Panic disorder: When symptoms have no apparent physical cause

Patients with undiagnosed panic disorder often have symptoms of several associated physical and social problems, and they frequently seek help initially from their primary care physician. Therefore, it is important to be knowledgeable in diagnosis and treatment of panic disorder and to consider it in differential diagnosis in patients reporting non-psychiatric complaints. Although the underlying pathophysiology of panic disorder is still unclear, current research suggests that an imbalance of several neurotransmitter systems may be responsible. Many effective cognitive, behavioral, and pharmacologic methods are available, and patients may require a combination of approaches. Selective serotonin reuptake inhibitors are emerging as first- line therapy because of their demonstrated efficacy and tolerability. Tricyclic antidepressants and monoamine oxidase inhibitors also have been used successfully, and high-potency benzodiazepines are an option when rapid onset of drug activity is desired. Effective treatment of panic disorder can significantly decrease hospitalizations, reduce unnecessary healthcare expenditures, and improve patient quality of life.