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Panic disorders may be viewed as dysfunctions of the normal adaptive responses to threat to an individual's security. These include ongoing psychophysiological preparedness for threat and sudden reactions to actual danger. Studies of primates and human beings suggest that about 15% of the population is genetically vulnerable to ordinary challenge and uncertainty, as well as to developmental adversities, such as separation. Pharmacotherapy aims to compensate for this constitutional vulnerability.
The interplay between limbic and central noradrenergic arousal has been identified as an important component of the neuropsychological security system; this is relevant to the everyday pharmacotherapy of anxiety. Antidepressants are the agents of choice for panic disorders. Clonazepam, a benzodiazepine anticonvulsant, may be useful in cases that do not respond to conventional antidepressant treatment. A few patients suffer from atypical panic attacks that are elements of partial complex seizures; carbamazepine or valproate may be particularly helpful in such cases.
Psychotherapy for these disorders focuses on their developmental, interpersonal, and intrapsychic components.