Long-term pharmacologic treatment of panic disorder.

In this paper, the author reviews the existing knowledge regarding the long-term treatment of panic disorder, including extensive clinical experience and data available from controlled studies. He conceptualizes long-term treatment in four phases--acute, stabilization, maintenance, and discontinuation--and in discussing these phases, outlines specific treatment goals for each of them. He presents measures for the management of withdrawal symptoms and relapse, focusing on the use of a slow taper over 3 to 6 months. The author then reviews the limited data currently available on long-term treatment outcome, including comparisons of 2 and 8 months of treatment demonstrating greater improvements with the longer treatment, and presents follow-up data 3 to 6 years after pharmacologic treatment. From clinical and research experience, he concludes that longer-term treatment of panic disorder is indicated for full recovery, although further studies are needed.