Panic disorder across the life span: a differential diagnostic approach to treatment resistance

There has been significant progress over the past 30 years in our understanding of the treatment of panic disorder. There are now several different classes of pharmacological treatments, as well as cognitive-behavioral treatments that have been shown to have efficacy in treating panic disorder. Despite the increase in the knowledge base, many patients are only partially responsive or unresponsive to initial treatment efforts. A differential diagnostic approach to reviewing possible causes for treatment failure is presented. These causes include coexisting psychiatric disorders, unrecognized medical factors, environmental stressors, and others. Additionally, a review of factors specifically related to elderly and to very young treatment-resistant panic disorder patients is presented, along with some suggestions for evaluation and treatment. Based on the limited literature and clinical experience, practical clinical suggestions for approaching identified factors are presented.