Quetiapine extended-release augmentation has not been found to be beneficial , in comparison to placebo , in non-responders to previously recommended pharmacotherapy .
In non-responders to cognitive behavioral therapy ( CBT ) , switching to paroxetine/citalopram has been found to be more effective than continuing CBT .
Acceptance and commitment therapy ( ACT ) has shown some improvement in patients ’ resistance to previous psychological/pharmacological interventions compared with a waiting-list condition .
Prolonged pharmacotherapy may produce significant improvement in patients with unsatisfactory response to short-term pharmacotherapy  , while switching to pharmacotherapy may help non-responders to CBT .
Purpose of Review Purpose of Review Management of treatment-resistant ( TR ) panic disorder ( PD ) is an unresolved issue .
In this paper , we provide a brief summary of previous findings , an up date d ( 2015–2017 ) systematic review of pharmacological/non-pharmacological studies , and our personal perspective on this topic .
Feedback of end-tidal pCO2 as a therapeutic approach for panic disorder.
BACKGROUND Given growing evidence that respiratory dysregulation is a central feature of panic disorder ( PD ) interventions for panic that specifically target respiratory functions could prove clinical ly useful and scientifically informative . We tested the effectiveness of a new , brief , capnometry-assisted breathing therapy ( BRT ) on clinical and respiratory measures in PD . METHODS Thirty-seven participants with PD with or without agoraphobia were r and omly assigned to BRT or to a delayed-treatment control group .  Clinical status , respiration rate , and end-tidal pCO(2 ) were assessed at baseline , post-treatment , 2-month and 12-month follow-up . Respiratory measures were also assessed during homework exercises using a portable capnometer as a feedback device . RESULTS Significant improvements ( in PD severity , agoraphobic avoidance , anxiety sensitivity , disability , and respiratory measures ) were seen in treated , but not untreated patients , with moderate to large effect sizes . Improvements were maintained at follow-up . Treatment compliance was high for session attendance and homework exercises ; dropouts were few . CONCLUSIONS The data provide preliminary evidence that raising end-tidal pCO(2 ) by means of capnometry feedback is therapeutically beneficial for panic patients . Replication and extension will be needed to verify this new treatment 's efficacy and determine its mechanisms
Quetiapine extended-release augmentation has not been found to be beneficial , in comparison to placebo , in non-responders to previously recommended pharmacotherapy .
In non-responders to cognitive behavioral therapy ( CBT ) , switching to paroxetine/citalopram has been found to be more effective than continuing CBT .
Acceptance and commitment therapy ( ACT ) has shown some improvement in patients ’ resistance to previous psychological/pharmacological interventions compared with a waiting-list condition .
Prolonged pharmacotherapy may produce significant improvement in patients with unsatisfactory response to short-term pharmacotherapy  , while switching to pharmacotherapy may help non-responders to CBT .
Purpose of Review Purpose of Review Management of treatment-resistant ( TR ) panic disorder ( PD ) is an unresolved issue .
In this paper , we provide a brief summary of previous findings , an up date d ( 2015–2017 ) systematic review of pharmacological/non-pharmacological studies , and our personal perspective on this topic .