A 30-year-old female presents with a 4-month history of panic attacks, occurring weekly, characterized by sudden onset of intense fear, palpitations, shortness of breath, and dizziness. She now actively avoids public places due to fear of having an attack. She is otherwise healthy. Which of the following is the most appropriate initial pharmacological management?
- ALorazepam 0.5 mg PRN
- BSertraline 25 mg daily
- CPropranolol 10 mg PRN
- DBuspirone 5 mg TID
Show answer & explanationAnswer & explanation
Correct answer: B. Sertraline 25 mg daily
Selective serotonin reuptake inhibitors (SSRIs) are considered first-line pharmacological treatment for panic disorder due to their efficacy in reducing panic attack frequency and severity, and managing anticipatory anxiety and agoraphobia. Sertraline is a commonly used SSRI. While benzodiazepines (lorazepam) can provide acute relief, they are not first-line for long-term management due to dependence risk. Propranolol is for performance anxiety or situational anxiety, not panic disorder. Buspirone is less effective for panic disorder.
Why the other options are wrong
- A. Lorazepam (benzodiazepine) provides acute relief but is not recommended as first-line for long-term panic disorder due to dependence and withdrawal risks.
- C. Propranolol (beta-blocker) is typically used for situational anxiety or performance anxiety, not for the comprehensive management of panic disorder.
- D. Buspirone is an anxiolytic that is effective for generalized anxiety disorder but has limited efficacy in treating panic disorder.
Panic Disorder First-Line Pharmacotherapy
Selective serotonin reuptake inhibitors (SSRIs) are the first-line pharmacological treatment for panic disorder, effectively reducing panic attack frequency and severity, as well as comorbid anxiety and avoidance behaviors.
- SSRIs are preferred over benzodiazepines for long-term treatment.
- Start SSRIs at a low dose and titrate slowly due to initial anxiety.
- Therapeutic effects may take several weeks.
- CBT is also a first-line treatment and can be combined with medication.
Memory trick: Panic's a fright? SSRIs make it right!