Panic Disorder: The Daily PANCE Blueprint
A 32-year-old woman presents to her primary care physician with a 6-month history of recurrent, unexpected panic attacks. She reports intense fear, palpitations, trembling, and shortness of breath during these episodes, which occur about twice a week. She has become increasingly anxious about having another attack and has started avoiding social situations and public places. Which of the following is the most appropriate first-line treatment for the long-term management of this patient's condition?
A. Alprazolam (Xanax)
B. Amitriptyline
C. Sertraline (Zoloft)
D. Bupropion (Wellbutrin)
E. Buspirone (Buspar)
Answer and topic summary
The answer is C. Sertraline (Zoloft)
Selective serotonin reuptake inhibitors (SSRIs) are considered the first-line treatment for the long-term management of panic disorder. SSRIs, such as sertraline, have been shown to be effective in reducing the frequency and severity of panic attacks, as well as improving overall anxiety symptoms and quality of life. They are generally well-tolerated and have a favorable side effect profile compared to other antidepressants. SSRIs work by increasing the levels of serotonin in the brain, which helps to regulate mood and anxiety.
Incorrect Answers:
A. Alprazolam (Xanax) – Alprazolam is a benzodiazepine that can be used for the short-term relief of acute panic symptoms. However, benzodiazepines are not recommended for long-term treatment of panic disorder due to the risk of dependence, tolerance, and withdrawal symptoms. They should be used cautiously and only as a short-term adjunctive treatment when necessary.
B. Amitriptyline – Amitriptyline is a tricyclic antidepressant (TCA) that can be effective in treating panic disorder. However, TCAs are not considered first-line treatment due to their less favorable side effect profile compared to SSRIs. They can cause anticholinergic effects, sedation, and cardiac conduction abnormalities, which may limit their use in some patients.
D. Bupropion (Wellbutrin) – Bupropion is an antidepressant that works primarily by inhibiting the reuptake of dopamine and norepinephrine. While it can be effective for the treatment of depression and smoking cessation, it is not typically used as a first-line treatment for panic disorder. In fact, bupropion has been associated with an increased risk of anxiety and agitation in some patients.
E. Buspirone (Buspar) – Buspirone is an anxiolytic medication that works by modulating serotonin receptors in the brain. It can be effective for the treatment of generalized anxiety disorder (GAD) but is not considered a first-line treatment for panic disorder. Buspirone has a slower onset of action compared to SSRIs and may not be as effective in reducing the frequency and severity of panic attacks.
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