; New Orleans, LA.Google Scholar
127.Arato, M, Lepola, U, Austin, C. Sertraline vs imipramine treatment of comorbid panic disorder and major depression. Poster presented at: the American Psychiatric Association annual meeting; May 2001; New Orleans, LA.CrossRefGoogle Scholar
128.Saiz Ruiz, J, Gomez Beneyto, M, Gutierrez Casares, JR, et al. Sertraline in the treatment of panic disorder: a naturalistic study. Poster presented at: the American Psychiatric Association Annual Meeting; May 2001; New Orleans, LA.Google Scholar
129.Roy-Byrne, PP, Clary, CM, Miceli, RJ, Colucci, SV, Xu, Y, Grudzinski, AN. The effect of selective serotonin reuptake inhibitor treatment of panic disorder on emergency room and laboratory resource utilization. J Clin Psychiatry. 2001;62:678–682.CrossRefGoogle ScholarPubMed
130.Leinonen, E, Lepola, U, Koponen, H, et al.Citalopram controls phobic symptoms in patients with panic disorder: randomized controlled trial. J Psychiatry Neurosci. 2000;25:25–32.Google ScholarPubMed
131.Pollack, MH, Otto, MW, Tesar, GE, et al.Long-term outcome after acute treatment with alprazolam or clonazepam for panic disorder. J Clin Psychopharmacol. 1993;13:257–263.CrossRefGoogle ScholarPubMed
132.Brown, TA, Barlow, DH. Long-term outcome in cognitive-behavioral treatment of panic disorder: clinical predictors and alternative strategies for assessment. J Consult Clin Psychol. 1995;63:754–765.CrossRefGoogle ScholarPubMed
133.Gelder, MG. Combined pharmacotherapy and cognitive behavior therapy in the treatment of panic disorder. J Clin Psychopharmacol. 1998;18:2S–5S.CrossRefGoogle ScholarPubMed
134.American Psychiatric Association. Practice guidelines for the treatment of patients with panic disorder. Am J Psychiatry. 1998;155:1–34.Google Scholar
135.Wiborg, IM, Dahl, AA. Does brief dynamic psychotherapy reduce the relapse rate of panic disorder? Arch Gen Psychiatry. 1996;53:689–694.CrossRefGoogle ScholarPubMed
136.Mavissakalian, M, Michelson, L. Agoraphobia: relative and combined effectiveness of therapist-assisted in vivo exposure and imipramine. J Clin Psychiatry. 1986;47:117–122.Google ScholarPubMed
137.Zitrin, CM, Klein, DF, Woerner, MG. Treatment of agoraphobia with group exposure in vivo and imipramine. Arch Gen Psychiatry. 1980;37:63–72.CrossRefGoogle ScholarPubMed
138.Lecrubier, Y. The impact of comorbidity on the treatment of panic disorder. J Clin Psychiatry. 1998;59(suppl 8):11–14.Google ScholarPubMed
139.Baldwin, DS, Birtwistle, J. The side effect burden associated with drug treatment of panic disorder. J Clin Psychiatry. 1998;5(suppl 8):39–44.Google Scholar
140.Roy-Byrne, P, Stein, M, Bystrisky, A, et al.Pharmacotherapy of panic disorder: proposed guidelines for the family physician. J Am Board Fam Pract. 1998; 11:282–290.CrossRefGoogle ScholarPubMed
141.Anxiety Review Panel. Evans, M, Bradwejn, J, Dunn, L, eds. Guidelines for the treatment of anxiety disorders in primary care. Toronto, Canada: Queen's Printer of Ontario; 2000. Available at: www.opot.org Accessed November 10, 2001.Google Scholar