Citalopram for panic disorder (with or without agoraphobia) Case report

Abstract

This article discusses the role of citalopram, a selective serotonin reuptake inhibitor (SSRI), in the treatment of panic disorder (with or without agoraphobia), highlighting its efficacy confirmed in clinical trials and recommending it as first-line treatment. According to the summary of product characteristics, therapy should be initiated at 10 mg daily, gradually increasing the dose to 20 mg (maximum 40 mg), which reduces the risk of a transient increase in anxiety at the beginning of treatment. An integrated approach combining pharmacotherapy with cognitive behavioral therapy (CBT) yields the best results, as the medication reduces symptoms while psychotherapy affects the pathomechanisms maintaining the disorder. The article emphasizes the importance of psychoeducation, monitoring for adverse effects (including the risk of QT prolongation), and adequate maintenance treatment. A stepped-care model and clinical examples illustrating the practical use of citalopram in patients with varying clinical presentations and somatic burdens are also presented. Careful dose titration, tapering planning, and concurrent implementation of CBT are crucial to maintain therapeutic benefit and reduce the risk of relapse.