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Home Formulary 4.0 Central Nervous System 4.3 Antidepressant drugs 4.3.2 Antidepressants for the treatment of anxiety disorders* 4.3.2.2 Panic disorder

4.3.2.2 Panic disorder

ChoiceDrugDosage
1st choiceNon –pharmacological treatment
2nd choicesCitalopram tablets 10mg, 20mg, 40mgDose:
Initially 10mg daily, increased gradually if necessary in steps of 10mg daily, usual dose 20-30mg daily; max 40mg daily (elderly over 65 years, max 20mg daily)
Or
Sertraline tablets 50mg, 100mgDose:
Initially 25mg (half a tablet) daily, increased after one week to 50mg daily; if response is partial and if drug tolerated, dose increased in steps of 50mg at intervals of at least one week to max 200mg daily

Prescribing Notes

  • Refer to NICE CG113 Generalised Anxiety Disorder and Panic Disorder
  • Treatment options include psychological, pharmacological and self-help approaches
  • Before starting antidepressants refer to NICE NG215 for information that should be considered and discussed with the patient, including steps to reduce the risk of dependence or withdrawal symptoms
  • In panic disorder, symptoms frequently get worse before they get better after starting a SSRI
  • Most patients will require a SSRI for 6–12 months before the gradual discontinuation of treatment

Cautions

See section 4.3.1

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