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Nefazodone15 and mirtazapine16 are also likely to be useful in treating panic disorder; use of these agents has a low risk of sexual dysfunction.17 Benzodiazepines may be an appropriate alternative if there is no contraindication to their use and if patients are not able to tolerate an antidepressant trial.18 CBT is presumably free of sexual side effects.
Depression is usually associated with loss of appetite and weight loss, but it can also result in increased appetite and weight gain.
There aren't many well-controlled studies on the effectiveness of different treatments for concurrent depression and insomnia.
The basic premise of CBT is that internal cognitive distortions (e.g., “My heart is beating too fast,” or “I’m going to die.”) are linked with maladaptive behaviors (e.g., fleeing a crowded room), which are then reinforced because this behavior usually temporarily reduces anxiety.19The gains made with CBT tend to be maintained after the treatment is discontinued, which is generally not the case for pharmacotherapy.10 The high initial cost for the treatment may be offset by savings in the cost of long-term medications.
CBT is particularly effective for agoraphobic or avoidance symptoms, an area where medication alone has limited benefit.20 CBT can also reduce the risk of relapse during a medication taper.20 Finally, panic disorder may be refractory to medications alone; CBT can be useful in these cases.216 The monthly cost of SSRI therapy can exceed $100 for the higher dosages of medication that are often required.21 Imipramine (Tofranil) has proven efficacy in treating panic disorder, depression, and generalized anxiety disorder.
Most patients should receive one half of the usual beginning dose of SSRIs and TCAs that would be prescribed for the treatment of depression.15 For patients who have had negative experiences with other medications or who seem unusually apprehensive, one fourth of the usual beginning dose can be used. Cost to the patient will be higher, depending on prescription filling fee Based on the lowest average wholesale price for a one-month supply (without splitting tablets) for the range of dosages typically used to treat panic disorder. Cost to the patient will be higher, depending on prescription filling fee Based on the lowest average wholesale price for a one-month supply (without splitting tablets) for the range of dosages typically used to treat panic disorder.