Social Anxiety Disorder and Panic Disorder 2026

What does panic disorder consist of?

Recurrent, unexpected panic attacks.

A panic attack is an intense surge fo fear with at least four symptoms:

-Palipations

-Sweating

-Nausea

-Feeling dizzy

-Fear of dying

-Fear of losing control

What are the first line options for panic disorder?

CBT

SSRI

SNRI (Venlafaxine)

Which of the following is the most appropriate second line option for panic disorder?

a. a different first-line agent

b. phenelzine

c. gabapentin

d. propranolol

a. a different first line agent

Which SNRI is FDA approved and specifically recommended for panic disorder?

a. desvenlafaxine

b. duloxetine

c. paroxetine

d. venlafaxine

d. venlafaxine

(paroxetine is an SSRI not SNRI, the other options are not FDA approved for panic disorder)

The doctor would like to start a benzodiazepine short term while titrating sertraline for panic disorder. Which of the following is most appropriate?

a. alprazolam 0.5 mg twice daily as needed for panic attacks

b. clonazepam 0.5 mg twice daily

c. gabapentin 300 mg twice daily

d. imipramine 75 mg daily

b. clonazepam 0.5 mg twice daily

a is incorrect because you don't do PRN benzos for panic disorder. C and D are not benzos.

A patient wants to know how quickly fluoxetine will work for panic disorder. How do you counsel her?

Although you may notice some effects in the first few weeks, the full effect takes 8-10 weeks on average

What differentiates social anxiety disorder from generalized anxiety disorder?

Generalized occurs in many situations, social anxiety disorder is anxiety about social situations only

What are the first line options for social anxiety disorder?

CBT

SSRI

SNRI (Venlafaxine)

Which medication is sometimes trialed for performance anxiety?

Propranolol, take it 1-2 hours prior to the performance

Can you use any SSRI first line for social anxiety disorder?

Yes, of note paroxetine and sertraline are FDA approved so these may be more commonly recommended, but it is appropriate to recommend another SSRI as first line

What is the brand name of fluoxetine?

Prozac

What is the brand name of sertraline?

Zoloft

What is the brand name of paroxetine?

Paxil

What is the brand name of venlafaxine?

Effexor

What is the mechanism of action of benzodiazepines?

GABA-A agonist (GABA is an inhibitory neurotransmitter, so agonizing this calms the brain and is sedating - helps with anxiety, also used for seizures, insomnia, alcohol withdrawal and more)

What is the brand name of alprazolam?

Xanax, very common med, commonly misused

What are some long-term risks of benzodiazepine use?

Addiction potential

Dementia

Withdrawal potential (if stopped suddenly)

Which of the following is a TCA?

a. clonazepam

b. clomipramine

c. mirtazapine

d. sertraline

b. clomipramine

Which hypertension medication can be used for performance anxiety?

Propranolol (Inderal)