Panic Disorder

The prevalence of panic disorder in chronic obstructive pulmonary disease: a systematic review, meta-analysis, and meta-regression.

Todd B, Foldes-Busque G, Way KL, Le KDR, Alvarenga M, Celano CM · Systematic reviews · 2026

Chronic obstructive pulmonary disease (COPD) symptoms of dyspnea and chest tightness overlap with some symptoms of panic attacks, the hallmark feature of panic disorder (PD). Our objective was to quantify PD prevalence in COPD from a systematic review and meta-analysis. A database search from inception to January 2025 was performed using five electronic databases. Eligible studies utilized structured clinical psychiatric interviews to identify PD in adult populations with COPD derived from inpatient, outpatient, or general population sampling. Twenty-one studies met inclusion criteria, with most from Asia (k = 9), reporting data from 1847 persons with COPD, 860 healthy controls, and 450 persons with comorbidities other than COPD. The prevalence of PD in persons with COPD was 12.5% (95% confidence interval [CI] 8.2-18.7, I2 = 90%), revised to 8.1% (95% CI 5.7-11.6, I2 = 73%) after the exclusion of k = 5 outliers. In case-control

Panic Disorder in Patients With Vestibular Dysfunction: A Systematic Review and Meta-analysis.

McCray LR, Kim CH, Nguyen SA, Harvey EA, Meyer TA · Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology · 2025 · n=874

To assess the prevalence of panic disorder (PD) among patients with vestibular dysfunction. CINAHL, Cochrane Library, PubMed, PsycINFO, and SCOPUS. Databases were searched from inception through August 2024. Observational studies on PD in adults with vestibular dysfunction were included. Studies of patients without a vestibular disorder diagnosis or vertigo arising from trauma or tumors were excluded. Primary outcome measures included continuous measures (mean), proportions (%), and relative risk (RR) with 95% confidence intervals (CI). Two authors extracted data and discrepancies were resolved with a third party. Level of evidence was evaluated using Oxford Centre for Evidence-Based Medicine criteria. Risk of bias was assessed with Risk Of Bias In Non-randomized Studies-of Exposure for cohort studies and Joanna Briggs Institute criteria for case-control and cross-sectional studies. Ten studies (n = 874) on PD and vestibular disorders were included. The mean age was 49.7 years for t

Efficacy and acceptability of brain stimulation for anxiety disorders, OCD, and PTSD: A systematic review and network meta-analysis of randomized controlled trials.

Yang X, Ma L, Fan C, Wang H, Zhang M, Du H · Journal of affective disorders · 2025 · n=1333

The present study aimed to conduct a systematic review and network meta-analysis to investigate the efficacy and acceptability of brain stimulation techniques (BSTs) for anxiety disorders, obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD). A comprehensive search was performed in Embase, PubMed, Web of Science, PsycINFO, Cochrane, ClinicalTrials.gov and HowNet databases for studies published before September 10, 2023. Randomized clinical trials that involved deep brain stimulation (DBS), electroconvulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), sham therapy, or health control were included for analysis. The primary outcome was efficacy, while acceptability was considered as a secondary outcome. The sample consisted of 1333 patients with various anxiety disorders including social anxiety disorder, general anxiety disorder, panic disorder, social panic, obsessive-compulsive disorder,

Neurochemical and genetic factors in panic disorder: a systematic review.

Moraes ACN, Wijaya C, Freire R, Quagliato LA, Nardi AE, Kyriakoulis P · Translational psychiatry · 2024

This systematic review addresses the complex nature of Panic Disorder (PD), characterized by recurrent episodes of acute fear, with a focus on updating and consolidating knowledge regarding neurochemical, genetic, and epigenetic factors associated with PD. Utilizing the PRISMA methodology, 33 original peer-reviewed studies were identified, comprising 6 studies related to human neurochemicals, 10 related to human genetic or epigenetic alterations, and 17 animal studies. The review reveals patterns of altered expression in various biological systems, including neurotransmission, the Hypothalamic-Pituitary-Adrenal (HPA) axis, neuroplasticity, and genetic and epigenetic factors leading to neuroanatomical modifications. Noteworthy findings include lower receptor binding of GABAA and serotonin neurotransmitters in the amygdala. The involvement of orexin (ORX) neurons in the dorsomedial/perifornical region in triggering panic reactions is highlighted, with systemic ORX-1 receptor antagonists

The cognitive theory of panic disorder: A systematic narrative review.

