COMORBIDITY OF PANIC AND DEPRESSION - IMPLICATIONS FOR CLINICAL MANAGEMENT

Data from the National Comorbidity Survey (NCS) general population stu dy and the World Health Organization (WHO) primary care study have est ablished that comorbidity between panic and depression is one of the s trongest psychiatric associations. The two studies agree that patients with panic-depression comorbidity have greater symptomatology, in ter ms of frequency and severity of panic attacks and depressive episodes, work and role impairment, chronic illness and healthcare use, compare d with those with a single disorder. Although the rate of presentation of panic and depression in the primary care setting is high, at prese nt their recognition is low and inappropriate treatment is often given . Education of primary care physicians about these disorders is theref ore necessary. An important conclusion from the NCS and WHO studies is that panic attacks have an important signal value. In addition to bei ng an excellent marker for future panic disorder and depression, a pan ic attack is indicative of the almost certain presence of at least one other psychiatric condition. Since treatment of panic attacks with an appropriate selective serotonin reuptake inhibitor such as paroxetine not only significantly reduces panic symptoms, but also alleviates co morbid anxiety and depression, a simple, yet effective, approach in th e primary care setting may be to look for panic attacks and to treat s ufferers with this dass of antidepressants. With this approach, both p anic attack symptoms and any underlying anxiety and depressive disorde rs would be managed. (C) 1998 Lippincott-Raven Publishers.