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Diagnosis and Treatment of Agoraphobia with Panic Disorder

  • Therapy In Practice
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Abstract

Agoraphobia with panic disorder is a phobic-anxious syndrome where patients avoid situations or places in which they fear being embarrassed, or being unable to escape or get help if a panic attack occurs. During the last half-century, agoraphobia has been thought of as being closely linked to the recurring panic attack syndrome, so much so that in most cases it appears to be the typical development or complication of panic disorder.

Despite the high prevalence of agoraphobia with panic disorder in patients in primary-care settings, the condition is frequently under-recognised and undertreated by medical providers. Antidepressants have been demonstrated to be effective in preventing panic attacks, and in improving anticipatory anxiety and avoidance behaviour. These drugs are also effective in the treatment of the frequently coexisting depressive symptomatology. Among antidepressant agents, SSRIs are generally well tolerated and effective for both anxious and depressive symptomatology, and these compounds should be considered the first choice for short-, medium- and long-term pharmacological treatment of agoraphobia with panic disorder. The few comparative studies conducted to date with various SSRIs reported no significant differences in terms of efficacy; however, the SSRIs that are less liable to produce withdrawal symptoms after abrupt discontinuation should be considered the treatments of first choice for long-term prophylaxis. Venlafaxine is not sufficiently studied in the long-term treatment of panic disorder, while TCAs may be considered as a second choice of treatment when patients do not seem to respond to or tolerate SSRIs. High-potency benzodiazepines have been shown to display a rapid onset of anti-anxiety effect, having beneficial effects during the first few days of treatment, and are therefore useful options for short-term treatment; however, these drugs are not first-choice medications in the medium and long term because of the frequent development of tolerance and dependence phenomena. Cognitive-behavioural therapy is the best studied non-pharmacological approach and can be applied to many patients, depending on its availability.

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Acknowledgements

Dr Perugi is a consultant for Boehringer Ingelheim, Novartis Farma, Sanofi-Synthélabo and Wyeth-Lederle, and is a member of the speakers’ bureau of AstraZeneca, Eli Lilly Italia, Lundbeck Italia, Pfizer and GlaxoSmithKline. Drs Frare and Toni have no personal or financial relationships that may cause conflicts of interest relevant to the content of this review. No sources of funding were used to assist in the preparation of this review.

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  1. Department of Psychiatry, University of Pisa, Pisa, 56100, Italy

    Giulio Perugi

  2. Institute of Behavioural Science “G. De Lisio”, Carrara-Pisa, Italy

    Giulio Perugi, Franco Frare & Cristina Toni

  3. Adults Mental Health Unit, Pistoia Zone, Pistoia, Italy

    Franco Frare

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Perugi, G., Frare, F. & Toni, C. Diagnosis and Treatment of Agoraphobia with Panic Disorder. CNS Drugs 21, 741–764 (2007). https://doi.org/10.2165/00023210-200721090-00004

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