A 35-year-old woman with Panic Disorder has not responded to an adequate trial of an SSRI. According to current evidence-based pharmacotherapy guidelines, what is the most appropriate next step?
- A Switch to a tricyclic antidepressant such as imipramine
- B Augment with low-dose benzodiazepine long-term
- C Switch to an SNRI (e.g., venlafaxine ER) or try a second SSRI ✓
- D Add buspirone as first augmentation choice
Explanation
For Panic Disorder not responding to an initial SSRI trial, evidence-based guidelines recommend switching to an SNRI (venlafaxine ER has FDA approval for Panic Disorder) or trying a second SSRI before escalating to TCAs or benzodiazepine augmentation. Benzodiazepines (option B) are effective acutely but long-term use risks dependence and is not recommended as a maintenance strategy. Buspirone (option D) lacks evidence for panic disorder (it is used for GAD). TCAs like imipramine are effective but reserved for treatment-resistant cases due to their adverse effect profile.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
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Written and medically reviewed by the StethoPrep medical team.