How to correctly start, titrate, and optimize venlafaxine for panic disorder

I was asked about a patient with panic disorder who has been on venlafaxine extended-release 75 mg/day for a few months but continues to have panic attacks.

This made me want to briefly clarify some important things about the efficacy and dosing of venlafaxine extended-release for the treatment of panic disorder.

In patients with panic disorder who continue to have panic attacks despite an adequate trial of venlafaxine extended-release, what should be the next step in terms of medications? (We are ignoring cognitive behavior therapy for the purpose of this article. Should a higher dose of venlafaxine be tried? Or, should the patient’s medication be changed from venlafaxine to something else?