Panic Disorder
Reference
Comments/Instructions
There is usually a delay in response to these agents that may be accompanied by initial agitation. Combining the SSRI or SNRI with a brief course of low-dose benzodiazepine augmentation therapy (i.e., no longer than 8 weeks) can increase adherence to medication and produce a more rapid response than with antidepressants alone.3
The tricyclic antidepressants (TCAs) imipramine, desipramine and clomipramine have been shown to reduce the frequency and severity of panic attacks4 and are inexpensive. The side effect profiles of TCAs and SSRIs differ and are used to guide treatment choice. Mirtazapine has been effective in open-label trials.5 , 6 The older monoamine oxidase inhibitors (MAOIs) phenelzine and tranylcypromine are also effective but more difficult to use.7
The dose requirements and length of treatment are the same as for major depression (see Psychiatric Disorders: Depression). However, the initial dose should be as low as possible (e.g., 10 mg daily of the TCAs or fluoxetine) and then increased, as tolerated, to the usual antidepressant dose range. If a higher starting dose is used, patients may become extremely agitated and discontinue treatment abruptly. Determining the duration of drug treatment is of great importance; medication is usually required for months or years. There is evidence that a majority of patients suffer relapse after benzodiazepines or antidepressants are discontinued.8
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- Psychiatry and Behaviour
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