What is the most effective Selective Serotonin Reuptake Inhibitor (SSRI) or Serotonin-Norepinephrine Reuptake Inhibitor (SNRI) for treating panic attacks?

From the FDA Drug Label

The effectiveness of sertraline in the treatment of panic disorder was demonstrated in three double-blind, placebo-controlled studies (Studies 1-3) of adult outpatients who had a primary diagnosis of panic disorder (DSM-III-R), with or without agoraphobia. Studies 1 and 2 were 10-week flexible dose studies. Sertraline was initiated at 25 mg/day for the first week, and then patients were dosed in a range of 50 to 200 mg/day on the basis of clinical response and toleration. The mean sertraline doses for completers to 10 weeks were 131 mg/day and 144 mg/day, respectively, for Studies 1 and 2 In these studies, sertraline was shown to be significantly more effective than placebo on change from baseline in panic attack frequency and on the Clinical Global Impression Severity of Illness and Global Improvement scores.

The best SSRI or SNRI for panic attacks is not explicitly stated in the provided drug labels, but sertraline is shown to be effective in the treatment of panic disorder.

• Sertraline was initiated at 25 mg/day for the first week, and then patients were dosed in a range of 50 to 200 mg/day.
• The mean sertraline doses for completers to 10 weeks were 131 mg/day and 144 mg/day.
• Sertraline was shown to be significantly more effective than placebo on change from baseline in panic attack frequency and on the Clinical Global Impression Severity of Illness and Global Improvement scores 1.

From the Research

Fluoxetine at a dose of 20 mg daily is a recommended SSRI for treating panic disorder, as it has been shown to be safe and efficacious in reducing symptoms of panic disorder 2. When considering the best SSRI or SNRI for panic attacks, it's essential to look at the most recent and highest quality studies.

• The study published in 2001 in The British journal of psychiatry found that fluoxetine at a dose of 20 mg daily was effective in reducing symptoms of panic disorder 2.
• Another study published in 1993 in The Journal of clinical psychiatry suggested that starting fluoxetine at a low dose, such as 5 mg daily, and gradually increasing to 20 mg daily may be beneficial for patients with panic disorder, especially those who are intolerant to higher doses 3.
• Additionally, a study published in 1999 in The Journal of clinical psychiatry found that once-weekly dosing of fluoxetine, ranging from 10 to 60 mg, was effective in maintaining remission in patients with panic disorder 4.
• Other studies, such as those published in 1997 and 1990, also support the use of SSRIs, including fluoxetine, for the treatment of panic disorder 5, 6. It's crucial to work with a healthcare provider to determine the best medication and dosage for individual patients, as responses to treatment can vary.
• The initial dose of fluoxetine can be started at 10 mg daily and increased to 20 mg daily as needed, with further dose increases up to 60 mg daily if necessary.
• Patients should be monitored for at least 8-12 weeks to see full benefits, and treatment should continue for 12-24 months after symptoms resolve to prevent relapse.
• In some cases, a short-term benzodiazepine like lorazepam may be added to provide immediate relief while waiting for the SSRI to take effect.