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Strategies to improve management of such patients include optimizing SSRI dosing (starting at a low dose and slowly increasing the dose to reach the target dose) and ensuring an adequate trial before switching to a different drug.
While most patients have a favorable response to SSRI therapy, 30 percent will not be able to tolerate these medications or will have an unfavorable or incomplete response.1 Eight strategies to manage patients who have not tolerated initial therapy or who have had an unsatisfactory response to it are presented here.3 The initial activating effects of SSRIs and tricyclic antidepressants (TCAs) can be especially troubling.4 As a result, many patients abandon SSRI therapy before they experience any benefits.
Anecdotally, self-help groups like Agoraphobics in Motion, 1719 Crooks Rd., Royal Oak, MI 48067; telephone: 248-547-0400, can be inexpensive and helpful.22 Patients with panic disorder commonly have other comorbidities including mood and anxiety disorders, and substance use.23 Because these disorders may be associated with panic attacks and anticipatory anxiety23 and may require distinct treatments,4 the diagnosis of panic disorder should consistently trigger a systematic search for other anxiety disorders.22 Because the common comorbidities of panic disorder respond differentially to antipanic treatments, knowledge of these comorbidities also helps in treatment selection. I.),24 which takes less than 20 minutes to complete, is a more effective screening tool.
Unfortunately, most commonly used diagnostic and screening tools for mental health disorders in the primary care setting are not sufficiently comprehensive; the less familiar Mini-International Neuropsychiatric Interview (M. Finally, it is important to assess the risk of suicide in all patients who have panic disorder.18Because panic disorder is a chronic condition that often manifests early in adult life,25 comorbid mood disorders, substance use, and anxiety disorders can develop over time.
Typical starting, therapeutic, and maximum dosages for antidepressants are shown in Estimated cost based on typical therapeutic daily dose range to the pharmacist based on average wholesale prices in Red Book. Costs in parentheses are for generic drugs Estimated cost based on typical therapeutic daily dose range to the pharmacist based on average wholesale prices in Red Book. Costs in parentheses are for generic drugs The dosage of antidepressant should be slowly increased.
Clinical experience suggests that seven days is usually an appropriate interval.2Drug response varies with individual patients.