Aslam SY, Zortea T, Salkovskis P · Clinical psychology review · 2024

The cognitive theory of panic disorder proposes that individuals with panic disorder have a relatively enduring tendency to catastrophically misinterpret bodily sensations resulting in panic attacks. We investigated whether the evidence is consistent with the theory and its predictions, if updates are required and sought to identify future research considerations. We searched Scopus, Web of Science, PsycInfo, EMBASE, MEDLINE and CINAHL (1986 to July 2024). Inclusion criteria were studies collecting quantitative data derived from panic disorder patients, testing one of the predictions and using appropriate outcome measures. Exclusion criteria were non-English language publications, all participants under the age of 18 and studies that were not published in a peer-reviewed journal. Quality was assessed using 'QualSyst' and synthesis was based on each prediction tested. PROPSERO registration #CRD42022332211. 53 studies were identified amongst 49 publications. There was substantial evid

Can regular physical exercise be a treatment for panic disorder? A systematic review.

Machado S, Telles G, Magalhaes F, Teixeira D, Amatriain-Fernández S, Budde H · Expert review of neurotherapeutics · 2022

In the last few decades, exercise has been explored as a potential tool to reduce symptoms experienced by patients with panic disorder (PD). This systematic review aims to assess the effects of regular exercise interventions on panic severity, global anxiety, and depression symptoms of these patients. A search was conducted on PubMed, ISI Web of Science, and Cochrane Central Register of Controlled Trials using search terms related to PD and exercise. Eight trials were included, Furthermore, regular exercise programs presented different methodological characteristics. There is o clear evidence indicating that regular exercise programs (at least two 20-minute sessions per week for at least 6 weeks) reduce panic-related symptoms. Regular exercise is effective in improving global anxiety measures and depression. Continuous aerobic exercise is the main type of intervention in the literature, generally providing a limited prescription. Currently, it is recommended the interval training, wi

2019

Brazilian Medical Association guidelines for the diagnosis and differential diagnosis of panic disorder.

Levitan MN, Chagas MH, Linares IM, Crippa JA, Terra MB, Giglio AT · Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999) · 2013

To present the most relevant findings regarding the Brazilian Medical Association guidelines for the diagnosis and differential diagnosis of panic disorder. We used the methodology proposed by the Brazilian Medical Association for the Diretrizes Project. The MEDLINE (PubMed), Scopus, Web of Science, and LILACS online databases were queried for articles published from 1980 to 2012. Searchable questions were structured using the PICO format (acronym for "patient" [or population], "intervention" [or exposure], "comparison" [or control], and "outcome"). We present data on clinical manifestations and implications of panic disorder and its association with depression, drug abuse, dependence and anxiety disorders. In addition, discussions were held on the main psychiatric and clinical differential diagnoses. The guidelines are proposed to serve as a reference for the general practitioner and specialist to assist in and facilitate the diagnosis of panic disorder.

The CANMAT task force recommendations for the management of patients with mood disorders and comorbid anxiety disorders.

Schaffer A, McIntosh D, Goldstein BI, Rector NA, McIntyre RS, Beaulieu S · Annals of clinical psychiatry : official journal of the American Academy of Clinical Psychiatrists · 2012

Comorbid mood and anxiety disorders are commonly seen in clinical practice. The goal of this article is to review the available literature on the epidemiologic, etiologic, clinical, and management aspects of this comorbidity and formulate a set of evidence- and consensus-based recommendations. This article is part of a set of Canadian Network for Mood and Anxiety Treatments (CANMAT) Comorbidity Task Force papers. We conducted a PubMed search of all English-language articles published between January 1966 and November 2010. The search terms were bipolar disorder and major depressive disorder, cross-referenced with anxiety disorders/symptoms, panic disorder, agoraphobia, generalized anxiety disorder, social phobia, obsessive-compulsive disorder, and posttraumatic stress disorder. Levels of evidence for specific interventions were assigned based on a priori determined criteria, and recommendations were developed by integrating the level of evidence and clinical opinion of the authors. C

The effect of lavender aroma for anxiety disorder: a study protocol for a multicenter, double-masked, randomized, placebo-controlled clinical trial.

