Panic disorder and social phobia: possible implications of comorbid depression for drug therapy

Major depression is a common mental disorder with a lifetime prevalence of approximately 15% of the general population, affecting almost twice as many females as males. Panic disorder is a severe anxiety disorder with a lifetime prevalence of 2-3% or more. Like major depression, panic disorder affects nearly twice as many females as males. Both panic disorder and major depression are often chronic conditions, resulting in significant morbidity and mortality. Among patients who seek treatment for either panic disorder or major depression, both conditions are present in approximately one-third of the patient population. Substantial information suggests that individuals who suffer from both panic disorder and major depression respond poorly to acute treatment, are more likely to remain ill over the long term, require more psychiatric treatment, and are at approximately twice the risk of suicide attempts than individuals who suffer from either condition alone. There has been very little systematic study of individuals with coexisting panic disorder and major depression. This has left significant gaps in our knowledge about optimal treatment for the substantial subgroup of individuals suffering from both disorders simultaneously. Social phobia is a common disorder which affects 2-8% (females more than males) of the population. Recent advances in the pharmacological treatment of social phobia are reviewed. Patterns of comorbidity, effects of coexisting psychiatric disorders on disability, health care utilization and suicidality are discussed, together with treatment implications for coexisting social phobia and major depression.