Which is first-line long-term management for Panic Disorder?

• A. SSRI
• B. Benzodiazepine monotherapy
• C. MAOI
• D. TCA

Answer: (A)

The main concept is that long-term management of panic disorder is best started with an SSRI. SSRIs effectively reduce the frequency of panic attacks and overall anxiety, and they have a favorable safety and tolerability profile compared with older antidepressants. They also pair well with cognitive behavioral therapy, which helps patients confront and modify the thoughts and avoidance behaviors that accompany panic. It’s important to recognize that benzodiazepines, while useful for short-term relief or as a bridge until an SSRI takes effect, are not preferred for long-term monotherapy due to risks of dependence, tolerance, and withdrawal. Older options like MAO inhibitors and tricyclic antidepressants carry more side effects and safety concerns, making them less favorable as first-line choices. In short, starting an SSRI—often alongside CBT—is the best long-term strategy for panic disorder.