Amitani H, Nishi R, Sagiyama K, Fukumoto T, Funakoshi K, Takayanagi N · BMC complementary medicine and therapies · 2023

Anxiety disorder is the most prevalent psychiatric disorder. Benzodiazepines, which are often used for anxiety in patients with anxiety disorder, have various side effects. Lavender, one of the most commonly used essential oils in aromatherapy, has the potential to reduce benzodiazepine use for anxiety disorders. This study is a multicenter, double-masked, randomized, placebo-controlled clinical trial. The study will recruit patients aged 20-59 years old with generalized anxiety disorder and panic disorder among anxiety disorders. The bottle containing the test solution (lavender aroma essential oil or distilled water) will be given to the patients. Patients will carry the bottles with them in their daily life and use the drops on tissue paper when anxious. The primary endpoint is the number of times anxiolytics used in 28 days. If the use of benzodiazepines could be reduced by sniffing lavender aroma, which is inexpensive and safe, it would contribute not only to the risks

Pharmacotherapy of Anxiety Disorders: Current and Emerging Treatment Options.

Garakani A, Murrough JW, Freire RC, Thom RP, Larkin K, Buono FD · Frontiers in psychiatry · 2020

Anxiety disorders are the most prevalent psychiatric disorders and a leading cause of disability. While there continues to be expansive research in posttraumatic stress disorder (PTSD), depression and schizophrenia, there is a relative dearth of novel medications under investigation for anxiety disorders. This review's first aim is to summarize current pharmacological treatments (both approved and off-label) for panic disorder (PD), generalized anxiety disorder (GAD), social anxiety disorder (SAD), and specific phobias (SP), including selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), azapirones (e.g., buspirone), mixed antidepressants (e.g., mirtazapine), antipsychotics, antihistamines (e.g., hydroxyzine), alpha- and beta-adrenergic medications (e.g., propranolol, clonidine), and GABAergic medications (benzodiazepines, pregabalin, and gabapentin). Posttraumatic stress disorder and obsessive-compulsive disorder are excluded from this

Integrative Systematic Review on Pharmacological, Psychotherapeutic, and Neurostimulatory Treatment Options in Treatment-Resistant Anxiety Disorders.

Schiele MA, Fagan HA, Baldwin DS, Domschke K · Psychotherapy and psychosomatics · 2026

Treatment resistance in anxiety disorders (TR-ADs) constitutes a major clinical challenge conferring a considerable burden regarding quality of life and societal health costs. This systematic review provides an overview of pharmacological, psychotherapeutic, and neurostimulatory treatment options in adults with treatment-resistant generalized anxiety disorder (TR-GAD), panic disorder (TR-PD)/agoraphobia, and social anxiety disorder (TR-SAD). A total of 26 randomized controlled trials (RCTs) and 36 open label studies were identified, with, however, mostly small sample sizes and several methodological limitations. According to RCTs, selective serotonin reuptake inhibitors (SSRIs) or clomipramine are effective in TR-PD after failure to respond to cognitive behavioral therapy (CBT). In pharmacological TR-SAD, switching from one SSRI to another or to venlafaxine was found helpful in open label trials. RCTs further suggest augmentation with quetiapine, risperidone, olanzapine, or pregabali

The bergen 4-day treatment for panic disorder: a longer-term follow-up.

Eide TO, Hansen B, Hjelle KM, Solem S, Wheaton MG, Björgvinsson T · BMC psychiatry · 2025

Bergen 4-Day treatment (B4DT) is a form of concentrated exposure-based cognitive behavioral therapy (CBT) in which patients receive treatment over four consecutive days. Previous studies have shown B4DT to be a promising treatment format for panic disorder (PD), although the long-term stability of treatment gains requires additional study. The aim of the current study was to evaluate the longer-term effectiveness of B4DT for patients with panic disorder with or without agoraphobia. This study extends a previously published study by providing a long-term follow-up of the same cohort (n = 30), initially assessed at three months post-treatment. Thirty patients with panic disorder were consecutively included in a retrospect open trial. The primary outcome measure was the Panic Disorder Severity Scale. The secondary outcome measures were the Generalized Anxiety Disorder-7 and the Patient Health Questionnaire-9. Outcomes were assessed at pretreatment, posttreatment, 3-month f

Neurocircuitry and Neuroanatomy in Panic Disorder: A Systematic Review.

