Panic Disorder Associated With Clozapine

Panic attacks after treatment with zuclopenthixol decanoate

“…In a study that examined the relationship between Parkinson's disease and panic attacks it was observed that panic attacks were exclusively present during periods where motor function was impaired and that after the ingestion of a new dose of levodopa, panic attack symptoms disappeared; the authors suggested that a lack of striatal dopamine could lead to disinhibition of the locus coeruleus and thereby precipitate panic attacks [14]. Takahashi et al [2] postulated that quetiapine was effective in ameliorating panic attacks because of its transient, versus prolonged, D2 receptor occupancy; if this were the case though, the same should be true of clozapine given its transient D2 occupancy [15], though it too has been associated with panic attacks [6]. The presence of extrapyramidal symptoms suggests a high degree of dopamine receptor occupancy [16]; in the case above, no such symptoms or signs were noted.…”

“…For instance, Takahashi et al [2] reported on three cases of people with schizophrenia, one of whose panic attacks resolved after switching from risperidone (10 mg daily) to quetiapine, though Takahashi et al [3] reported a patient with schizophrenia who experienced a cessation of panic attacks after switching to risperidone (3 mg daily) from haloperidol. There has been a report of new-onset panic attacks associated with the introduction of olanzapine (15 mg daily) [4] but, by contrast, a report on two cases of treatmentrefractory panic attacks suggested that starting olanzapine (between 10 and 12.5 mg daily) was of benefit [5], as it was in a woman with schizophrenia who experienced new onset panic attacks 20 weeks after being started on clozapine (400 mg daily) [6]. Dose may be of importance given Higuchi et al's [7] finding that there was a non-statistically significant trend towards higher chloropromazine-equivalent doses of neuroleptics among those who had schizophrenia and panic attacks compared to those with schizophrenia but without panic attacks.…”

Atypical Uses of Atypical Antipsychotics

“…These reports included cases in which there was new onset of panic symptoms in patients treated with clozapine, olanzapine, or risperidone; 32−34 in two of these cases, symptoms resolved with a change to an alternate AAP or with the addition of a benzodiazepine. 33,34 Others report clinical improvement in panic symptoms with olanzapine augmentation of benzodiazepines, nefazodone, or SRIs. 35,36 Data on the use of AAPs in anxiety-spectrum disorders other than OCD, PTSD, and panic are quite limited.…”

Potential effectiveness and safety of olanzapine in refractory panic disorder

“…There are two reports of two cases each where panic attacks were ablated when olanzapine was added to other anti-panic medications [Etxebeste et al, 2000;Khaldi et al, 2003]. Contrarily, we know of two case reports of new-onset panic attacks associated with olanzapine and clozapine therapy for schizophrenia [Bressan et al, 2000;Mandalos and Szarek, 1999].…”