한국형 공황장애 약물치료 알고리듬 2008：치료 불응성 공황장애 및 공존질환이 동반된 경우

Abstract

OBJECTIVE: This study investigated the consensus about treatment strategies for non-responsive and comorbid conditions in panic disorder, which represents one subject addressed by the Korean medication algorithm project for panic disorders 2008. METHODS: The executive committee developed questionnaires about treatment strategies for patients with panic disorder based on guidelines or algorithms and clinical trial studies previously published in foreign countries. This study analyzed the treatment strategies in cases of non-responsive panic disorder and comorbid conditions accompanying panic disorder. Fifty-four (68%) of 80 experts on a committee reviewing panic disorders responded to the questionnaires. We classified the consensus of expert opinions into three categories (first-line, second-line, and third-line treatment strategies) and identified the treatment of choice according using a chi-square test and 95% confidence interval. RESULTS: The consensus about first-line treatment strategies in cases of non-responsive panic disorder included "switch from a selective serotonin reuptake inhibitor to venlafaxine XR or vice versa" and "clonazepam or alprazolam can be combined with another drug even from the initial period". Second-line strategies included tricyclic antidepressants (clomipramine, imipramine) and high dosages of high potency benzodiazepines (alprazolam, clonazepam). The consensus about treatment strategy in cases of comorbid disorders (e.g., depression or other anxiety disorders) recommended antidepressants combined with anxiolytics and cognitive-behavioral therapy as the treatments of choice. Antidepressants combined with anxiolytics were recommended as the first-line strategy, and antidepressant monotherapy and antidepressants combined with cognitive-behavioral therapy emerged as second-line strategies. In cases of comorbid conditions accompanying panic disorder, paroxetine was selected as the treatment of choice. Escitalopram, venlafaxine XR, sertraline, citalopram, alprazolam, and clonazepam were selected as first-line treatments and fluoxetine, mirtazapine, and imipramine were selected as second-line treatments. CONCLUSION: This study provided information about the consensus among Korean experts in regard to treatment strategies for non-responsive panic disorder and comorbid conditions accompanying panic disorder