B. Pharmacotherapy is indicated when patients have marked distress from panic attacks or are experiencing impairment in work or social functioning.
1. Serotonin-specific reuptake inhibitors and tricyclic antidepressants are most often used.
2. SSRIs are the first-line treatment for Panic disorder. A low dose, such as 5-10 mg of paroxetine (Paxil) or 12.5-25 mg of sertraline (Zoloft) is used initially. The dose may then be gradually increased up to 20-40 mg for paroxetine or 50 to 100 mg for sertraline. Fluoxetine (Prozac) may exacerbate panic symptoms unless begun at very low doses (2-5 mg).
3. When using a tricyclic antidepressant, the initial dose should also be low because of the potential for exacerbating panic symptoms early in treatment. Imipramine (Tofranil) is the best studied agent, and it should be started at 10-25 mg per day and increased slowly up to 100-200 mg per day as tolerated.
4. Benzodiazepines may be used adjunctively with TCAs or SSRIs during the first few weeks of treatment. When a patient has failed other agents, benzodiazepines are very effective. Alprazolam (Xanax) should be given four times a day to decrease interdose anxiety. The average total dose is 0.5 mg qid (2 mg/day). Some patients may require up to 6 mg per day. A long-acting agent such as clonazepam (Klonopin ) is also effective and has decreased interdose anxiety compared to alprazolam.
6. Monoamine oxidase inhibitors may be the most efficacious agents available for panic disorder but are not often used due to concern over hypertensive crisis when patients do not follow a low tyramine diet.
7. Medication should be combined with cognitive-behavioral therapy.
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It seems like you hear it all the time from nearly every one you know I'm SO stressed out!? Pressures abound in this world today. Those pressures cause stress and anxiety, and often we are ill-equipped to deal with those stressors that trigger anxiety and other feelings that can make us sick. Literally, sick.