Is it okay to take panic disorder medication for over 10 years? The key to safe discontinuation is 'gradualness'

Recently, as a celebrity revealed through a broadcast that they have been taking medication for panic disorder for over 10 years, patients' anxiety regarding long-term use is increasing. Many patients worry, "Will I have to depend on medication for the rest of my life?" or "Is long-term use harmful to my body?" According to a video from Uihak Channel Biondwi, the core of pharmacological treatment for panic disorder is not simply stopping the medication, but improving the patient's quality of life.

The difference in roles between lead antidepressants and supporting benzodiazepines

Panic disorder medications are largely divided into 'antidepressants,' which are the center of treatment, and 'benzodiazepines (anti-anxiety drugs),' which alleviate urgent symptoms. Kim Gi-won, director of Gaya Samsung Psychiatry Clinic, compares them to 'lead actors' and 'supporting actors.' Antidepressants (such as SSRIs, SNRIs, etc.) play the lead role as the center of treatment, but they have the characteristic that it takes time for their effects to appear. Director Kim explains, "Antidepressants are so slow that patients often feel the side effects first in the early stages, while the effects are felt a bit later."

On the other hand, benzodiazepines play the supporting role of 'extinguishing the urgent fire,' quickly alleviating anxiety or panic symptoms. However, both types of drugs require caution. If antidepressants are stopped suddenly, 'discontinuation symptoms' such as sweating, nausea, or dizziness may appear. Benzodiazepines can also cause withdrawal symptoms if stopped abruptly. Therefore, when reducing or stopping medication, one must consult with their primary physician to adjust the dosage gradually. In particular, global guidelines emphasize reducing benzodiazepines very slowly.

Major drugs currently used in clinical practice include SSRIs such as paroxetine, sertraline, and fluoxetine, which are approved by the FDA, and SNRIs such as venlafaxine (extended-release). In the benzodiazepine class, alprazolam and clonazepam are commonly used. In Korean guidelines, escitalopram is also mentioned as a drug that experts may prioritize for consideration.

Side effects depending on the type of drug and personalized selection

The drugs used to treat panic disorder are selected in a very diverse manner depending on the patient's condition and comorbid diseases. The most widely used SSRI (Selective Serotonin Reuptake Inhibitor) class has abundant evidence for treatment, but about 40–60% of patients may experience sexual dysfunction or gastrointestinal symptoms (nausea, bloating). Some drugs may actually induce agitation in the early stages.

Among the SNRI class, venlafaxine (extended-release) tends to increase blood pressure when taken in high doses, so patients with hypertension need to be careful. Additionally, the highly effective TCA class antidepressants (imipramine, clomipramine, etc.) are sometimes considered as a lower priority because they have strong side effects such as dry mouth, constipation, drowsiness, and anticholinergic effects. Beta-blockers (such as Indenol) are used to alleviate physical symptoms, but their use may be limited for patients with diabetes, asthma, chronic obstructive pulmonary disease (COPD), or arrhythmia. In addition, bupropion, buspirone, and antihistamines may be selected according to the patient's characteristics.

Ultimately, medical staff decide on the optimal medication by comprehensively considering the side effects the patient has experienced in the past, comorbid diseases, preference for certain drugs, and interactions with other medications currently being taken. Drug selection is based not only on the level of evidence but also on how well the patient can tolerate the drug (tolerability) as an important criterion.

The true goal of panic disorder treatment is 'improving quality of life'

Many patients set 'zero (0)'—completely stopping medication—as their goal, but the ultimate goal of panic disorder treatment is not to avoid taking medication altogether. Director Kim Gi-won emphasizes, "The goal of panic disorder treatment is ultimately to improve the quality of life so that even if panic attacks occur, the patient can live well without feeling significant discomfort in their daily life."

To this end, it is very important to combine pharmacological treatment with 'cognitive behavioral therapy.' While medication helps control physical symptoms and prevents the recurrence of anxiety, cognitive behavioral therapy corrects erroneous thoughts about panic symptoms (referred to as 'shock' in the video) or excessive fear regarding physical sensations. Furthermore, helping patients reduce avoidance behavior and return to daily life through methods such as exposure therapy, which involves gradually facing specific situations, is a core pillar of treatment.