Kyriakoulis P, Wijaya C, Quagliato L, Freire RC, Nardi AE · Alpha psychiatry · 2025

This review updates our understanding of the neuroanatomical and neurocircuitry factors involved in panic disorder (PD). Many aspects remain undetermined. Clinical studies and a randomized controlled trial were identified via PubMed database and included in this review. The search, following PRISMA guidelines, identified 13 human studies and 3 animal studies. Nine human studies compared brain activity and connectivity between regions in PD patients. Neural activity in the amygdala was highlighted in six studies. The hippocampus had higher activation in PD patients compared to those with social phobia, but generally showed less activity compared to healthy controls. The parahippocampal gyrus and thalamus exhibited greater activation in PD patients than healthy controls. Activity in the prefrontal cortices was also noted, particularly the ventromedial prefrontal cortex (vmPFC), ventrolateral prefrontal cortex (vlPFC), dorsomedial prefrontal cortex (dmPFC), and dorsolateral prefrontal c

Panic disorder

NHS

The NHS offers information on panic disorder, explaining what it is, its symptoms, causes, and how it's treated. It also provides advice on self-help and where to get support in the UK.

An 8-week, Randomized, Double-Blind, Placebo-Controlled Trial of Seroquel SR Co-administration for SSRI-Resistant, Comorbid Panic Disorder

n=26 · NCT00619892 · COMPLETED · COMPLETED

The primary objective of this study is to test the hypothesis that a SSRI plus quetiapine SR (Seroquel SR) will result in superior early (first 1-3 weeks of treatment) stabilization of panic symptoms in SSRI-resistant, comorbid Panic Disorder patients versus a SSRI plus placebo.

A Pragmatic Randomized Controlled Trial of a Group Self-management Support Program Versus Treatment-as-usual for Anxiety Disorders

n=414 · NCT05124639 · ACTIVE_NOT_RECRUITING · ACTIVE_NOT_RECRUITING

Background. Self-management support is a complementary approach to treatment that aims to educate participants on the nature of anxiety and to improve their strategies to manage symptoms and well-being, thus presenting the potential to enhance recovery, improve outcomes, reduce recurrence rates and lower health care costs. There is limited evidence to support the effectiveness of group self-management support for anxiety disorders in community-based care. Objectives. This study aims at examining the effectiveness of a virtual group self-management support program (SMS) for anxiety disorders as an add-on to treatment-as-usual (TAU) in community-based care settings. We will also assess the incremental cost/effectiveness ratio and the implementability of the intervention. Methods. The trial is a pragmatic randomized controlled trial with a pre-treatment, post-treatment (4-month post-randomization), and follow-ups at 8, 12 and 24-months. Intervention. The experimental condition will consist of a 10-week SMS program for anxiety disorders in addition to TAU. The control condition will receive TAU without restrictions for anxiety disorders. Inclusion criteria will comprise being 18 years old or older, French-speaking, and presenting symptoms of anxiety disorders based on self-reported validated assessment scales. Patients will be recruited in the province of Quebec (Canada). Outcome measures: The primary outcome measure is the Beck Anxiety Inventory (BAI). The secondary outcome measures include self-reported instruments for anxiety and depressive symptoms, recovery, self-management, quality of life, and service utilisation. Statistical analysis: Intention-to-treat analysis. A mixed effects regression model will be used to account for between and within-subject variations in the analysis of the longitudinal effects of the intervention. Expected outcomes. The rigorous evaluation of the SMS intervention in the real world will provide information to decision makers, health care managers, clinicians and patients regarding the added value of group SMS for patients with anxiety disorders. Widespread implementation of this intervention could lead to more efficient mental health care services, to better long-term outcomes and to a significant reduction in the extensive social and economic burden of anxiety disorders.

Respiratory Training in the Treatment of Transdiagnostic Pathological Anxiety: A Randomized Clinical Trial

n=180 · NCT05427708 · RECRUITING · RECRUITING

Purpose of the Research: The primary aim of the proposed study is to conduct a randomized parallel-group 2-arm clinical trial investigating capnometry-guided respiratory intervention (CGRI) for pathological anxiety. CGRI aims to raise end-tidal CO2 levels thereby lowering hyperventilation-induced respiratory alkalosis and its associated fear-eliciting somatic reactions. Psycho-education about anxiety and its effects (PsyEd) will serve as a credible control comparator.

Cochrane reviews on Panic disorder

Cochrane

Cochrane Library provides systematic reviews of primary research in human health care and health policy. Searching for 'Panic disorder' reveals various reviews on interventions and treatments for the condition.

TRIP Database search for Panic Disorder

TRIP Database

TRIP is a clinical search engine designed to allow users to quickly and easily find high-quality evidence for clinical practice. A search for 'Panic Disorder' yields numerous evidence-based resources.

Panic Disorder (Search)

TRIP Database

TRIP Database is a clinical search engine that allows users to quickly find high-quality evidence for clinical practice, including for panic disorder. It aggregates evidence from various sources, making it easier to discover relevant guidelines and research.