Rosh Psychiatry Board Practice Exam

What is the most appropriate first-line therapy for a patient experiencing recurrent panic attacks without other disorders?

1. Bupropion

2. Clomipramine

3. Phenelzine

4. Venlafaxine

The correct answer is: Venlafaxine

The most appropriate first-line therapy for a patient experiencing recurrent panic attacks without other disorders is indeed venlafaxine. This medication is a serotonin-norepinephrine reuptake inhibitor (SNRI) that has shown efficacy in treating panic disorder. Venlafaxine works by increasing the levels of serotonin and norepinephrine in the brain, which can help alleviate the frequency and intensity of panic attacks. Venlafaxine is particularly beneficial because it is effective at treating both anxiety and depressive symptoms, making it suitable for patients who might experience comorbid anxiety or depressive disorders. In clinical practice, it is often preferred for panic disorder due to its favorable profile compared to other medications. The other options may offer some benefits but are not as appropriate for first-line treatment in uncomplicated panic disorder. For instance, bupropion, primarily used for depression and smoking cessation, can potentially increase anxiety levels and is not typically prescribed for panic attacks. Clomipramine, a tricyclic antidepressant, is also effective for panic disorder; however, it is usually considered when first-line options like SSRIs or SNRIs are ineffective or not tolerated. Phenelzine, a monoamine oxidase inhibitor, is generally reserved for resistant cases and has