What is the best medication for treating panic disorder?

From the Guidelines

Selective serotonergic reuptake inhibitors (SSRIs) are the best medication for treating panic disorder. According to the clinical practice guideline for the assessment and treatment of children and adolescents with anxiety disorders, published in the Journal of the American Academy of Child and Adolescent Psychiatry in 2020 1, SSRIs are recommended for patients with panic disorder. The guideline suggests that SSRIs be offered to patients 6 to 18 years old with social anxiety, generalized anxiety, separation anxiety, or panic disorder.

Some of the commonly used SSRIs for panic disorder include:

• Sertraline (Zoloft)
• Paroxetine (Paxil)
• Fluoxetine (Prozac)
• Escitalopram (Lexapro)

Treatment with SSRIs typically starts with a low dose and gradually increases over several weeks to a therapeutic dose. For example, sertraline may start at 25mg daily and increase to 50-200mg daily. It's essential to note that SSRIs may take 4-6 weeks to reach full effectiveness, and treatment should continue for at least 6-12 months after symptoms improve to prevent relapse.

While benzodiazepines like alprazolam (Xanax) or lorazepam (Ativan) may be prescribed short-term for immediate relief during panic attacks, they carry risks of dependence and are not recommended for long-term use. Cognitive-behavioral therapy (CBT) combined with medication often provides the best outcomes for managing panic disorder.

From the FDA Drug Label

Panic Disorder Sertraline Hydrochloride Oral Concentrate is indicated for the treatment of panic disorder in adults, with or without agoraphobia, as defined in DSM-IV The efficacy of sertraline was established in three 10 to 12 week trials in adult panic disorder patients whose diagnoses corresponded to the DSM-III-R category of panic disorder The efficacy of sertraline in maintaining a response, in adult patients with panic disorder who responded during a 52-week treatment phase while taking sertraline and were then observed for relapse during a period of up to 28 weeks, was demonstrated in a placebo-controlled trial

Best Medication for Panic Disorder:

• Sertraline is indicated for the treatment of panic disorder in adults, with or without agoraphobia.
• The efficacy of sertraline in treating panic disorder was established in three 10 to 12 week trials.
• Sertraline is also effective in maintaining a response in adult patients with panic disorder for up to 28 weeks after the initial treatment phase 2.
• Alprazolam is also effective in treating panic disorder, as shown in three short-term, placebo-controlled studies (up to 10 weeks) in patients with diagnoses closely corresponding to DSM-III-R criteria for panic disorder 3.
• However, the use of alprazolam at doses greater than 4 mg/day, often necessary to treat panic disorder, is accompanied by risks of severe emotional and physical dependence in some patients 3.

From the Research

Medication Options for Panic Disorder

The following medications are commonly used to treat panic disorder:

• Selective serotonin reuptake inhibitors (SSRIs) such as sertraline, fluoxetine, fluvoxamine, and paroxetine 4, 5
• Serotonin-norepinephrine reuptake inhibitors (SNRIs) 6
• Benzodiazepines such as alprazolam, although these are generally used for short-term treatment or in non-responsive cases due to the risk of dependency and tolerance 7, 6
• Tricyclic antidepressants, although these are less well tolerated than modern antidepressants 6

Efficacy of Medications

Studies have shown that:

• Sertraline is an effective and well-tolerated treatment for panic disorder, with a significant reduction in panic attack frequency and improvement in quality of life 4, 8
• SSRIs are better tolerated than tricyclic antidepressants, with fewer adverse effects 7
• Benzodiazepines may be beneficial in the short-term treatment of panic disorder, but their use is limited due to the risk of dependency and tolerance 7, 6

Treatment Recommendations

Based on the available evidence, the following treatment recommendations can be made:

• Selective serotonin reuptake inhibitors (SSRIs) such as sertraline are a first-line treatment option for panic disorder 4, 5, 6
• Combining drug treatment with cognitive behavior therapy is the most successful treatment strategy for panic disorder 6
• Treatment should be individualized, taking into account the patient's medical history, tolerance, and response to treatment 7, 6