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When initiating a drug regimen for a patient with panic disorder, it is crucial for the patient to understand that the drug will block the panic attacks but may not necessarily decrease the amount of intervening anticipatory anxiety and avoidance, at least initially. For patients with severe anxiety, it can be helpful to initially prescribe a concomitant benzodiazepine that can be gradually tapered and discontinued after several weeks of antidepressant treatment. Also importantly, some patients with panic disorder display an initial hypersensitivity to antidepressants, whether TCAs or serotonin reuptake inhibitors, during which they complain of jitteriness, agitation, a speedy feeling, and insomnia. Although this is usually transient, it is one of the main reasons why patients unfortunately opt to discontinue medication early on. Therefore, it is strongly recommended that patients with panic disorder be started on lower dosages of antidepressants than would be given to depressed patients. The central feature in the treatment of panic disorder is the pharmacological blockade of the spontaneous panic attacks. Several classes of medications have been shown to be effective in accomplishing this goal, and a summary of the pharmacological treatment of panic disorder is presented in Table 12–8.

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Table Reference Number
TABLE 12–8. Pharmacological treatment of panic disorder

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