Risperidone in augmentation treatment of panic disorder: A case of patient after the treatment with repetitive transcranial magnetic stimulation (rTMS)
Abstract
Summary: Panic disorder is severe and often disabled disorder, which life-time prevalence is ranging between 4 - 8%. Despite standard treatment 20 - 40% patients remain symptomatic.
Case report: A 42 - year - old woman with a history of panic disorder (20 years) was hospitalized for a relapse of panic disorder with agoraphobia. History of her treatments included SSRI's and behavioral psychotherapy (exposure in vivo).
During hospitalization she was treated with combination of paroxetine in long - term treatment (40mg pd) and slow repetive transcranial magnetic stimulation (rTMS) over the right dorsolateral prefrontal cortex for 2 weeks (10 sessions, 1 Hz, 100% of motor treshold, 1800 pulses per session). Improvement of her clinical status (40% reduction of score on Panic Disorder Severity Scale) was unstable and anxiety (including panic attacks) became worse 2 weeks after finishing of rTMS.
Atypical antipsychotic risperidone (1 mg pd) was added to paroxetine. She did not describe any adverse effects during this treatment.
Results: After 2 weeks of augmentation of paroxetine by risperidone score on Panic Disorder Severity Scale decreased about 58%, her score on Beck Anxiety Inventory about 66% and score on Clinical Global Impression about 25%. This improvement was stable next 3 months.
Conclusion: Our case report showed potential usefulness of combination (augmentation) SSRI and risperidone in the treatment of panic disorder.