Decisions for the clinician in the treatment of panic disorder: when to treat, which treatment to use, and how long to treat.

Issues in clinicians' decisions about initiation, selection, and duration of treatment for patients with panic disorder are reviewed. Panic disorder may entail considerable morbidity, particularly if left untreated. This observation, coupled with clinical experience that the benefits of pharmacologic treatment generally outweigh their risks, suggests that patients with panic disorder should be treated with medication. A decision tree for the acute and maintenance treatment of panic disorder patients is presented, and possible indications for both acute and maintenance treatments are discussed. The advantages and disadvantages of treatment with each of the three classes of drugs that have been found effective for panic disorder--the tricyclic antidepressants, the monoamine oxidase inhibitors, and the benzodiazepines--are reviewed.