Panic disorder: diagnosis and treatment

Panic disorder is an important entity for primary care physicians to be aware of, as patients with panic disorder often present with physical complaints and may be misdiagnosed as having a somatization disorder or hypochondriasis. While the latter disorders are difficult to treat, panic disorder is well suited to treatment using the traditional medical model. This article describes suggested evaluation of suspected panic disorder and outlines treatment strategies. While tricyclic antidepressants, monoamine oxidase inhibitors, and alprazolam are all effective antipanic agents, tricyclic antidepressants are suggested as the medication of first choice. Treatment failures most often result from an inadequate medication trial (ie, trial too brief or dosage inadequate); with adequate treatment most patients with panic disorder can be helped.