Anxiety and mood (대한불안의학회지)

Korean Academy of Anxiety Disorders (대한불안의학회)
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Korean Guidelines for the Treatment of Panic Disorder 2018 : Initial and Maintenance Treatment Strategies for the Pharmacological Treatment of Panic Disorder

2018 한국형 공황장애 치료지침서 : 초기 및 유지 약물치료 전략

  • Kim, Min-Kyoung (Department of Psychiatry, CHA University School of Medicine) ;
  • Lee, Jae-Hon (Department of Psychiatry, National Rehabilitation Center) ;
  • Gim, Minsook (Department of Psychiatry, Sanggye Paik Hospital, Inje University College of Medicine) ;
  • Kim, Won (Department of Psychiatry, Seoul Paik Hospital, Inje University College of Medicine) ;
  • Moon, Eunsoo (Department of Psychiatry, Pusan National University School of Medicine) ;
  • Seo, Ho-Jun (Department of Psychiatry, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Koo, Bon-Hoon (Department of Psychiatry, College of Medicine, Yeungnam University) ;
  • Yang, Jong-Chul (Department of Psychiatry, Chonbuk National University Hospital) ;
  • Lee, Kang Soo (Department of Psychiatry, CHA University School of Medicine) ;
  • Lee, Sang-Hyuk (Department of Psychiatry, CHA University School of Medicine) ;
  • Kim, Chan-Hyung (Department of Psychiatry, Yonsei University College of Medicine, Severance Hospital) ;
  • Yu, Bum-Hee (Dr. Yu's Psychiatric Clinic) ;
  • Suh, Ho-Suk (Department of Psychiatry, CHA University School of Medicine)
  • 김민경 (차의과학대학교 정신건강의학교실) ;
  • 이재헌 (국립재활병원 정신건강의학과) ;
  • 김민숙 (인제대학교 의과대학 상계백병원 정신건강의학교실) ;
  • 김원 (인제대학교 의과대학 서울백병원 정신건강의학교실) ;
  • 문은수 (부산대학교 의과대학 정신건강의학교실) ;
  • 서호준 (가톨릭대학교 의과대학 성빈센트병원 정신건강의학교실) ;
  • 구본훈 (영남대학교 의과대학 정신건강의학교실) ;
  • 양종철 (전북대학교병원 정신건강의학교실) ;
  • 이강수 (차의과학대학교 정신건강의학교실) ;
  • 이상혁 (차의과학대학교 정신건강의학교실) ;
  • 김찬형 (연세대학교 의과대학 정신건강의학교실) ;
  • 유범희 (유범희정신건강의학과의원) ;
  • 서호석 (차의과학대학교 정신건강의학교실)
  • Received : 2018.09.21
  • Accepted : 2018.10.23
  • Published : 2018.10.31
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Abstract

Objective : The Korean Association of Anxiety Disorders developed Korean guidelines for treatment of panic disorder (PD) 2018. In this paper, we discussed the consensus among psychiatrists, regarding initial and maintenance treatment strategies for pharmacological treatment of PD in Korea. Methods : Based on current treatment guidelines published by the American Psychiatric Association, the National Institute for Clinical Excellence, and the Canadian Psychiatric Association, we developed questionnaires pertinent to initial and maintenance treatment strategies for pharmacological treatment of PD. Seventy-two experts in PD answered questionnaires. We classified expert opinions into three categories, first, second, and third-line treatment strategies, by analyzing the 95% confidence interval. Results : Antidepressants, benzodiazepine anxiolytics, and cognitive-behavioral therapy (CBT) were recommended as treatments of choice (ToC), and first-line strategies for initial treatment of PD. Escitalopram, paroxetine, sertraline, and venlafaxine were preferred from among many anti-panic drugs. Mean starting dose of anti-panic drugs for initial treatment of PD was relatively lower, than that for other psychiatric illnesses such as major depressive disorder. In the case of maintenance treatment of PD, antidepressants and CBT were selected as ToC and first-line strategies. Patients were typically examined every four weeks during treatment, to review effectiveness and side effects of the drug. Pharmacotherapy was generally continued for one year or more. Conclusion : This study provides information about consensus among Korean experts regarding pharmacological treatment strategies for patients with panic disorder.

