What medications are FDA approved for the treatment of panic disorder?

FDA-Approved Medications for Panic Disorder

The FDA has specifically approved sertraline, paroxetine, alprazolam, and fluoxetine for the treatment of panic disorder. These medications have demonstrated efficacy in reducing the frequency and severity of panic attacks and associated symptoms.

FDA-Approved Medications

SSRIs (First-Line Treatment)

• Sertraline (Zoloft): FDA-approved for panic disorder with or without agoraphobia 1
• Paroxetine: FDA-approved for panic disorder 2
• Fluoxetine (Prozac): FDA-approved for panic disorder 2

Benzodiazepines

• Alprazolam: FDA-approved for panic disorder with or without agoraphobia 3

Treatment Approach

First-Line Treatment: SSRIs

• SSRIs are the recommended first-line pharmacological treatment for panic disorder due to:
  • Better long-term safety profile
  • Lower risk of dependence
  • Effectiveness for comorbid conditions (depression, other anxiety disorders)
  • Sustained efficacy with continued use 4, 5

Benzodiazepines: Limited Role

• Alprazolam may be used for:
  • Short-term treatment
  • Rapid symptom control
  • Adjunctive therapy with SSRIs during initial weeks
  • Treatment-resistant cases 5, 6
• Important caution: Should be reserved for patients without history of substance dependence due to risk of tolerance and dependence 6

Medication Selection Considerations

When Selecting an SSRI:

• Sertraline and paroxetine have the strongest evidence base specifically for panic disorder 4, 7
• Consider pharmacokinetic differences:
  • Fluoxetine has a longer half-life (may be beneficial for patients who occasionally miss doses)
  • Paroxetine has more anticholinergic side effects and discontinuation symptoms
  • Sertraline has a more favorable drug interaction profile 2

Dosing Considerations

• Start with lower doses than used for depression (especially with paroxetine and fluoxetine)
• Gradually titrate to therapeutic doses to minimize initial anxiety/activation symptoms
• Higher doses may be required for optimal response in panic disorder compared to depression 2

Treatment Duration and Monitoring

• Continue treatment for at least 12 months after symptom remission
• Monitor for:
  • Treatment response (reduction in panic attack frequency and severity)
  • Side effects (particularly sexual dysfunction, activation symptoms)
  • Suicidal ideation, particularly in younger patients 4

Common Pitfalls to Avoid

1. Premature discontinuation: Patients often stop medication once symptoms improve, leading to relapse
2. Inadequate dosing: Underdosing is common in panic disorder treatment
3. Failure to address comorbid conditions: Depression and other anxiety disorders frequently co-occur with panic disorder
4. Overreliance on benzodiazepines: While effective short-term, they carry risks of dependence and cognitive impairment with long-term use
5. Abrupt discontinuation: All medications for panic disorder should be tapered gradually to minimize withdrawal symptoms

Remember that combining medication with cognitive behavioral therapy provides the most effective treatment outcomes for panic disorder 5, 8.