Prognosis

Panic disorder is a common condition associated with high medical service utilization. Naturalistic longitudinal studies indicate that the course of untreated panic disorder can be chronic and disabling.[29] Relapse rates are higher among women than men.

Effective management of panic disorder requires early detection, education, and delivery of evidence-based pharmacotherapy and/or cognitive behavioral therapy (CBT). In a longitudinal study of CBT, 87% of patients were panic-free at the end of treatment, 96% remained in remission at 2-year follow-up, 77% at 5-year follow-up, and 67% after 7-year follow-up.[167] Other longitudinal studies of cognitive CBT suggest that many patients still experience ongoing panic symptoms across time, thereby necessitating additional monitoring.[168] Relapse probability may be reduced through periodic "booster" exposure-based sessions.

Pharmacotherapy for panic disorder should be continued for at least 1 year from the point of treatment response, to help ensure symptom reduction and protection against relapse.[147][148] Relapse rates following medication discontinuation are estimated to be between 55% and 70%.[169] Discontinuing antidepressant medication is associated with moderate rates of relapse, and discontinuation of benzodiazepines is associated with a higher risk for relapse. There is evidence to suggest that CBT has an enduring positive effect for at least 12 months after treatment completion compared with control conditions.[152] Long-term management of panic disorder requires adequate dosing and attainment of maximal functioning before medication discontinuation.[170] Antidepressants combined with CBT may be indicated to manage relapse, with some patients remaining on maintenance pharmacotherapy and booster CBT sessions to protect against relapse over the longer term.[111][112][113][170]

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