First-Line Treatment for Agoraphobia
For agoraphobia associated with panic disorder, first-line treatment is referral for cognitive behavioral therapy (CBT) and consideration of an antidepressant when symptoms are moderate to severe or psychological therapy is declined or not effective.[1]
Medication Selection Algorithm
Antidepressants are the only pharmacological intervention recommended for longer-term management of panic disorder with or without agoraphobia.[1]
- Selective serotonin reuptake inhibitors (SSRIs) (escitalopram, sertraline, citalopram, paroxetine) are recommended as evidence-based antidepressant options for longer-term management.[1]
- Serotonin–norepinephrine reuptake inhibitors (SNRIs) (venlafaxine) are recommended as evidence-based antidepressant options for longer-term management.[1]
- Tricyclic antidepressants (TCAs) are recommended as evidence-based antidepressant options for longer-term management.[1]
Core Recommendation for Psychological Treatment
CBT should be used for panic disorder with or without agoraphobia.[1]
Monotherapy Versus Combination Therapy
CBT or an antidepressant is recommended for moderate to severe panic disorder (with or without agoraphobia) as the referral options.[1]
Important Clarifications and Nuances
Benzodiazepines should not be prescribed for the treatment of panic disorder due to less good long-term outcomes.[1] Sedating antihistamines and antipsychotics should not be prescribed for the treatment of panic disorder.[1]
Initiation Thresholds and Indications
Referral for CBT or an antidepressant should be considered for moderate to severe panic disorder (with or without agoraphobia).[1] An antidepressant should be considered when the disorder is long-standing or when psychological intervention has not benefitted or has been declined.[1]
Common Pitfalls to Avoid
Benzodiazepines should not be used for long-term management of panic disorder.[1] Sedating antihistamines and antipsychotics should not be used for panic disorder treatment.[1]
Treatment Goals of Therapy
Longer-term management should use evidence-based antidepressants or CBT rather than benzodiazepines, sedating antihistamines, or antipsychotics.[1]