What are the recommended pharmacological treatments for panic disorder, and how do they compare in efficacy?

Recommended pharmacological treatments for panic disorder include antidepressants as the only pharmacological option for longer-term management. The classes with evidence of effectiveness are selective serotonin reuptake inhibitors (SSRIs), serotonin-noradrenaline reuptake inhibitors (SNRIs), and tricyclic antidepressants (TCAs) ¹.

Specifically, escitalopram, sertraline, citalopram, paroxetine (all SSRIs), and venlafaxine (an SNRI) are licensed for panic disorder treatment ¹.

Benzodiazepines and sedating antihistamines or antipsychotics are not recommended due to poorer long-term outcomes and lack of evidence for efficacy ¹.

When choosing among antidepressants, factors such as patient age, previous treatment response, risk of overdose or self-harm (highest with TCAs), tolerability, drug interactions, patient preference, and cost should be considered ¹.

Regarding efficacy, SSRIs and SNRIs are generally preferred due to better tolerability and safety profiles compared to TCAs, which carry higher overdose toxicity risk ¹.

All antidepressants may initially increase anxiety symptoms, and patients should be informed about side effects and withdrawal risks ¹.