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Treatment of panic disorder in primary care

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

  • choice of treatment will be a consequence of the assessment process and shared decision-making

General principles

  • benzodiazepines are associated with a less good outcome in the long term and should not be prescribed for the treatment of individuals with panic disorder
  • sedating antihistamines or antipsychotics should not be prescribed for the treatment of panic disorder
  • in the care of individuals with panic disorder, any of the following types of intervention should be offered and the preference of the person should be taken into account. The interventions that have evidence for the longest duration of effect, in descending order, are:
    • psychological therapy
    • pharmacological therapy (antidepressant medication)
    • self-help

Psychological interventions

  • cognitive behavioural therapy (CBT) should be used
  • CBT in the optimal range of duration (7-14 hours in total) should be offered
  • for most people, CBT should take the form of weekly sessions of 1-2 hours and should be completed within a maximum of 4 months of commencement
  • briefer CBT should be supplemented with appropriate focused information and tasks
  • where briefer CBT is used, it should be around 7 hours and designed to integrate with structured self-help materials
  • for a few people, more intensive CBT over a very short period of time might be appropriate

Pharmacological interventions - antidepressant medication

Antidepressants should be the only pharmacological intervention used in the longer term management of panic disorder

  • the two classes of antidepressants that have an evidence base for effectiveness are the selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs)
  • unless otherwise indicated, an SSRI licensed for panic disorder should be offered
  • if an SSRI is not suitable or there is no improvement after a 12-week course and if a further medication is appropriate, imipramine or clomipramine may be considered


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