Panic disorder and social phobia: Current treatments and new strategies
Jonathan R.T. Davidson, MDAddress reprint requests to J.R.T.D., Box 3812, Durham, N C 27710.
Kathryn M. Connor, MD
Suzanne M. Sutherland, MD
Panic disorder and social phobia are two common anxiety disorders that affect many adults in the United States today. It has been estimated that 3.5% of adults in the United States will suffer from panic disorder at some time in their lives,1 and that 13% will experience social phobia.1 Left untreated, the ultimate outcome of these pathologic reactions can be devastating: significant impairment can occur in several realms, including perceived physical and emotional deterioration, reduced productivity, increased absenteeism, onset of alcohol abuse, marital discord, and even suicide.
Treatment for panic disorder and social phobia can dramatically improve patient functioning and quality of life. A combination of psychotherapy and pharmacotherapy is most often used to control anxiety symptoms and enable patients to resume a normal routine and productive lifestyle. Until the 1980s, benzodiazepines were the pharmacologic agents of choice for anxiety disorders: they were considered highly effective and largely safe. As the associated cognitive impairment and abuse potential became apparent, however, scientists searched for newer agents with improved safety profiles.
In the last decade, several classes of compounds with anxiolytic efficacy without the risk for cognitive impairment, abuse, or dependence observed with benzodiazepines have been identified. The most promising of these agents are the selective serotonin reuptake inhibitors (SSRIs) and anticonvulsants. The roles for these compounds in panic disorder and social phobia are reviewed here, particularly in the historical context of benzodiazepine use and its inherent benefits and risks.
Cost benefits of therapy
The benefit of successful treatment for. . .