The conceptualisation and investigation of panic disorder have developed on two different axes, medical and psychological, for more than 100 years. In medicine, reports of acute anxiety attacks with cardiac, circulatory, and respiratory symptoms date back to the French Revolution, and terms such as “soldier's heart”, “neurocirculatory neurasthenia”, or “hyperventilation syndrome” have been used to describe them. In psychological medicine, anxiety attacks were first reported by Domrich in 1849. These attacks, which were thought to be caused by strong emotions, were classified mainly within neurasthenia, until Freud created the concept of anxiety neurosis in 1895.

The most important feature of panic disorder is the existence of a discrete crescendo of distress that peaks very quickly and disappears quickly (DSM-IV, 1994). However, a patient will frequently erroneously say that the panic lasted hours. When a person has a panic attack they feel tremendously overwhelmed and often seek help in accident and emergency units. An estimated one in three people who present at these units with chest pains has symptoms consistent with panic disorder (Fleet et al, 1994).

Depression and panic disorder co-occur in about one-third of people presenting with either condition. When they occur together they present diagnostic and treatment dilemmas for the clinician. However, this is a clinical problem that has been routinely ignored by researchers because of the diagnostic criteria before DSM-III-R, and the restrictive entry criteria in drug trials where patients must have one clearly defined illness.

The principal management strategy for patients with panic attacks and agoraphobia has traditionally been behavioural therapy, but the delineation of panic disorder as a distinct diagnostic entity has stimulated psychopharmacological research on this psychiatric condition. As a result, the treatment of panic disorder has diversified. Effective pharmacological treatment of this disorder began with the antidepressant imipramine, but today a wide variety of efficacious agents are available for treating the symptoms of panic disorder. The four primary classes of agents for panic disorder are the tricyclic antidepressants (TCAs), the serotonin reuptake inhibitors (SSRIs), the monoamine oxidase inhibitors (MAOIs) and the high-potency benzodiazepines (BZs). Effective non-pharmacological treatments are primarily behavioural, although cognitive approaches have also been shown to be successful.