Hi! You know, to give you the best answer, I think I should ask you a few questions first that will help define the problem and the situation.
Josh, You are taking a heavy duty course of meds. The only ones not on your list are either Ativan or Xanax that are often prescribed. I have a feeling it is because the addictive potential for those two meds is so high that with your long term panic disorder, if you got help from one of them, you'd be trading in one problem for a worse problem.
So my question is: given that you are trying standard pharmacological treatment and it's not working, are you interested in behavioral treatment? That would be psychotherapy.
How long have you had these symptoms?
Was there trauma or abuse in your childhood? What about alcohol or dysfunction in your family when you were growing up?
Are you getting any therapy treatment right now? If so, what type? How is it going?
If not, when was the last treatment? What type of treatment was it? Was it helpful?
Any extra information that will help, feel free to share.