Anxiety and related disorders: SSRI jitteriness in panic disorder: 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 jitteriness in panic disorder

Sample item

A woman with panic disorder is started on sertraline 50 mg and returns after 4 days with greater anxiety, restlessness and more frequent attacks. She wants to stop. What is the best course?

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

The answer and the reasoning

D. Reassure, restart at a lower dose with slow titration, and consider brief cover

Patients with panic disorder are very sensitive to the early activating effects of SSRIs, which can transiently worsen anxiety. Starting at a low dose, increasing slowly and warning the patient, sometimes with short-term benzodiazepine cover, improves tolerance.

Option by option

  • A. Stop and label her as SSRI-resistant

    Four days is too short to judge resistance, which requires an adequate trial.

  • B. Double the dose immediately

    Doubling the dose is likely to worsen the early jitteriness.

  • C. Switch to a monoamine oxidase inhibitor

    An MAOI is not a sensible response to a transient early adverse effect.

  • D. Reassure, restart at a lower dose with slow titration, and consider brief cover (correct)

    Correct. Low starting doses, slow titration and reassurance manage early activation.

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.

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Questions about this Psychiatry question

What is the answer to this Psychiatry question?

The best answer is D, Reassure, restart at a lower dose with slow titration, and consider brief cover. Patients with panic disorder are very sensitive to the early activating effects of SSRIs, which can transiently worsen anxiety.

Why is "Stop and label her as SSRI-resistant" not the answer?

Four days is too short to judge resistance, which requires an adequate trial.

Why is "Double the dose immediately" not the answer?

Doubling the dose is likely to worsen the early jitteriness.

Why is "Switch to a monoamine oxidase inhibitor" not the answer?

An MAOI is not a sensible response to a transient early adverse effect.

What concept does this question test?

It tests Anxiety and related disorders: SSRI jitteriness in panic disorder in Psychiatry. Starting at a low dose, increasing slowly and warning the patient, sometimes with short-term benzodiazepine cover, improves tolerance.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. 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 jitteriness in panic disorder?

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.