Treatment-resistant panic disorder

Panic disorder is a common and chronic psychiatric condition. Its treatment response is suboptimal, meaning that only one-third of the patients are able to stabilize to a panic-free state during follow-up. Panic disorder and its suboptimal treatment responses indeed significantly interfered with the individual’s functions and life qualities. In this systemic review, we wish to define treatment-resistant panic disorder and to discuss its related biopsychosocial risk factors involved in resistance. We also summarized the underlying potential pathophysiology in terms of treatment resistance, including genetic susceptibility, brain function alterations, hypothalamus-pituitary-adrenal (HPA) axis dysregulation, and long-term systemic inflammation. The current available pharmacological options to manage treatment-resistant panic disorder include augmentation or adjunctive combination strategies. As well, non-pharmacological interventions including cognitive-behavioral therapy may be used in either first-line or adjunctive approaches.