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Psychiatric Treatment Received by Primary Care Patients With Panic Disorder With and Without Agoraphobia

The authors are affiliated with the Department of Psychiatry and Human Behavior and Dr. Weisberg is also with the Department of Family Medicine at the Warren Alpert Medical School of Brown University, Providence, Rhode Island. Send correspondence to Dr. Marcks at the Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Box G-BH, Duncan Bldg., Providence, RI 02912 (e-mail: brook_marcks{at}brown.edu).

OBJECTIVE: Although the majority of individuals with panic disorder first present to the primary care setting, little is known about the psychiatric treatment that primary care patients with the disorder typically receive. The purpose of this study was to explore characteristics of treatment received by patients with panic disorder with agoraphobia and by those with panic disorder without agoraphobia, examine demographic and clinical predictors of receiving treatment, and explore treatment barriers. METHODS: This study used data from the Primary Care Anxiety Project (PCAP), which is a naturalistic, longitudinal study of anxiety disorders among primary care patients. This study presents data for 235 PCAP participants diagnosed at the study intake assessment as having panic disorder with agoraphobia (N=150) or without agoraphobia (N=85). RESULTS: Many patients with panic disorder were not receiving psychiatric treatment at study intake (38%), with those without agoraphobia being less likely to receive treatment. Psychotropic medications were the treatment of choice, with selective serotonin reuptake inhibitors or serotonin and norepinephrine reuptake inhibitors being the most commonly received class of medications (34%). Only 38% of those with panic disorder with agoraphobia and 24% of those with panic disorder without agoraphobia were receiving psychotherapy, and the use of empirically supported interventions was rare. The most common treatment barriers were not believing in using medication or therapy for emotional problems and not receiving a treatment recommendation from one's provider. CONCLUSIONS: The findings suggest a need for better treatment dissemination, in addition to making interventions more accessible or adapting them to the particular needs of primary care patients.

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