*5.2.4 Optimal duration of pharmacotherapy of panic disorder*

Studies reported that more than half of the patients interrupt treatment within several months to years [62, 64]. But considering, often relapsing course of panic disorder long-term treatment is recommended [3, 7, 12, 22, 43]. Most guidelines refer to expert consensus and suggest pharmacotherapy for at least a year [6].


#### **Table 2.**

*Dosage of benzodiazepines effective in panic disorder.*

Providing psychotherapy to panic disorder patients is also beneficial in enhancing the long-term outcome. Some evidence indicates that a CBT relapse-prevention program prevents relapse in patients with panic disorder [23, 59].

#### *5.2.5 Pharmacotherapy in treatment-refractory patients with panic disorder*

Some panic disorder patients do not respond, or only respond partially to pharmacotherapy. The treatment of refractory patients should consist of optimizing the current treatment, switching to another agent, or augmentation. Optimizing the current pharmacotherapy may be useful but some studies reported that an increased dosage of a SSRI is no more effective [8, 43].

Switching within or between classes of pharmacological agents, or to another treatment modality with proven efficacy in treating panic disorder, such as CBT, may be effective [23, 29, 53, 57].

Augmentation of antidepressants with an antipsychotic has been suggested for refractory panic disorder patients [30, 54, 56].

## **6. Conclusion**

Panic disorder is a prevalent and disabling disorder with unknown etiology. Panic disorder should be diagnosed as soon as possible and to start the treatment which can be effective. The main treatment for panic disorder is psychotherapy and medication. One or both types of treatment may be recommended, depending of the patient preference, his history and the severity of the panic. The first-line treatment of panic disorder usually is CBT and pharmacotherapy with SSRIs. The recommendations are at least a year of antidepressant treatment. Management of treatment-refractory panic disorder includes a range of switching and augmentation strategies. Psychotherapy helps patients to overcome their fears usually within several months, but occasional visits afterward can help them to ensure that panic attacks are under control.

#### **Conflict of interest**

The authors declare that there is no conflict of interest.

### **Author details**

Dimitar Bonevski and Andromahi Naumovska\* Faculty of Medicine, St. Cyril and Methodius, Skopje, North Macedonia

\*Address all correspondence to: andromahi\_n@yahoo.com

© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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