Zoloft, also known by the generic name sertraline, is an antidepressant medication in the SSRI class (Selective Serotonin Reuptake Inhibitor). Zoloft is prescribed for panic disorder, and is a popular medication amongst all the SSRIs, as it is relatively well tolerated and easy to dose.
For panic disorder, you can start off by taking 25mg, once daily for 1 to 2 weeks, then increase by 25mg every 1 to 2 weeks. If you experience significant side effects on the 25mg daily to start, then decrease the dose to 12.5mg daily, and increase by 12.5mg every 1 to 2 weeks. The therapeutic dose for panic disorder is at least 50mg once daily, and can be titrated up to a maximum dose of 200mg daily for clinical effect.
The problem with SSRIs is that they can take 4 to 6 weeks before they are effective at reducing your anxiety symptoms. If you have significant anxiety symptoms and panic attacks, then you probably can’t wait 4 to 6 weeks until Zoloft becomes effective. So one option your doctor can consider is adding a benzodiazepine until the Zoloft takes effect weeks later. The advantage of benzodiazepines for anxiety is that it works immediately for anxiety relief. However, benzodiazepines have several disadvantages, which include short duration of action and addictive potential. To overcome these disadvantages of benzodiazepines, they should be prescribed for short periods of time to reduce the risk for addiction. Also, using a long-acting benzodiazepine such as Klonopin (clonazepam) can help to keep the benzodiazepine blood level more steady, and hence the duration of action is longer.
Klonopin can be initiated at the same time Zoloft is started for panic disorder. Klonopin can be started at 0.5mg twice daily, and may be increased to 1mg twice daily if needed. Once the Zoloft becomes effective for the anxiety symptoms weeks later, then the Klonopin can be slowly decreased and eventually discontinued, as the benzodiazepine is no longer needed.