What is the role of SSRIs and TCAs in the management of panic disorder?

Updated: Mar 21, 2018
  • Author: Mohammed A Memon, MD; Chief Editor: Randon S Welton, MD  more...
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Selective serotonin reuptake inhibitors (SSRIs) (e.g., citalopram, escitalopram, fluoxetine, sertraline, paroxetine and paroxetine controlled release, fluvoxamine) are generally used as first-line pharmacologic agents in panic disorder, followed remotely by tricyclic antidepressant agents (TCAs) (e.g., imipramine, desipramine, nortriptyline, clomipramine). [55, 56]

The National Collaborating Centre for Mental Health practice guidelines indicate that TCAs such as imipramine or clomipramine may be considered for the management of panic disorder if an SSRI is not suitable or if there is no improvement after a 12-week course of SSRI treatment. [56] (Prior to the use of SSRIs for panic disorder, the TCAs and the monoamine oxidase inhibitors [MAOIs] were used much more commonly for this condition.) In addition to SSRIs, the APA reported that there is strong support from randomized controlled trials for the effective use of serotonin-norepinephrine reuptake inhibitors (SNRIs) (e.g., venlafaxine, duloxetine) as the initial treatment of panic disorder. [55]

Citalopram (Celexa) and escitalopram (Lexapro) are likely to cause fewer hepatic enzyme interactions than other SSRIs and may be appropriate initial choices for patients with complicated medical regimens or for those who are concerned about drug interactions.

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