Treatment Guidelines for Panic Disorder

Drug of choice

SSRIs

Sertraline is recommended first-line per NICE Stepped Care Model

Second-line

MAOIs, Mirtazapine, Imipramine, Clomipramine, Venlafaxine

Experimental

Gabapentin, Inositol, Pindolol as augmentation

Psychotherapy     

CBT, Anxiety management

Canadian Mood and Anxiety Network Guidelines

First-line

• Citalopram
• Escitalopram
• Fluoxetine
• Fluvoxamine
• Paroxetine
• Paroxetine CR
• Sertraline
• Venlafaxine XR

Second-Line

1. Alprazolam
2. Clomipramine 
3. Clonazepam
4. Diazepam
5. Imipramine
6. Lorazepam
7. Mirtazapine
8. Reboxetine

Third-line

Bupropion SR, Divalproex, duloxetine, gabapentin, levetiracetam, milnacipran, moclobemide, olanzapine, phenelzine, quetiapine, risperidone, tranylcypromine

Adjunctive Therapy

Second-line: alprazolam ODT, clonazepam, Third-line: aripiprazole, Divalproex, olanzapine, pindolol, risperidone

Not Recommended

Buspirone, propranolol, tiagabine, trazodone