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Accordingly, as long as some meaningful improvement occurs in four to six weeks after initiation of therapy, several months should be allowed to pass before assessing the full effect of the drug and considering a change in therapy.1Benzodiazepines are effective in treating panic disorder5; they are also used to treat generalized anxiety disorder and social phobia, two common comorbidities of panic disorder.

In contrast to antidepressants, benzodiazepines relieve anxiety within hours,7 can prevent panic attacks within a few days to a few weeks,5 and are free of troublesome activating effects.7 Nevertheless, benzodiazepine use in treating panic disorder can be complicated by abuse, physiologic and psychologic dependence, and sedative and neurocognitive side effects.7Beta blockers, once widely touted as effective antipanic medications, have proven disappointing as monotherapy in subsequent placebo-controlled trials.5 Buspirone (Bu Spar) is ineffective as monotherapy for panic disorder, as is the antidepressant bupropion (Wellbutrin).5 Traditional forms of psychotherapy (psychodynamic, insight-oriented, and supportive) have little proven benefit in treating panic disorder, but they may be efficacious in treating comorbidities or to help patients adapt to their condition.10When directly questioned by a physician, about 60 percent of patients who take SSRIs report experiencing sexual dysfunction, including delayed orgasm, anorgasmia, loss of libido, decreased lubrication, and erectile dysfunction11; that number drops to 14 percent when patients spontaneously report the information.12 Only 25 percent of these patients with sexual dysfunction report being able to tolerate this side effect—presenting a major challenge because of the long-term nature of the treatment.12In general, the sexual dysfunction is dose-related and responds to reductions in the total amount of antidepressant medication used.1112 Occasionally, patients can successfully alter the time of dosing or skip doses prior to sexual activity.

They also have an increased risk of recurrence of depression, and there is some evidence that people with depression also experience suicidal thoughts.

CBT, a form of psychotherapy that is usually short-term and focused on symptom resolution through the observation and change of cognitive distortions and their subsequent behaviors, should be encouraged in patients with panic disorder.Augmentation therapy should be considered in patients who do not have a complete response.Drugs to consider for use in augmentation therapy include benzodiazepines, buspirone, beta blockers, tricyclic antidepressants, and valproate sodium.It may take several months for the patient to feel confident that he or she is free of panic attacks.It may take even longer before patients stop avoiding feared situations and are relieved of generalized anxiety.

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Effective management of panic disorder is a common challenge for family physicians.