Patient discussions
Encourage patients to learn more about the nature and treatment of anxiety and panic. Online, skill-based treatment programmes, such as from Anxieties.com, may be a preferred option for some patients. Anxieties.com Opens in new window
Explain to patients who present for new-onset panic attacks that attacks are common, affecting up to one third of people in their lifetime, but with less than 10% developing full panic disorder with recurrent attacks and avoidance behaviours, and that although the attacks are uncomfortable, they are not dangerous and are time-limited. Encourage patients to monitor the intensity, frequency, and duration of attacks and whether episodes are expected or unexpected.
Explain to patients with panic disorder about currently available evidence-based treatment options, especially the efficacy and effectiveness of pharmacotherapy and cognitive behavioural psychotherapy.
Anxiety, avoidance behaviour, and substance use may maintain attacks and uncomfortable physical sensations across time. Normalising the patient's distress and ambivalence for panic treatment may assist in motivating treatment engagement.
Caution patients that resuming certain activities, such as drinking coffee, consuming alcohol, and smoking, may produce uncomfortable physical sensations similar to panic episodes. Encourage gradual re-engagement with physical exercise.[69]
Following initial presentation, encourage patients to monitor the intensity, frequency, and duration of attacks, and whether episodes are expected or unexpected. Arrange a follow-up evaluation or a telephone check within 2 weeks to reassess the patient's symptoms.
One large population-based cohort study from the UK found that antidepressant use may be linked to a modestly increased risk of long-term weight gain over 10 years, with the risk being highest in the second and third years of treatment. Although the number needed to harm appears to be low (assuming the relationship is causal, 59 people would need to be treated for one to develop weight gain of 5% or greater), such a link could have a significant impact on a population level. Based on this, it is recommended that healthcare professionals discuss the possibility of weight gain with their patients who require antidepressant treatment, and provide advice on diet and exercise.[174]
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