A 26-year-old woman experiences recurrent, unexpected panic attacks with palpitations, dyspnea, derealization, and fear of dying. Between attacks she has persistent worry about future attacks for 2 months and avoids shopping malls. What is the pharmacological first-line agent and the minimum treatment duration recommended before assessing non-response?
- A SSRI (e.g., escitalopram); 8–12 weeks at adequate dose ✓
- B Alprazolam; 2 weeks
- C Buspirone; 4 weeks
- D Propranolol; 6 weeks
Explanation
SSRIs are first-line pharmacotherapy for panic disorder per international guidelines (APA, NICE). An adequate trial requires 8–12 weeks at therapeutic doses because anti-panic effects are delayed (4–8 weeks for full response). Alprazolam (a benzodiazepine) provides rapid symptom relief but carries risks of dependence, cognitive impairment, and rebound anxiety; it may be used short-term adjunctively but is not first-line monotherapy. Buspirone is effective for GAD but has limited evidence in panic disorder. SSRIs reduce both frequency of panic attacks and anticipatory anxiety.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
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