- 1 Introduction
- 2 Clinical features
- 3 Differential diagnoses
- 4 Complications
- 5 Investigations
- 6 Treatment objectives
- 7 Non-drug treatment
- 8 Drug treatment
- 9 A. Initial management for patients unresponsive to non pharmacological treatment
- 10 B. For very frequent panic attacks
- 11 C. For anticipated anxiety attacks
- 12 D. For Acute Symptomatic Control
- 13 Supportive measures
- 14 Notable adverse drug reactions
- 15 Prevention
- 16 Referral Criteria
Panic disorder is a disorder characterized by episodic attacks of extreme fear, mostly unrelated to specific objects or situations.
It is associated with multiple somatic and
Each attack lasts for about 5-30 minutes
and often begins abruptly.
It affects about 0.5-1.0% of the population
- A feeling of choking
- Pounding heart
- Chest pressure or pain
- Shortness of breadth
- Tingling or numbness in the hands or feet Hot flushes
- Other causes of intense fear (phobias, obsessive-compulsive disorders, etc.)
- Medical causes (e.g. hyperthyroid states, episodic hypoglycemia, etc)
- Seizure disorders.
As indicated to exclude medical aetiologies
- To reduce intensity and frequency of attacks
- To reduce anticipatory anxiety
- Cognitive-behavioural treatment
A. Initial management for patients unresponsive to non pharmacological treatment
1st Line Treatment
Evidence Rating: [B]
Adults: 10 mg daily (as a single morning dose) then increase up to 60 mg daily if necessary
- 6-18 years; 10 mg daily then increase up to 20 mg after 1-2 weeks if necessary
Adults: 25 mg daily (as a single evening dose) Then increase to 50 mg after 1 week if necessary, then 50 mg weekly to a max. of 200 mg daily if necessary
Children: Not recommended
Adults: 25-50 mg daily (as a single evening dose) max. 150 mg daily
Children: Not recommended for this indication
B. For very frequent panic attacks
Adults: 1-4 mg daily for 2 weeks
- 2-18 years; 0.05 mg/kg daily for 2 weeks
C. For anticipated anxiety attacks
Adults: 1-4 mg stat.
Children: 0.25-0.5 mg stat.
D. For Acute Symptomatic Control
Adults: 1-4 mg 8-12 hourly as required (max. 10 mg daily)
Children: Not recommended for this indication.
Adults: 0.25-0.5 mg 6-8 hourly. Increase if necessary every 3-4 days, max. 4 mg daily.
Children < 18 years; Not recommended
Adults: 2-5 mg 12 hourly for 2 weeks and gradually taper off over the next 2 weeks (Do not give for more than one month continuously)
- 1-12 years; 1.25-5 mg 6 hourly as needed
Duration of treatment for recurrent cases should be at least 6 weeks and should be continued for up to 6 months or more after attacks have remitted to prevent early relapse. Wean off slowly over a month or more.
- Relaxation techniques
Notable adverse drug reactions
- Tricyclic antidepressants are cardiotoxic in overdose
- Increased risk of suicidal attempts by patients with panic disorder
- No specific primary prevention measures.
- Refer children with symptoms suggestive of a panic disorder to a paediatrician.
- Also refer patients to a psychologist for Cognitive Behaviour Therapy and to a psychiatrist for additional drug therapy where indicated