Management of Panic Attacks with Sertraline and Clonazepam

Medication Management

• The American Academy of Child and Adolescent Psychiatry recommends monitoring for common side effects of sertraline, including gastrointestinal symptoms, insomnia, sexual dysfunction, and potential for discontinuation syndrome 1, 2
• The American Academy of Sleep Medicine suggests that long-term benzodiazepine use carries risks of tolerance, dependence, and cognitive effects, making tapering necessary 3
• The American Academy of Child and Adolescent Psychiatry advises scheduling follow-up appointments every 1-2 weeks during the clonazepam taper to monitor for withdrawal symptoms or panic recurrence, and to assess for any signs of discontinuation syndrome during the taper 1, 2
• If sertraline alone proves insufficient after clonazepam discontinuation, the American Academy of Child and Adolescent Psychiatry recommends considering switching to another SSRI or SNRI 1, 4

Special Considerations

• The American Academy of Child and Adolescent Psychiatry suggests that continuing benzodiazepines indefinitely without attempting tapering can lead to tolerance and dependence, and recommends tapering clonazepam gradually 3
• The American Academy of Child and Adolescent Psychiatry advises recognizing that sertraline may take 4-6 weeks to reach full therapeutic effect for panic disorder, and to be aware of the potential for discontinuation syndrome with both medications, particularly with abrupt discontinuation 1, 2