What to do when SSRIs fail: eight strategies for optimizing treatment of panic disorder.
Selective serotonin reuptake inhibitors (SSRIs) are the drug of choice for treatment of patients with panic disorder. Most patients have a favorable response to SSRI therapy; however, 30 percent will not be able to tolerate these drugs or will have an unfavorable or incomplete response. 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. Slower-onset, longer-acting benzodiazepines are preferred. All patients should be encouraged to try cognitive behavior therapy. Augmentation therapy should be considered in patients who do not have a complete response. Drugs to consider for use in augmentation therapy include benzodiazepines, buspirone, beta blockers, tricyclic antidepressants, and valproate sodium.
Zamorski
Mark A
MA
University of Michigan Medical School, Ann Arbor, USA.
Albucher
Ronald C
RC
D000465:Algorithms; D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D001569:Benzodiazepines; D015928:Cognitive Behavioral Therapy; D015897:Comorbidity; D006801:Humans; D016584:Panic Disorder / Q000188:drug therapy* / Q000628:therapy; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D017211:Treatment Failure
D014151:Anti-Anxiety Agents; D001569:Benzodiazepines; D017367:Selective Serotonin Reuptake Inhibitors