Treatment–resistant panic disorder: a systematic review

ABSTRACT

Introduction: The prevalence of panic disorder (PD) in the population is high and these patients have work impairment, high unemployment rates, seek medical treatment more frequently and have more hospitalizations than people without panic symptoms. Despite the availability of pharmacological, psychological and combined treatments, approximately one-third of all PD patients have persistent panic attacks and other PD symptoms after treatment.

Areas covered: MEDLINE/Pubmed, CENTRAL, PsycINFO and Web of Science databases were searched for clinical trials in treatment–resistant PD. Only studies published between 1980 and 2015, in English, with human subjects, considered “journal articles” and clinical trial were included. We included trials recruiting only adult subjects with treatment–resistant PD, consistent with criteria from DSM-III to DSM5. We included all prospective experimental studies. Case, case series, retrospective studies or studies with <10 PD subjects were not included.

Expert opinion: Only 11 articles were included in this review. There were few quality studies, only two were randomized, controlled and double blind. Augmentation of the pharmacological treatment with cognitive-behavioral therapy demonstrated some short-term efficacy in treatment–resistant PD. There were also preliminary evidences of efficacy for monotherapy with reboxetine and olanzapine, and augmentation with pindolol, divalproex sodium, aripiprazole and olanzapine in short-term treatment.

KEYWORDS:

• Agoraphobia
• anxiety
• clinical trial
• cognitive-behavioral therapy
• panic attack

Declaration of interest

Funding for this study was provided by the Brazilian Council for Scientific and Technological Development (CNPq). RC Freire has received support from the Brazilian Council for Scientific and Technological Development (CNPq). A Nardi has received support from the Brazilian Council for Scientific and Technological Development (CNPq). The authors have no other relevant affiliations or financial involvement with any other organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

ORCID

Rafael C. Freire http://orcid.org/0000-0003-3875-4601