Panic disorder , treatment strategies

FIG. 13-2. Treatment strategy for panic disorder with or without agoraphobia. 

Currently, many physicians adopt a benzodiazepine-sparing strategy by using benzodiazepines when necessary but conservatively. That is, benzodiazepines can often be helpful when treatment is initiated or when a rapid-onset therapeutic effect is desired. They can also help improve the short-term tolerability of SSRIs by blocking the jitteriness and exacerbation of panic sometimes observed when initiating treatment with an SSRI or other antidepressant. Benzodiazepines can also be useful to top up the patient s treatment on an as-needed basis for sudden and unexpected decompensation or short-term psychosocial stressors. Finally, if a patient is not fully responsive to an antidepressant or combinations of antidepressants, long-term treatment with concomitant benzodiazepines and antidepressants may become necessary to effect full or adequate control of symptoms. Sometimes, once symptoms are suppressed for several months to a year, the benzodiazepine can be slowly discontinued and the patient maintained long-term on the antidepressant alone. The consequences of inadequate treatment of panic disorder can be very severe loss of social and oc-... 

Some of the same augmentation strategies discussed in detail in Chapter 7 for the treatment of depression, mentioned above for the treatment of OCD, can also be applied to the treatment of panic disorder. Thus, adding the 5HT2A antagonist trazodone to an SSRI can boost the actions of an SSRI, as possibly also could the... 

Pollack MH, Simon NM, Worthington JJ, Doyle AL, Peters P, Toshkov F, Otto MW. Combined paroxetine and clonazepam treatment strategies compared to paroxetine monotherapy for panic disorder. J Psychopharmacol 2003 17 276-82. 

Zamorski MA, Albucher RC. What to do when SSRls fail Eight strategies for optimizing treatment of panic disorder. Am Fam Physician 2002 66 1471-1484. 

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