A Medline search of research on pharmacotherapy was undertaken , and a previous systematic review on the evidence -based pharmacotherapy of panic disorder was up date d. Selective serotonin reuptake inhibitors remain a first-line pharmacotherapy of panic disorder , with the serotonin noradrenaline reuptake inhibitor venlafaxine also an acceptable early option .
Temporary co-administration of benzodiazepines can be considered .
For patients not responding to first-line agents several pharmacotherapy options are available , but there is a notable paucity of data on the optimal choice
The evidence -based pharmacotherapy of panic disorder continues to evolve .
This paper review s data on first-line pharmacotherapy , evidence for maintenance treatment , and management options for treatment-refractory patients .
A dose-finding and discontinuation study of clomipramine in panic disorder
Eighty-one panic disorder patients with or without agoraphobia were treated with flexible doses of clomipramine under single-blind conditions . Fifty-seven ( 70.3 % ) reached operational criteria for full remission in 16.2 ± 6.5 weeks , with a mean dose of 89.1 ± 8.2 mg/day . Fifty-four ( 81 % ) of them received a continuous post-remission maintenance treatment at full doses of clomipramine for 4–6 months . No patient relapsed during the clomipramine maintenance phase . Their medication was then tappered and discontinued with placebo substitution under double-blind conditions . Fifty-one ( 63 % ) patients were followed-up until relapse or recurrence for up to 3 years , with periodic assessment s. Three different outcome groups were identified : the first ( n = 19 , 19 ; 37.2 % ) experienced an early/immediate relapse ( 5.2 ± 4.9 weeks after drug discontinuation ) ; the second group ( n= 22 , 22 ; 43.1 % ) experienced recurrence after 42.9 ± 35 weeks following discontinuation ; and the third group ( n = 10 , 10 ; 19.6 % ) remained assymptomatic and functionally well throughout the follow-up . Predictors of early relapse were : ( 1 ) higher baseline score in the Beck Depression Inventory ; ( 2 ) higher global score on the phobic avoidance scale after the full remission criteria ; and ( 3 ) the need for  higher clomipramine  doses to reach full remission . The need for long-term or intermittent maintenance for most patients is emphasized
A Medline search of research on pharmacotherapy was undertaken , and a previous systematic review on the evidence -based pharmacotherapy of panic disorder was up date d. Selective serotonin reuptake inhibitors remain a first-line pharmacotherapy of panic disorder , with the serotonin noradrenaline reuptake inhibitor venlafaxine also an acceptable early option .
Temporary co-administration of benzodiazepines can be considered .
For patients not responding to first-line agents several pharmacotherapy options are available , but there is a notable paucity of data on the optimal choice
The evidence -based pharmacotherapy of panic disorder continues to evolve .
This paper review s data on first-line pharmacotherapy , evidence for maintenance treatment , and management options for treatment-refractory patients .