Panic Disorder and SSRIs

Selective serotonin reuptake inhibitors (SSRIs) affect the concentration of the neurotransmitter serotonin, which plays a role in anxiety and may therefore help to treat panic disorders.

Common names include:

• Citalopram (Celexa)
• Fluvoxamine (Luvox)
• Paroxetine (Paxil)
• Fluoxetine (Prozac)
• Sertraline (Zoloft)
• Escitalopram (Lexapro)

Although these drugs are considered to be antidepressants, SSRIs have been used effectively for the treatment of panic and other anxiety disorders. Improvement is usually seen in 4-6 weeks after beginning treatment. SSRIs are not addictive. Do not take an SSRI if you have taken an MAOI in the last 2-5 weeks.

Read more details about SSRIs.

Possible side effects of SSRIs include:

• Drowsiness
• Dryness of mouth
• Blurred vision
• Nausea
• Dizziness
• Difficulty sleeping
• Sexual dysfunction
• Risk of severe mood and behavior changes
• Suicidal thoughts and actions

Gastrointestinal upset is the most common side effect that users experience. These include nausea, diarrhea, and cramping. It is commonly recommended that users take SSRIs with food and an antacid or antiemetic for the first 2-3 weeks of treatment.

SSRIs also activate the central nervous system, which can result in agitation, anxiety, restlessness, and insomnia.

FDA issued a warning that combining an SSRI with one of the commonly-used "triptan" medications for migraine headaches can cause serious side effects such as agitation, hallucinations, elevated body temperature, and rapid changes in blood pressure. (6)

Other side effects can include headache, dry mouth, excessive sweating, tremor, and sexual dysfunction.

Do not take selective serotonin inhibitors (SSRIs) with monoamine inhibitors (MAOIs).

The first SSRI on the market was fluoxetine (Prozac). The newer agents are: citalopram (Celexa), escitalopram (Lexapro), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft).⁸ They all share the same side effects but in varying degrees. Unlike TCAs, they interact very little with other receptors besides the serotonin 5-HT reuptake receptor. Their side effects tend to be related to increased serotonin activity: nausea, gastrointestinal upset, sweating, anxiety, insomnia, headache, restlessness, and sexual dysfunction. This class of drugs is prescribed for mild to moderate depression.⁸