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BOSTON, March 28, 1998 – A combination of drug treatment and psychotherapy may offer the most help to people who suffer from panic disorder, according to new guidelines provided by the American Psychiatric Association.

The Practice Guidelines for the Treatment of Patients with Panic Disorder announced at the Anxiety Disorders Association of America (ADAA) National Conference, are designed to assist psychiatrists in assessing panic disorder and prescribing appropriate and effective treatment.

Among the most common psychiatric conditions, panic disorder affects more than two million people throughout the U.S., including children and adolescents. Leading South African experts believe similar figures apply to South Africa. The majority of sufferers are women who experience their first panic episode before the age of 24. It is characterised by recurrent panic attacks – brief periods of intense fear and discomfort in which the person feels a sense of danger and the need for escape. While emotionally troubling, panic attacks can also interfere with daily living and a person’s ability to function.

According to the new guidelines, the most effective treatment for panic disorder includes psychotherapy – specifically cognitive behavioural therapy – and anti-panic medication, including selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants, benzodiazepines, and monoamine oxidasse inhibitors (MAOIs).

While the guidelines emphasise that all the drugs are comparable with respect to effectiveness, eash has adifferent side effect profile. For example, the SSRIs carry a risk of sexual side effects, but tricyclics and MAOIs can be toxic at high doses and result in cardiovascular and anticholinergic side effects in some patients. Ptients using benzodiazepines can develop a physical dependency on these drugs.

The guidelines therefore urge psychiatrists to carefully target drug treatment in light of a patient’s current health status and the severity of their panic disorder.

In addition, the guidelines note that patients benefit from a combination of drug treatment and cognitive behavioural therapy. Cognitive behavioural therapy consists of psychoeducation, continuous panic montioring, breath retraining, cognitive restructuring – i.e., techniques to counter fear of bodily sesantions – and exposure to fear cues.