Maintenance treatment with antidepressants in panic disorder.

Because panic disorder is a chronic illness, patients may require long-term pharmacologic treatment. Unfortunately, the benefits and risks of such therapy have received little study. At least two classes of antidepressants, the tricyclic antidepressants and the monoamine oxidase inhibitors, are effective for the treatment of panic disorder, but because relapse is common when these drugs are discontinued, many patients require maintenance treatment. However, such long-term use of tricyclic antidepressants and monoamine oxidase inhibitors exposes patients to risks that include potentially fatal overdoses and hypertensive crises. Patients should be aware of the risks involved and should weigh them against the benefits of long-term use. They should reduce the dose to the lowest effective level, from time to time gradually taper medications to assess continuing need, and avail themselves of other therapies rather than rely solely on drug treatment. Above all, more research should be done on the long-term risks and benefits of antidepressant drugs.