BMJ  2006;332:1094 (6 May), doi:10.1136/bmj.332.7549.1094

Letter

Panic disorder: propranolol and behavioural therapy

The first 150 words of the full text of this article appear below.

EDITOR—Barr Taylor clearly shows that selective serotonin reuptake inhibitors (SSRIs) are well accepted as first line treatment for panic disorder.1 However, many patients are still prescribed propranolol along with diazepam as first line treatment in primary care trusts to treat the adrenergic symptoms of panic disorder—such as palpitations, etc—although beta blockers have no proved efficacy in the treatment of panic disorder.

Considering patients' choice of treatments, many patients are generally quite keen on non-pharmacological methods such as cognitive behaviour therapy, especially after they consider the side effect profile of SSRIs. But if we consider the cost implications, one year's treatment with an SSRI—for example, paroxetine 20 mg—costs an estimated £289, including direct and indirect prescribing and including follow-up costs, which is around £10 more or less than other generic drugs. However, 16 one hour sessions of cognitive behaviour therapy delivered by a clinical psychologist cost an estimated £1056. That . . . [Full text of this article]

Manjeestha Das, senior house officer in psychiatry

NHS Grampian, Dr Gray's Hospital, Elgin, Moray IV30 1SN m.das@nhs.net


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