Panic disorder occurs in up to 3% of the adult population at some time, and is associated with other psychiatric and personality disorders, and with drug and alcohol abuse. The risk of suicide and attempted suicide has been found to be higher in people with panic disorder than in people with other psychiatric illness, including depression.
Methods and outcomes
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of non-drug treatments for panic disorder? What are the effects of drug treatments for panic disorder? What are the effects of combined drug and psychological treatments for panic disorder? We searched: Medline, Embase, The Cochrane Library, and other important databases up to June 2007 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
We found 36 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
In this systematic review, we present information relating to the effectiveness and safety of the following interventions: applied relaxation; benzodiazepines; breathing retraining; brief dynamic psychotherapy; buspirone; client-centred therapy; cognitive behavioural therapy (CBT) (alone or plus drug treatments); cognitive restructuring; couple therapy; exposure (external or interoceptive); insight-orientated therapy; monoamine oxidase inhibitors (MAOIs); psychoeducation; selective serotonin reuptake inhibitors (SSRIs); self-help; and tricyclic antidepressants (imipramine).
Panic disorder is characterised by recurrent, unpredictable panic attacks, making people worry about or change their behaviour to avert subsequent panic attacks or their consequences.
Panic disorder occurs in up to 3% of the adult population at some time, and is associated with other psychiatric and personality disorders, and with drug and alcohol abuse.The risk of suicide and attempted suicide has been found to be higher in people with panic disorder than in people with other psychiatric illness, including depression.
CBT is effective in reducing symptoms of panic disorder over 6 months or longer, but we don't know whether it is more effective than other psychological treatments.
CBT is more effective than waiting list and other controls in reducing symptoms in panic disorder with or without mild to moderate agoraphobia. We don't know whether CBT alone is more effective than antidepressants alone, but weak evidence suggests that the effects of CBT may last longer. Combined treatment with CBT plus antidepressants has shown to be more effective than CBT alone or antidepressants alone in reducing symptoms in the short term.
Other forms of psychotherapy can also be beneficial in reducing symptoms associated with panic disorder, with or without drug treatments.
cognitive restructuring, and exposure to the panic-inducing stimulus are all likely to be effective in reducing symptoms.
Self-help using CBT techniques may be as effective as therapist-based CBT.
psychoeducation, and brief dynamic psychotherapy may be beneficial, but we found insufficient evidence to be sure.
SSRIs and tricyclic antidepressants are also effective at reducing the symptoms of panic disorder.
Benzodiazepines can be effective in reducing symptoms in panic disorder, but their adverse-effect profile makes them unsuitable for long-term treatment.We don't know whether buspirone or MAOIs are effective.