Pharmacologic Treatment Response in Panic Disorder with Comorbid Medical Conditions: A Systematic and Narrative Review

Abstract

Panic disorder frequently co-occurs with medical conditions, complicating diagnosis and treatment.Although pharmacotherapy is a first-line treatment for panic disorder, pharmacotherapeutic evidence for patients with medical comorbidities is limited.Therefore, this review systematically evaluates the efficacy of pharmacologic treatments for panic disorder in adults with medical comorbidities and synthesizes clinical insights using a narrative approach.We searched PubMed, Embase, and the Cochrane Library through April 22, 2024, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Eligible studies compared pharmacotherapy with placebo or no treatment in patients with panic disorder and comorbidities.The review protocol was registered in the International Prospective Register of Systematic Reviews (registration number CRD42024544914).A hybrid approach combining systematic review methods with narrative synthesis was employed to enable broader interpretation.Two randomized controlled trials met the inclusion criteria.Both had small sample sizes and used different outcome measures, limiting cross-study comparability.Selective serotonin reuptake inhibitors and benzodiazepines showed potential in alleviating panic symptoms among patients with irritable bowel syndrome or noncardiac chest pain.Narrative synthesis underscored the bidirectional link between panic disorder and medical conditions, challenges in pharmacologic treatment, and gaps in existing clinical guidelines.Current evidence on pharmacologic treatment of panic disorder with medical comorbidities is very limited, derived from only two small studies with heterogeneous designs.Selective serotonin reuptake inhibitors and benzodiazepines showed preliminary signals of potential benefit, but definitive conclusions cannot be drawn.Individualized treatment and interdisciplinary collaboration are essential.Large-scale clinical trials and updated guidelines are needed to better support this population.