What are the medications for panic disorder?

From the Guidelines

Medications for panic disorder include Selective Serotonergic Reuptake Inhibitors (SSRIs) and Serotonin Norepinephrine Reuptake Inhibitors (SNRIs).

SSRI Medications

• The SSRI class includes citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, and vilazodone 1
• These medications work by inhibiting the presynaptic reuptake of serotonin in the brain, increasing its availability and facilitating cognitive processing of emotions
• Although no specific SSRI has FDA approval for anxiety, the class as a whole has substantial empirical support for effectiveness and safety 1

SNRI Medications

• The SNRI class includes venlafaxine, desvenlafaxine, duloxetine, and levomilnacipran 1
• These medications inhibit the presynaptic reuptake of both norepinephrine and serotonin, modulating stress responses and anxiety
• Duloxetine is the only SNRI with an FDA indication for generalized anxiety disorder in children and adolescents 7 years old 1

Treatment Recommendations

• The American Academy of Child and Adolescent Psychiatry (AACAP) recommends offering SSRIs to patients 6 to 18 years old with panic disorder 1
• AACAP also suggests considering combination treatment with Cognitive Behavioral Therapy (CBT) and an SSRI for patients with panic disorder 1
• SNRIs may be offered as an alternative, considering factors such as pharmacokinetics, pharmacodynamics, and tolerability 1

From the Research

Medications for Panic Disorder

The following medications are used to treat panic disorder:

• Selective serotonin reuptake inhibitors (SSRIs) 2, 3, 4, 5, 6
• Serotonin-norepinephrine reuptake inhibitors (SNRIs) 2
• Tricyclic antidepressants (TCAs) 2, 5
• Benzodiazepines, such as alprazolam, for short-term treatment or in non-responsive cases 2, 3, 4, 5

Characteristics of Medications

• SSRIs are standard treatments for panic disorder and have a delayed onset of therapeutic effect 3
• Benzodiazepines have a rapid onset of action but can cause tolerance and dependence 3
• TCAs are as effective as modern antidepressants but are less well tolerated 2
• The choice of medication is based on side effect profiles and patient preferences 5

Combination Therapies

• Combining drug treatment with cognitive behavior therapy is the most successful treatment strategy for panic disorder 2, 4, 5, 6
• Combining an antidepressant with exposure in vivo produces the greatest treatment gains 6