Laura Duffy, M.D. is an Attending Psychiatrist at California Pacific Medical Center in San Francisco who was recently referred a patient with panic disorder whose anxiety was triggered in an unusual way.
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Dr. Pollack, as the head of the Anxiety Disorders Program at Mass General, you’ve had the opportunity to evaluate thousands of patients with panic disorder. Do have any practical tips for those of us with less experience?
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Neurontin (gabapentin) spends plenty of time in our patient’s medicine cabinets, but lately it has spent nearly as much time splashed across news sections of daily papers. Parke-Davis, the company that used to market Neurontin before it merged with Pfizer, has been accused of improperly promoting its use for a variety of off-label indications (1).
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When it comes to cognitive behavior therapy (CBT) and most psychiatrists, a little knowledge is a troubling thing. We know that CBT is effective, but we don’t know how to practice it. We know that a lot of patients ask us about it, but we don’t know enough to confidently describe to them what it entails.
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Panic disorder is a much harder nut to crack than we give it credit for. We tend to get complacent about treating it, because so many patient appear to do well on the standard starting regimen of an SSRI with or without a benzodiazepine.
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In the dark old days of American Psychiatry, most patients were diagnosed with schizophrenia and prescribed Thorazine (chlorpromazine) or its equivalent. One of the true pioneers of rational medication treatment is Donald Klein of Columbia University, who in 1962 was a psychiatrist practicing at Hillside Hospital in New York.
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Dr. Aiken is the Editor in Chief of The Carlat Psychiatry Report; director of the Mood Treatment Center in North Carolina, where he maintains a private practice combining medication and therapy along with evidence-based complementary and alternative treatments; and Assistant Professor NYU Langone Department of Psychiatry. He has worked as a research assistant at the NIMH and a sub-investigator on clinical trials, and conducts research on a shoestring budget out of his private practice. Follow him on Twitter and find him on LinkedIn.
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