Treatment with a selective serotonin reuptake inhibitor (SSRI) such as sertraline is appropriate for this patient who meets the diagnostic criteria for panic disorder. Panic disorder is characterized by recurrent, unexpected, and abrupt surges of extreme anxiety that peaks within minutes and is accompanied by four or more of the following symptoms: palpitations, sweating, trembling, dyspnea, choking sensation, chest pain, nausea or abdominal pain, lightheadedness, chills or heat sensations, numbness or tingling, feeling detached from oneself, and fear of losing control or dying. Diagnosis requires that an attack be followed by at least 1 month of worry by the patient that he or she will experience a recurrent attack. Recommended treatment of panic disorder is a combination of cognitive-behavioral therapy and medication because this has been shown to be more effective than either treatment alone. Various forms of pharmacologic treatment for panic disorder are available: SSRIs, serotonin-norepinephrine reuptake inhibitors (SNRIs), benzodiazepines, tricyclic antidepressants, and monoamine oxidase inhibitors. SSRIs, SNRIs, benzodiazepines, and tricyclic antidepressants are equally effective in treating anxiety and reducing frequency of panic attacks. However, SSRIs are the mainstay of pharmacologic treatment for panic disorder because of side effects associated with the other drug classes. The initial SSRI dose should be low and gradually titrated upward, with the goal of elimination of panic attacks. If response is inadequate, then switching to another SSRI or another class of drug is recommended.

Benzodiazepines, such as alprazolam, are not recommended as the first treatment choice for panic disorder because of their side effects, including potential for dependency and withdrawal syndrome. However, benzodiazepines (such as clonazepam) may have a short-term role in combination with an SSRI for initial treatment of panic disorder. Such short-term (but not long-term) combinations result in more rapid resolution of symptoms and elimination of attacks than SSRI treatment alone.

Buspirone is effective in treating generalized anxiety disorder, but not panic disorder.

β-Blockers such as propranolol can reduce situation-specific anxiety symptoms (for example, public speaking) but are not effective as monotherapy for panic disorder.