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(SSRI = selective serotonin reuptake inhibitor; TCA = tricyclic antidepressant; MAOI = monoamine oxidase inhibitor)*--Indications include unusually severe and frequent attacks, substantial disability, and rapidly developing agoraphobia.
†--Consider patient preferences and availability of quality cognitive behavior therapy.
Selective serotonin reuptake inhibitors (SSRIs) are the drug of choice for treatment of patients with panic disorder.
Most patients have a favorable response to SSRI therapy; however, 30 percent will not be able to tolerate these drugs or will have an unfavorable or incomplete response.
Following are several strategies to help patients overcome resistance to therapy.
Effective management of panic disorder is a common challenge for family physicians.§--Augmentation is often preferred if the patient has had at least a partially favorable response to therapy.//--Allow at least two weeks (five weeks for fluoxetine [Prozac]) between dosing with other antidepressants and MAOIs. Algorithm for sequencing treatment for panic disorder.Typically, patients who have panic disorder require dosages at the high end of the therapeutic range for SSRIs, and full dosages for TCAs, as shown in 6 Before switching to a different agent, the highest recommended dosage for a given SSRI should be tried as long as the drug is tolerated.It may take several months for the patient to feel confident that he or she is free of panic attacks.