Panic disorder and social phobia: current treatments and new strategies

Panic disorder and social phobia are among the most disabling of the anxiety disorders. The emotional cost to the patient suffering from these diagnoses is exceeded only by the very real economic costs to the community because of reduced productivity, lost workdays, and increased health care costs for associated physical complaints. It is imperative, therefore, that the medical community focus on the accurate diagnosis and effective treatment of these potentially devastating conditions. Pharmacologic treatments for panic disorder and social phobia have been available since the early 1960s. The limited efficacy and significant side effects of the early medications, however, led to a search for new treatment options. For many years, the benzodiazepines were the principal first-line therapy for treatment of these illnesses. Yet, their potential for cognitive impairment, physiological dependence, abuse, and withdrawal phenomena warranted a continued search for newer agents with an improved safety profile. In the last 10 years, several treatments have been identified that may fill this need. Controlled trials and/or anecdotal reports have shown SSRIs and anticonvulsants to be effective treatments for the symptoms of panic disorder and social phobia. However, although SSRIs are emerging as a leading treatment for generalized social phobia, it is not at all clear whether they can benefit nongeneralized social phobia. Their side-effect profile, while a marked improvement over earlier antidepressant drugs, still can cause significant discomfort. The anticonvulsants are now emerging as a very important group of drugs in the anxiety disorders, with gabapentin having been the most extensively studied in social phobia.