Panic disorder (PD) is a common, persistent and disabling
mental disorder. It is often associated with
agoraphobia. The present article reviews the current status of
pharmacotherapy for PD with or without
agoraphobia as well as the current status of treatments combing
pharmacotherapy with cognitive behavior therapy (CBT). The review has been written with a focus on randomized controlled trials, meta-analyses, and reviews that have been published over the past few years. Effective pharmacological treatments include
tricyclic antidepressants,
monoamine oxidase inhibitors,
selective serotonin reuptake inhibitors,
serotonin norepinephrine reuptake inhibitors, and various
benzodiazepines. Treatment results obtained with CBT compare well with
pharmacotherapy, with evidence that CBT is at least as effective as
pharmacotherapy. Combining
pharmacotherapy with CBT has been found to be superior to
antidepressant pharmacotherapy or CBT alone, but only in the acute-phase treatment. Long term studies on treatments combining
pharmacotherapy and CBT for PD with or without
agoraphobia have found little benefit, however, for combination
therapies versus monotherapies. New investigations explore the potential additional value of sequential versus concomitant treatments, of
cognitive enhancers and virtual reality exposure therapy, and of education, self management and Internet-based interventions.