Gavin Andrews, Chair (Correspondence)
Australian and New Zealand clinical practice guidelines for the treatment of panic disorder and agoraphobia
Version of Record online: 25 NOV 2003
Australian and New Zealand Journal of Psychiatry
Volume 37, Issue 6, pages 641–656, December 2003
How to Cite
Royal Australian and New Zealand College of Psychiatrists Clinical Practice Guidelines Team for Panic Disorder and Agoraphobia (2003), Australian and New Zealand clinical practice guidelines for the treatment of panic disorder and agoraphobia. Australian and New Zealand Journal of Psychiatry, 37: 641–656. doi: 10.1111/j.1440-1614.2003.01254.x
CPG Team for Panic and Agoraphobia, Clinical Research Unit for Anxiety Disorders , St Vincent's Hospital, 299 Forbes Street, Darlinghurst NSW 2010. E-mail firstname.lastname@example.org
- Issue online: 25 NOV 2003
- Version of Record online: 25 NOV 2003
- panic disorder;
- treatment outcomes.
Background: The Royal Australian and New Zealand College of Psychiatrists is co-ordinating the development of clinical practice guidelines (CPGs) in psychiatry, funded under the National Mental Health Strategy (Australia) and the New Zealand Health Funding Authority.
Method: For these guidelines, the CPG team reviewed the treatment outcome literature, consulted with practitioners and patients and conducted a meta-analysis of recent outcome research.
Treatment recommendations: Education for the patient and significant others covering: (i) the nature and course of panic disorder and agoraphobia; (ii) an explanation of the psychopathology of anxiety, panic and agoraphobia; (iii) rationale for the treatment, likelihood of a positive response, and expected time frame.
Cognitive behaviour therapy (CBT) is more effective and more cost-effective than medication. Tricyclic antidepressants (TCAs) and serotonin selective reuptake inhibitors are equal in efficacy and both are to be preferred to benzodiazepines. Treatment choice depends on the skill of the clinician and the patient's circumstances. Drug treatment should be complemented by behaviour therapy.
If the response to an adequate trial of a first-line treatment is poor, another evidence-based treatment should be used. A second opinion can be useful. The presence of severe agoraphobia is a negative prognostic indicator, whereas comorbid depression, if properly treated, has no consistent effect on outcome.