Medication

Medication for Panic Disorder is an effective treatment option. It is the fastest intervention option with immediate effects on the symptoms. However, the psychotropic drugs can do little, if anything, for the psychological causes of the disorder. Thus, they repeatedly fail to protect against relapse, after their discontinuation. For this reason, therapeutic protocols in recent years progressively advised the parallel application of medication and psychotherapy for Panic Disorder.

However, there are numerous reports in the literature that draw attention to the fact that the use of psychotropic drugs may actually adversely interfere with treatment effectiveness. For instance, the use of benzodiazepines during the exposure phase of cognitive-behavioral psychotherapy may actually hinder, instead of augmenting, the therapeutic impact of the psychotherapeutic component of an intervention for Panic Disorder.

A more thoughtful strategy is to address Panic Disorder with a psychotherapeutic intervention and to introduce the use of medication only if comorbid psychopathology which is only partially responsive to psychotherapy and which interferes with Panic Disorder is present in the patient. For example, a patient diagnosed with Panic Disorder and Dysthymic Disorder may be treated effectively for both conditions with a psychological treatment. However, a patient with Panic Disorder and Bipolar I Disorder may be better served by a selective dual scheme: (1) a psychological therapy for both Panic Disorder and the psychological aspects of the Bipolar organization and (2) a pharmacological scheme for the mood instability of the Bipolar neurotransmission deficiency.

In considering the possibility of medication for the treatment of Panic Disorder the clinician should carefully consider the possible unwelcomed interference of the effect of the psychotropic drugs with the extinction goal of psychotherapies from the cognitive behavioral spectrum.