**5.2 Pharmacotherapy**

There are a large number of drugs that have been studied in patients with panic disorder, but no drug has proven superior to other drugs used in the treatment of patients with panic disorder. Pharmacological agents with sufficient evidence to support their use in the treatment of panic disorder include:


## *5.2.1 Antidepressants*

The modern treatment of panic disorder is based on the use of antidepressants from the selective serotonin reuptake inhibitor (SSRI) and antidepressants from the serotonin and noradrenaline reuptake inhibitor (SNRI). Use of these drugs has less danger of creating addiction and abuse than benzodiazepines. The disadvantage of these antidepressants is delayed by the onset of the positive effect and adverse effects that occur during treatment.

Clinical studies have demonstrated the significant efficacy of SSRI/SNRI drugs in the treatment of panic disorder. Certain differences in medication do not occur in terms of efficacy, but can be observed in terms of side effects, drug delivery methods during their use, and the occurrence of deterioration in dose reduction and upon discontinuation of the drug. Therefore, it is important to pay attention to these factors in the individual selection of medicines. The dosage of antidepressants effective in panic disorder is shown in **Table 1**.

### *5.2.1.1 Efficacy of antidepressants in acute phase treatment of panic disorder*

Antidepressants acting on the serotonergic system—citalopram, fluvoxamine, fluoxetine, paroxetine, sertraline [8, 16, 46, 61], the SNRIs venlafaxine and duloxetine [15, 35, 38, 58], and the TCAs imipramine and clomipramine [5, 39] are effective in treating acute phase of panic disorder.


#### **Table 1.**

*Dosage of antidepressants effective in panic disorder.*
