Panic Disorder — MRCPsych Paper B MCQ

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ModerateAnxiety & Stress-Related DisordersPanic DisorderMRCPsych Paper B

A 40-year-old man with moderate-to-severe panic disorder and agoraphobia has completed an adequate course of disorder-specific CBT but remains significantly impaired. He now prefers pharmacological treatment and has no contraindications to antidepressants. According to NICE CG113, which medication is the most appropriate to offer?

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Correct answer: A — Sertraline

A. Sertraline is correct. NICE CG113 recommends offering an SSRI licensed for panic disorder when pharmacological treatment is chosen; sertraline is licensed in the UK for panic disorder with or without agoraphobia. It is usually initiated at a low dose because SSRIs can transiently increase anxiety early in treatment. Diazepam should not be prescribed for panic disorder because benzodiazepines are associated with poorer long-term outcomes. Pregabalin is recommended in CG113 as an alternative for generalised anxiety disorder when SSRIs or SNRIs are not tolerated, not as standard treatment for panic disorder. Propranolol may reduce peripheral autonomic symptoms but is not a recommended treatment for the panic-disorder syndrome. Phenelzine is not a NICE-recommended routine pharmacological option for panic disorder.

Reference: National Institute for Health and Care Excellence. Generalised anxiety disorder and panic disorder in adults: management (CG113), recommendations 1.3.20 and 1.3.25, updated 2020. https://www.nice.org.uk/guidance/cg113/chapter/Recommendations