A RISK-BENEFIT ASSESSMENT OF PHARMACOLOGICAL TREATMENTS FOR PANIC DISORDER

Panic disorder, a psychiatric disorder characterised by frequent panic attacks, is the most common anxiety disorder, affecting 2 to 6% of th e general population. No one line of treatment has been found to be su perior, making a risk-benefit assessment of the treatments available u seful for treating patients. Choice of treatment depends on a number o f issues, including the adverse effect profile, efficacy and the prese nce of concomitant syndromes. Tricyclic antidepressants (TCAs) are ben eficial in the treatment of panic disorder. They have a proven efficac y, are affordable and are conveniently administered. Adverse effects, including jitteriness syndrome, bodyweight gain, anticholinergic effec ts and orthostatic hypotension are commonly associated with TCAs, but can be managed successfully. Selective serotonin (5-hydroxytryptamine; 5HT) reuptake inhibitors are also potential first line agents and are well tolerated and effective, with a favourable adverse effects profi le. There is little risk in overdose or of anticholinergic effects. Ad verse effects include sedation, dyspepsia and headache early in treatm ent, and sexual dysfunction and increased anxiety, but these can be ef fectively managed with proper dosage escalation and management. Benzod iazepines are an effective treatment, providing short-term relief of p anic-related symptoms. Patients respond to treatment quickly, providin g rapid relief of symptoms. Adverse effects include ataxia and drowsin ess, and cognitive and psyche-motor impairment. There are reservations over their first-line use because of concerns regarding abuse and dep endence. Monoamine oxidase inhibitors, because of their adverse effect s profile, potential drug interactions, dietary restrictions, gradual onset of effect and overdose risk, are not considered to be first-line agents. They are effective however, and should be considered for pati ents with refractory disease. Valproic acid (valproate sodium), while not intensively studied, shows potential for use in panic disorder. Mo re studies are needed in this area before the available data can be co nfirmed. As a supplement to drug therapy, cognitive behavioural therap y is effective. It is well tolerated, and may be beneficial in certain clinical situations. Its main drawback is the time commitment and eff ort needed to be made by the patient.