Anxiety and related disorders: SSRI initiation in panic: practice question

A Psychiatry question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Psychiatry · Anxiety and related disorders: SSRI initiation in panic

Sample item

A woman with panic disorder started sertraline at a high dose and within a week had increased anxiety, tremor and insomnia. She is willing to retry an SSRI. How should treatment be started?

AAn SSRI combined with an MAOIBA long-acting benzodiazepine as sole long-term therapyCA low starting dose with gradual titrationDThe maximum dose to hasten response

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. A low starting dose with gradual titration

In panic disorder patients are sensitive to activating effects of SSRIs, so initial anxiety can worsen. Starting at a low dose, titrating slowly and sometimes covering the first weeks with a short course of a benzodiazepine improves tolerability and adherence.

Option by option

A. An SSRI combined with an MAOI
Combining an SSRI with an MAOI risks serotonin syndrome.
B. A long-acting benzodiazepine as sole long-term therapy
Long-term benzodiazepine monotherapy risks dependence and is not first-line.
C. A low starting dose with gradual titration (correct)
Correct. Low dose, slow titration reduces early jitteriness.
D. The maximum dose to hasten response
A high starting dose would reproduce the early worsening of anxiety.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Psychiatry question

What is the answer to this Psychiatry question?

The best answer is C, A low starting dose with gradual titration. In panic disorder patients are sensitive to activating effects of SSRIs, so initial anxiety can worsen.

Why is "An SSRI combined with an MAOI" not the answer?

Combining an SSRI with an MAOI risks serotonin syndrome.

Why is "A long-acting benzodiazepine as sole long-term therapy" not the answer?

Long-term benzodiazepine monotherapy risks dependence and is not first-line.

Why is "The maximum dose to hasten response" not the answer?

A high starting dose would reproduce the early worsening of anxiety.

What concept does this question test?

It tests Anxiety and related disorders: SSRI initiation in panic in Psychiatry. Starting at a low dose, titrating slowly and sometimes covering the first weeks with a short course of a benzodiazepine improves tolerability and adherence.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Anxiety and related disorders: SSRI initiation in panic?

Learn each diagnosis by its core features and its first-line treatment. Then use the flashcards and the other Psychiatry questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.