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Panic Disorder

An anxiety disorder characterized by recurring panic attacks. It may also include significant behavioral changes lasting at least a month and worry about having other panic attacks.

PubMed Health Glossary
(Source: Wikipedia)

About Panic Disorder

People with panic disorder have sudden and repeated attacks of fear that last for several minutes. Sometimes symptoms may last longer. These are called panic attacks. Panic attacks are characterized by a fear of disaster or of losing control even when there is no real danger. A person may also have a strong physical reaction during a panic attack. It may feel like having a heart attack. Panic attacks can occur at any time, and many people with panic disorder worry about and dread the possibility of having another attack.

A person with panic disorder may become discouraged and feel ashamed because he or she cannot carry out normal routines like going to the grocery store or driving. Having panic disorder can also interfere with school or work.

Causes

Panic disorder sometimes runs in families, but no one knows for sure why some people have it while others don't. Researchers have found that several parts of the brain are involved in fear and anxiety....Read more about Panic Disorder NIH - National Institute of Mental Health

What works? Research summarized

Evidence reviews

Psychotherapy combined with antidepressants for panic disorder

Psychotherapy plus antidepressant treatment were compared with each of the two individual treatments alone for panic disorder. At the end of the acute phase treatment, the combined therapy was superior to psychotherapy or antidepressant treatment alone. After termination of active treatment, the combined therapy was superior to antidepressants alone and was as effective as psychotherapy alone. Either combined therapy or psychotherapy alone may be chosen as first line treatment for panic disorder with or without agoraphobia, depending on patient preference.

Psychotherapy and a benzodiazepine combined for treating panic disorder

Panic disorder is characterised by the repeated occurrence of unexpected panic attacks, during which the individual experiences a strong fear with anticipation of death. These attacks are often accompanied by somatic symptoms such as palpitations, dyspnoea or faintness. Those suffering from panic disorder have persistent anticipatory fear of recurrent attacks and feel anxious even while they have no occurrence of panic attacks for a certain period. Panic disorder is strongly associated with an increased risk for agoraphobia and depression. The prevalence of panic disorder is reported to be around 2 to 3 percent in the general population. Two broad categories of treatment have been shown to be effective in treating panic disorder, one being pharmacotherapy with antidepressants or benzodiazepines, the other being psychotherapy. These treatments are often combined, yet the efficacy of combining psychotherapy and benzodiazepine for panic disorder is unclear, despite its widespread use. This review included randomised controlled trials comparing the combination of psychotherapy and a benzodiazepine with either the psychotherapy or the benzodiazapine alone for people with panic disorder. We were able to include only three trials in this review. Two could be used in the comparison of the combination of psychotherapy and benzodiazepine versus psychotherapy alone and one in the comparison of the combination with benzodiazepine. These comparisons involved just 166 patients and 77 patients, respectively. These small numbers make it difficult to detect any differences between combination treatments and either treatment alone. The trials which compared the combination of treatments with psychotherapy alone (both using behaviour therapy) indicated no differences in response between the two approaches, either during the intervention, at the end of the intervention, or at the last follow‐up time point. The trial which compared the combination of treatments with a benzodiazepine alone demonstrated no differences in response during the intervention. Although the combination of treatments appeared to be more effective than the benzodiazepine alone at the end of treatment, no significant differences were observed at the 7‐month follow‐up. Before evidence‐based treatment recommendations are possible, more randomised controlled trials are required, comparing the combination of psychotherapy and benzodiazepines with either treatment alone, and involving enough people to be able to detect a true difference between the treatments if one exists.

Effectiveness of alprazolam in the treatment of panic disorder: a systematic review

Bibliographic details: Feijo de Mello M.  Effectiveness of alprazolam in the treatment of panic disorder: a systematic review. Revista Brasileira de Medicina 2006; 63(11): 606-610

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Summaries for consumers

Psychotherapy combined with antidepressants for panic disorder

Psychotherapy plus antidepressant treatment were compared with each of the two individual treatments alone for panic disorder. At the end of the acute phase treatment, the combined therapy was superior to psychotherapy or antidepressant treatment alone. After termination of active treatment, the combined therapy was superior to antidepressants alone and was as effective as psychotherapy alone. Either combined therapy or psychotherapy alone may be chosen as first line treatment for panic disorder with or without agoraphobia, depending on patient preference.

Psychotherapy and a benzodiazepine combined for treating panic disorder

Panic disorder is characterised by the repeated occurrence of unexpected panic attacks, during which the individual experiences a strong fear with anticipation of death. These attacks are often accompanied by somatic symptoms such as palpitations, dyspnoea or faintness. Those suffering from panic disorder have persistent anticipatory fear of recurrent attacks and feel anxious even while they have no occurrence of panic attacks for a certain period. Panic disorder is strongly associated with an increased risk for agoraphobia and depression. The prevalence of panic disorder is reported to be around 2 to 3 percent in the general population. Two broad categories of treatment have been shown to be effective in treating panic disorder, one being pharmacotherapy with antidepressants or benzodiazepines, the other being psychotherapy. These treatments are often combined, yet the efficacy of combining psychotherapy and benzodiazepine for panic disorder is unclear, despite its widespread use. This review included randomised controlled trials comparing the combination of psychotherapy and a benzodiazepine with either the psychotherapy or the benzodiazapine alone for people with panic disorder. We were able to include only three trials in this review. Two could be used in the comparison of the combination of psychotherapy and benzodiazepine versus psychotherapy alone and one in the comparison of the combination with benzodiazepine. These comparisons involved just 166 patients and 77 patients, respectively. These small numbers make it difficult to detect any differences between combination treatments and either treatment alone. The trials which compared the combination of treatments with psychotherapy alone (both using behaviour therapy) indicated no differences in response between the two approaches, either during the intervention, at the end of the intervention, or at the last follow‐up time point. The trial which compared the combination of treatments with a benzodiazepine alone demonstrated no differences in response during the intervention. Although the combination of treatments appeared to be more effective than the benzodiazepine alone at the end of treatment, no significant differences were observed at the 7‐month follow‐up. Before evidence‐based treatment recommendations are possible, more randomised controlled trials are required, comparing the combination of psychotherapy and benzodiazepines with either treatment alone, and involving enough people to be able to detect a true difference between the treatments if one exists.

Azapirones versus placebo for panic disorder in adults

Panic disorder is common in the general population and is often associated with various psychiatric disorders. Azapirones are a class of drugs occasionally used in the treatment of panic disorder, although none has been approved by a regulatory agency for this purpose. They are associated with less drowsiness, psychomotor impairment, alcohol potentiation and potential for addiction or abuse. However, azapirones are not widely used for panic disorder. Evidence for their efficacy in treating panic disorder is unclear. It is important to find out if azapirones are effective and acceptable in the treatment of panic disorder.

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Terms to know

Agoraphobia
Obsessive, persistent, intense fear of open places.
Anxiety
Feelings of fear, dread, and uneasiness that may occur as a reaction to stress. A person with anxiety may sweat, feel restless and tense, and have a rapid heart beat.
Anxiety Disorders
A category of disorders characterized by feelings of anxiety and fear. These feelings may cause physical symptoms, such as a racing heart and shakiness.
Panic Attack
An episode of intense fear accompanied by symptoms such as heart palpitations, sweating and chills or hot flushes.

More about Panic Disorder

Photo of an adult woman

Also called: Episodic paroxysmal anxiety disorder

Other terms to know: See all 4
Agoraphobia, Anxiety, Anxiety Disorders

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