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Psychiatry


Answer 3
  1. Reassurance and decrease fluoxetine to 10 mg/ day. Patients with panic disorder are extremely sensitive to the activating side effects of SSRIs.7 This patient is most likely experiencing side effects of activation rather than an increase in anxiety symptoms. For this reason, SSRIs should be started at low doses (eg, ≥ 10 mg/day for fluoxetine).7 In this case, decreasing the dose will likely resolve symptom exacerbation. Increasing or discontinuing fluoxetine would not be recommended as initial management. If the patient is unable to tolerate even a low dose of fluoxetine, a trial of a different agent or augmentation with a benzodiazepine should be considered.

    REFERENCE
    7. Davidson JR, Conner KM. Treatment of anxiety disorders. In: Schatzberg AF, Nemeroff CB, editors. Textbook of psychopharmacology. Washington (DC): American Psychiatric Publishing; 2004:913-34.

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