Ballenger J C
Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston 29425-0742, USA.
Int Clin Psychopharmacol. 1998 Apr;13 Suppl 4:S13-7. doi: 10.1097/00004850-199804004-00003.
Data from the National Comorbidity Survey (NCS) general population study and the World Health Organization (WHO) primary care study have established that comorbidity between panic and depression is one of the strongest psychiatric associations. The two studies agree that patients with panic-depression comorbidity have greater symptomatology, in terms of frequency and severity of panic attacks and depressive episodes, work and role impairment, chronic illness and healthcare use, compared with those with a single disorder. Although the rate of presentation of panic and depression in the primary care setting is high, at present their recognition is low and inappropriate treatment is often given. Education of primary care physicians about these disorders is therefore necessary. An important conclusion from the NCS and WHO studies is that panic attacks have an important signal value. In addition to being an excellent marker for future panic disorder and depression, a panic attack is indicative of the almost certain presence of at least one other psychiatric condition. Since treatment of panic attacks with an appropriate selective serotonin reuptake inhibitor such as paroxetine not only significantly reduces panic symptoms, but also alleviates comorbid anxiety and depression, a simple, yet effective, approach in the primary care setting may be to look for panic attacks and to treat sufferers with this class of antidepressants. With this approach, both panic attack symptoms and any underlying anxiety and depressive disorders would be managed.
来自全国共病调查（NCS）的普通人群研究以及世界卫生组织（WHO）的初级保健研究数据表明，惊恐障碍与抑郁症之间的共病是最强的精神疾病关联之一。这两项研究均表明，与单一疾病患者相比，患有惊恐障碍与抑郁症共病的患者在惊恐发作和抑郁发作的频率及严重程度、工作及角色功能受损、慢性病以及医疗保健利用方面，具有更严重的症状表现。尽管在初级保健机构中惊恐障碍和抑郁症的就诊率很高，但目前它们的识别率较低，且常常得到不恰当的治疗。因此，有必要对初级保健医生进行关于这些疾病的教育。NCS和WHO研究得出的一个重要结论是，惊恐发作具有重要的信号价值。除了是未来惊恐障碍和抑郁症的一个极佳标志物外，一次惊恐发作还表明几乎肯定存在至少一种其他精神疾病。由于使用如帕罗西汀这样合适的选择性5-羟色胺再摄取抑制剂治疗惊恐发作不仅能显著减轻惊恐症状，还能缓解共病的焦虑和抑郁，在初级保健机构中一种简单而有效的方法可能是寻找惊恐发作患者，并使用这类抗抑郁药对其进行治疗。通过这种方法，惊恐发作症状以及任何潜在的焦虑和抑郁障碍都将得到控制。
