[Causes of failure in psychopharmacological treatment of anxiety disorder]

A comprehensive review of literature on the causes of failure in pharmacologic treatment of panic disorder (PD).

PD has high rates of response to psychopharmacological treatment, reaching up to 80-90%. However, in a small percentage of cases (10-20%), the disorder is refractory to the combination of drugs and psychotherapy, at correct dosages and during adequate time periods. Refractoriness in PD is not a well-known issue as few studies have addressed this question. Intolerance to psychotropic drugs is usually reported to be the commonest cause, especially to antidepressants. Other causes are: comorbidity (especially with depressive disorders, personality disorders, and alcohol abuse, as well as with medical conditions); severe panic attacks; severe agoraphobia; and long illness duration. <> PD is to be ruled out, since incorrect diagnosis, incorrect treatment, or bad compliance are common causes of a poor response. We review treatment approaches for PD when no response is achieved with antidepressants (TCA, SSRI, MAOI), alprazolam and cognitive-behaviour therapy. Two recommended strategies are drug potentiation and use of clonazepam.