Comorbidity of panic and depression: implications for clinical management

Data from the National Comorbidity Survey (NCS) general population study and the World Health Organization (WHO) primary care study have established that comorbidity between panic and depression is one of the strongest psychiatric associations. The two studies agree that patients with panic-depression comorbidity have greater symptomatology, in terms of frequency and severity of panic attacks and depressive episodes, work and role impairment, chronic illness and healthcare use, compared with those with a single disorder. Although the rate of presentation of panic and depression in the primary care setting is high, at present their recognition is low and inappropriate treatment is often given. Education of primary care physicians about these disorders is therefore necessary. An important conclusion from the NCS and WHO studies is that panic attacks have an important signal value. In addition to being an excellent marker for future panic disorder and depression, a panic attack is indicative of the almost certain presence of at least one other psychiatric condition. Since treatment of panic attacks with an appropriate selective serotonin reuptake inhibitor such as paroxetine not only significantly reduces panic symptoms, but also alleviates comorbid anxiety and depression, a simple, yet effective, approach in the primary care setting may be to look for panic attacks and to treat sufferers with this class of antidepressants. With this approach, both panic attack symptoms and any underlying anxiety and depressive disorders would be managed.