DIFFERENTIAL-DIAGNOSIS AND DRUG-TREATMENT OF PANIC DISORDER, ANXIETY AND DEPRESSION

Depression and anxiety disorders are under-recognised in clinical prac tice. They are relatively common psychiatric disorders, affecting 2 to 5% of the population per year. Symptoms of depression and anxiety fre quently co-exist in a given patient. Recent diagnostic criteria allow a differential diagnosis to be made based on the history of the sympto matology in the current psychiatric episode. The Diagnostic and Statis tical Manual of Mental Disorders (DSM-III-R), although not the only di agnostic scheme available, has become widely used, particularly for th e diagnosis of anxiety states. Despite the relatively clear-cut diagno stic criteria of the DSM-III-R, the problem of comorbidity of diagnose s remains. Pragmatically, the differentiation of major depression and anxiety may not be very important, since pharmacological treatment of both disorders is heavily reliant on the use of antidepressant drugs. Tricyclic antidepressants, monoamine oxidase inhibitors (MAOIs) and se lective serotonin (5-hydroxytryptamine, 5-HT) reuptake inhibitors (SSR Is) are all effective in the treatment of major depression and panic d isorder. SSRIs and the tricyclic antidepressant clomipramine are effec tive in the treatment of obsessive-compulsive disorder, while MAOIs ar e effective in social phobia. Although their use has declined in recen t years, due to concerns about tolerance and dependence, benzodiazepin es have proven efficacy in the treatment of generalised anxiety disord er. At higher dosages, these agents are also effective in panic disord er. Some general guidelines on drug treatment for these disorders is p resented.