A physician wants to add a benzodiazepine for the first two weeks of treatment in a patient beginning an SSRI for panic disorder, to cover the period before the antidepressant takes effect. Which agent is classically preferred for this purpose?
- A Diazepam
- B Chlordiazepoxide
- C Clonazepam ✓
- D Temazepam
Correct answer: C. Clonazepam
Explanation
High-potency benzodiazepines with reliable oral absorption, principally clonazepam and alprazolam, are the traditional adjuncts during the lag phase of SSRI treatment in panic disorder. Clonazepam's longer half-life gives smoother plasma levels and less interdose rebound than alprazolam. Diazepam and chlordiazepoxide are low-potency agents with active metabolites and erratic absorption, making them unsuitable, and temazepam is a hypnotic without anti-panic evidence.
Reference: Kaplan and Sadock's Synopsis of Psychiatry, 12th ed.
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