Relapse prevention in panic disorder with pharmacotherapy: where are we now?

Relapse prevention in panic disorder with pharmacotherapy: where are we now?

Introduction: A substantial number of patients with PD experience relapse after the discontinuation
of effective pharmacotherapy, leading to detrimental effects on the individuals and considerable
societal costs. This suggests the need to optimize pharmacotherapy to minimize relapse risk.
Area covered: The present systematic review examines randomized, double-blind, placebo-controlled
relapse prevention studies published over the last 20 years involving recommended medications. The
authors aim to provide an overview of this topic and evaluate whether recent advances were achieved.
Only seven studies were included, providing limited results. One-year maintenance pharmacotherapy
with constant doses had protective effects against relapse in patients who had previously exhibited
satisfactory responses to the same medication at the same doses. The duration of maintenance treatment
did not influence relapse risk. No data were available concerning the use of lower doses or the predictors
of relapse.
Expert opinion: Relapse prevention in PD has received limited attention. Recent progress and conclusive
indications are lacking. Rethinking pharmacological research in PD may be productive.
Collecting a wide range of clinical and individual features/biomarkers in large-scale, multicenter longterm
naturalistic studies, and implementing recent technological innovations (e.g., electronic medical
records/‘big data’ platforms, wearable devices, and machine learning techniques) may help identify
reliable predictive models.