First AD

Second AD

A. It occurs in a third of all patients with panic disorder

B. Atypical antipsychotics should be used a monotherapy for TRP

C. Benzodiazepines can be a safe/effective adjunct to SSRI treatment

D. There are many good studies to inform clinical practice

Approximately one third of patients with panic disorder have chronic, persistent symptoms-and the majority of these patients have treatment-resistant panic.

While clinical guidelines tend to rank benzodiazepines as second- or third-line antipanic agents, this is primarily because of concerns about sedation, physiological dependence, psychological dependence, and the slight risk of benzodiazepine abuse/diversion, especially with longer-term use. In fact, benzodiazepines are similarly effective to antidepressants for panic disorder, and their panicolytic benefit is almost always sustained over the long term.

Adverse effects such as sedation and incoordination are most apparent in the initial weeks of therapy, and this is when the risks for operating heavy machinery and driving are elevated. Thereafter, tolerance to the sedative effects occurs.

Benzodiazepines may have a long-term tolerability edge over the SSRIs, SNRIs, and TCAs, as they do not cause weight gain or sexual dysfunction. Generally, high-potency, shorter half-life benzodiazepines are preferable because of their more predictable pharmacokinetics and simpler metabolism. Regular dosing (vs PRN) is recommended to achieve optimal anxiolysis.

Anxiety & Stress Disorders

Quizzes

Panic Disorder

Some patients with panic disorder have chronic, persistent symptoms. Take the quiz and learn more.

Mini Quiz: Panic Disorder