10.2217/14750708.2.2.249 © 2005 Future Medicine Ltd ISSN 1475-0708 Therapy (2005) 2(2), 249–254 249 R ESEARCH A RTICLE For reprint orders, please contact: reprints@futuremedicine.com Pharmacotherapy of panic disorder in the elderly: a naturalistic 12-month follow-up outcome study Pinhas N Dannon † , Iulian Iancu, Katherine Lowengrub, Leon Grunhaus & Moshe Kotler † Author for correspondence The Rehovot Community Mental Health & Rehabilitation Clinic, Remez Street 80, 76449, Rehovot, Israel Tel.: +97 289 461 893 Fax: +97 289 468 962 pinhasd@post.tau.ac.il Keywords: elderly, panic disorder, paroxetine, SSRI, treatment outcome Background: Despite the previously accepted notion that panic disorder (PD) is rare in the elderly, recent data have shown that late-life PD may be more common than previously thought. Paroxetine is a selective serotonergic reuptake inhibitor which has had clear efficacy in the treatment of PD in the general adult population. In this study we aimed to examine the treatment outcome of paroxetine pharmacotherapy for late-life PD. Method: In this long-term naturalistic follow-up study, a group of 61 elderly (aged 59 years or older) PD patients were compared with a group of 95 younger (aged between 18 and 59 years) PD patients in terms of treatment response to paroxetine pharmacotherapy. The two groups were followed during both the initial short-term treatment phase (first 3 months) and throughout long-term (month 4–12) maintenance treatment. The two groups were also compared for side effects of paroxetine therapy. Results: No differences were found between the two patient groups in terms of response rate, side effects and tolerability of drug treatment. Conclusions: The use of paroxetine for the treatment of late-life PD appears to be both beneficial and well tolerated. Further controlled studies are needed to confirm these preliminary results. Panic disorder (PD) is one of the most common anxiety disorders and has a lifetime prevalence of 3 to 5% [1]. PD is characterized by recurrent, unexpected panic attacks followed by a persist- ent concern about having additional attacks [2]. The panic attack itself is defined as a discrete period of intense fear accompanied by the abrupt development of a range of autonomic symptoms, which may include dizziness, chest pain, palpitations, sweating, shortness of breath, nausea and paresthesias. Typically, the autonomic symptoms are accompanied by cog- nitive symptoms such as a fear of dying or los- ing control or 'going crazy.' Anxiety about having the next attack is often associated with the development of avoidant behavior. The affected individuals may avoid any situation in which they perceive that they would be embar- rassed or that help may not be available in the event that a spontaneous panic attack should occur. These individuals may avoid family and social gatherings, public places or traveling. The avoidant behavior can lead to a significant decline in social functioning, which may, in turn, contribute to feelings of loneliness and isolation. Furthermore, individuals with PD are frequent users of both emergency and gen- eral medical treatment. Therefore, this disorder has significant costs for the healthcare delivery system [3]. PD in the elderly represents an especially challenging clinical diagnosis because this pop- ulation suffers from a relatively high rate of chronic physical disorders including cardiovas- cular, pulmonary and gastrointestinal disease. The evaluation of panic symptoms in the eld- erly patient must include a careful history and physical examination, as well as routine labora- tory tests to rule out an organic cause [4,5]. For example, in the elderly, side effects of medica- tion and/or psychoactive substances such as caf- feine and nicotine may precipitate or provoke anxiety symptoms. Some individuals with PD are convinced that the attacks are indicative of serious medical illness and seek out repeated medical consultation in order to allay their fears. The correct diagnosis and treatment of PD therefore, allows the patient to avoid unnecessary medical tests and leads to an improvement in the quality of life. While the elderly PD patient may suffer from a chronic and relapsing form of the disorder, which started in young adulthood, PD is also known to present with an onset in late life. Data from the Longitudinal Aging Study Amsterdam (LASA) suggest that the 6-month prevalence rate of PD in the elderly is around 1% [6] which is comparable with a 1.4% 12-month prevalence rate reported in the National Comorbidity Study (NCA) and the Epidemiological Catchment part of