Keywords

References

  1. Doyle A Pollack MH. Long-term management of panic disorder. J Clin Psychiatry 2004;65 Suppl 5:24-28.
  2. Katon W. Panic disorder: epidemiology, diagnosis, and treatment in primary care. J Clin Psychiatry 1986;47 Suppl:21-30.
  3. Batelaan NM, Van Balkom AJ Stein DJ. Evidence-based pharmacotherapy of panic disorder: an update. Int J Neuropsychopharmacol 2012;15:403-415. https://doi.org/10.1017/S1461145711000800
  4. Liebowitz MR. Panic disorder as a chronic illness. J Clin Psychiatry 1997;58 Suppl 13:5-8.
  5. Zamorski MA Albucher RC. What to do when SSRIs fail: eight strategies for optimizing treatment of panic disorder. Am Fam Physician 2002;66:1477-1484.
  6. Slaap BR den Boer JA. The prediction of nonresponse to pharmacotherapy in panic disorder: a review. Depress Anxiety 2001;14:112-122. https://doi.org/10.1002/da.1053
  7. Katschnig H Amering M. The long-term course of panic disorder and its predictors. J Clin Psychopharmacol 1998;18:6S-11S. https://doi.org/10.1097/00004714-199812001-00003
  8. Marchesi C. Pharmacological management of panic disorder. Neuropsychiatr Dis Treat 2008;4:93-106.
  9. Mitte K. A meta-analysis of the efficacy of psycho- and pharmacotherapy in panic disorder with and without agoraphobia. J Affect Disord 2005;88:27-45. https://doi.org/10.1016/j.jad.2005.05.003
  10. Bakker A, van Balkom AJ Stein DJ. Evidence-based pharmacotherapy of panic disorder. Int J Neuropsychopharmacol 2005;8:473-482. https://doi.org/10.1017/S1461145705005201
  11. Practice guideline for the treatment of patients with panic disorder. Work Group on Panic Disorder. American Psychiatric Association. Am J Psychiatry 1998;155:1-34. https://doi.org/10.1176/ajp.155.1.1
  12. Katzman MA, Bleau P, Blier P, Chokka P, Kjernisted K, Van Ameringen M, et al. Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders. BMC Psychiatry 2014;14 Suppl 1:S1. https://doi.org/10.1186/1471-244X-14-S1-S1
  13. American Psychiatric Association. Practice guideline for the Treatment of Patients with Panic Disorder 2010.
  14. Baldwin DS, Anderson IM, Nutt DJ, Bandelow B, Bond A, Davidson JR, et al. Evidence-based guidelines for the pharmacological treatment of anxiety disorders: recommendations from the British Association for Psychopharmacology. J Psychopharmacol 2005;19:567-596. https://doi.org/10.1177/0269881105059253
  15. Baldwin DS, Anderson IM, Nutt DJ, Allgulander C, Bandelow B, den Boer JA, et al. Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: a revision of the 2005 guidelines from the British Association for Psychopharmacology. J Psychopharmacol 2014;28:403-439. https://doi.org/10.1177/0269881114525674
  16. Executive Committee for Korean Medication Algorithm for Panic Disorder. Korean medication algorithm project for panic disorder 2008. ML Communication 2008.
  17. Executive Committee for Korean Treatment Guideline for Panic Disorder. Korean guidelines for the treatment of panic disorder 2018. Eims International 2018.
  18. National Institute for Health and Care Excellence. Panic disorder overview;2016.
  19. National Institute for Health and Care Excellence. Generalised anxiety disorder and panic disorder in adults: Management;2011.
  20. Andrisano C, Chiesa A, Serretti A. Newer antidepressants and panic disorder: a meta-analysis. Int Clin Psychopharmacol 2013;28:33-45. https://doi.org/10.1097/YIC.0b013e32835a5d2e
  21. Gorman JM. The use of newer antidepressants for panic disorder. J Clin Psychiatry 1997;58 Suppl 14:54-58;discussion 59.
  22. Montgomery S, Hansen T, Kasper S. Efficacy of escitalopram compared to citalopram: a meta-analysis. Int J Neuropsychopharmacol 2011;14:261-268. https://doi.org/10.1017/S146114571000115X
  23. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5);2013.
  24. Susman J, Klee B. The Role of High-Potency Benzodiazepines in the Treatment of Panic Disorder. Prim Care Companion J Clin Psychiatry 2005;7:5-11. https://doi.org/10.4088/PCC.v07n0101
  25. Sheehan DV. Benzodiazepines in panic disorder and agoraphobia. J Affect Disord 1987;13:169-181. https://doi.org/10.1016/0165-0327(87)90021-8
  26. Bruce SE, Vasile RG, Goisman RM, Salzman C, Spencer M, Machan JT, et al. Are benzodiazepines still the medication of choice for patients with panic disorder with or without agoraphobia? Am J Psychiatry 2003;160:1432-1438. https://doi.org/10.1176/appi.ajp.160.8.1432