Venlafaxine treatment of panic disorder: a case series

Venlafaxine inhibits the neuronal reuptake of both serotonin and norepinephrine and has been shown to be an effective antidepressant; however, its potential efficacy in treating panic disorder has not yet been evaluated.

Four consecutive patients with panic disorder were administered low doses of venlafaxine in an open-label, nonblinded trial. Outcome data were obtained at regular intervals via detailed clinical exploration and patient self-report. In no case was any depth psychotherapy or attempt at conflict resolution provided.

Panic attacks were completely eliminated in the first four patients with panic disorder that I treated with low doses of venlafaxine. Three of these patients experienced no further panic attacks after the institution of venlafaxine therapy. The total daily maintenance doses used were between 50 and 75 mg/day, and the effective starting doses were even lower.

The resolution of panic disorder in all four patients treated with low doses of venlafaxine suggests that venlafaxine might be an effective treatment for panic disorder. Moreover, the rapid, apparently immediate, disappearance of panic attacks after the initiation of venlafaxine in three of four patients raises the possibility that this agent may have an unusually fast onset of action. The efficacy of low doses of venlafaxine or the need to start treatment with very low doses in patients with panic disorder was predicted by experience with other monoamine reuptake inhibitors in this patient population. Double-blind, placebo-controlled studies of venlafaxine in panic disorder are indicated.