Recently, a meta-analysis for treatment of anxiety disorders (panic disorder: PD, generalized anxiety disorder and social phobia) indicated that medications were associated with a significantly higher average pre-post effect sizes (ES) 2.02 than psychotherapies 1.22 (P<0.0001) (Bandelow, et al., 2015). On the other hand, other meta-analysis dedicated to PD showed no evidence of a difference between psychological therapies and antidepressants including selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants, and other antidepressants, or benzodiazepines (BZDs) in terms of short-term remission or short-term response, and no evidence of a difference between psychological therapies and the drugs in treatment acceptability as measured using dropouts for any reason (Imai et al., 2016).
 In the latest clinical practice guidelines for the management of panic disorder (Bandelow, et al., 2014; Katzman, et al., 2014), first-line agents that have good evidences for efficacy in treating PD include SSRIs and venlafaxine (serotonin and norepinephrine reuptake inhibitors:SNRIs). Additionally, second-line and third-line agents are prepared for options when the first-lines are not effective in these guidelines.
 In this manner, clinical strategies for pharmacotherapy of PD seemingly appear to be, established to some degree. Actually, however, the clinical courses are chronic, recurrent, and fluctuating. That is to say, the full remission rate is lower and treatment-resistant PD patients are not uncommon naturally, because of unclear pathology of PD and only symptomatic treatments even if psychiatrists choose the best treatment among many pharmacological and/or psychological therapies.
 Under the circumstances, we psychiatrists are required the following attitude;groping for the best individual interventions on a routine basis, using psychotherapies adequately and excluding treatment-resistant factors, getting a great education from the latest knowledges and cuddling up to their every PD patient.
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