§--Augmentation is often preferred if the patient has had at least a partially favorable response to therapy.//--Allow at least two weeks (five weeks for fluoxetine [Prozac]) between dosing with other antidepressants and MAOIs. Algorithm for sequencing treatment for panic disorder.Typically, patients who have panic disorder require dosages at the high end of the therapeutic range for SSRIs, and full dosages for TCAs, as shown in 6 Before switching to a different agent, the highest recommended dosage for a given SSRI should be tried as long as the drug is tolerated.It may take several months for the patient to feel confident that he or she is free of panic attacks.
†--Consider patient preferences and availability of quality cognitive behavior therapy.
Strategies to improve management of such patients include optimizing SSRI dosing (starting at a low dose and slowly increasing the dose to reach the target dose) and ensuring an adequate trial before switching to a different drug.
Benzodiazepines should be avoided but, when necessary, may be used for a short duration or may be used long-term in patients for whom other treatments have failed.
Anecdotally, self-help groups like Agoraphobics in Motion, 1719 Crooks Rd., Royal Oak, MI 48067; telephone: 248-547-0400, can be inexpensive and helpful.22 Patients with panic disorder commonly have other comorbidities including mood and anxiety disorders, and substance use.23 Because these disorders may be associated with panic attacks and anticipatory anxiety23 and may require distinct treatments,4 the diagnosis of panic disorder should consistently trigger a systematic search for other anxiety disorders.22 Because the common comorbidities of panic disorder respond differentially to antipanic treatments, knowledge of these comorbidities also helps in treatment selection. I.),24 which takes less than 20 minutes to complete, is a more effective screening tool.
Unfortunately, most commonly used diagnostic and screening tools for mental health disorders in the primary care setting are not sufficiently comprehensive; the less familiar Mini-International Neuropsychiatric Interview (M. Finally, it is important to assess the risk of suicide in all patients who have panic disorder.18Because panic disorder is a chronic condition that often manifests early in adult life,25 comorbid mood disorders, substance use, and anxiety disorders can develop over time.