Pharmacological management of panic disorder

SUMMARY Panic disorder, characterised by sudden episodes of intense fear or anxiety, affects 1–4% of the population. Symptoms include rapid heartbeat, chest pain and fear of dying. Panic disorder often co-occurs with substance dependence and major depression. This review article examines pharmacological treatments, focusing on antidepressants and benzodiazepines, but also considering antipsychotics and anticonvulsants. It overviews the history of antidepressants and benzodiazepines in the treatment of panic disorder and their mechanisms of action. The results of a recent Cochrane Review network meta-analysis are then presented and contrasted with six current national and international treatment guidelines. Rankings of the various drugs in terms of efficacy, tolerability and safety are summarised, along with levels of evidence and lines of recommendation as a treatment option (first-, second or third-line, or reserved for treatment-resistant cases).