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Antidepressant for panic attacks -
Some are also available as a sublingual tablet, which is dissolved under the tongue, or as a solution for injection. Brand names available in Canada appear here in brackets. For example, alprazolam Xanax and lorazepam Ativan.
For most people, benzodiazepines are helpful only as a temporary measure, to be used only in the following ways:. Some people may continue to use benzodiazepines for longer, even months or years. Some do so because they continue to find these drugs helpful and have agreed with their prescribing physician that the benefits of continuing to use them outweigh the risks.
There are also those who continue to use benzodiazepines over a longer term because the prescribing doctor has not re-examined their continued use.
In this instance, ask another doctor to review your prescription. When used on occasion or daily for a few weeks, benzodiazepines have a low risk of addiction.
This risk increases, however, when benzodiazepines are taken regularly for more than a few weeks, especially when they are taken in higher than normal doses. People with a history of substance abuse should avoid or minimize use of benzodiazepines as they are at higher risk of becoming addicted.
Signs of addiction include strong cravings for the effects of the drug, taking more of the drug than intended and continuing to use the drug despite the problems it may cause. Addiction may develop with or without physical dependence. Physical dependence: When benzodiazepines are taken regularly over a long period of time, the body adapts to the presence of the drug.
This is known as physical dependence. Physical dependence, on its own, is not the same as addiction. Signs of physical dependence include tolerance and withdrawal.
Tolerance: People are said to have developed tolerance to a drug when the same dose, taken over time, no longer has the desired effect. With benzodiazepines, it is known that:. Some people who develop tolerance may take higher and higher doses to feel the same intensity of effect as when they started taking the drug.
These people may find it difficult to stop using benzodiazepines. Withdrawal: Withdrawal symptoms of benzodiazepines may be similar to the reasons why the drugs were prescribed in the first place. The severity of withdrawal symptoms depends on the type of benzodiazepine used, the amount used and length of time it is used, and on whether the drug is stopped abruptly.
Symptoms can include headache, insomnia, anxiety, tension, sweating, difficulty concentrating, tremor, sensory disturbances, fatigue, stomach upset and loss of appetite.
Severe withdrawal symptoms from regular use of benzodiazepines in high doses may include agitation, paranoia, delirium and seizures. Withdrawal symptoms generally begin within a few days after treatment is stopped, and they may continue for two to four weeks or longer.
Once you have slept well for two or three nights in a row, try to get to sleep without taking the medication. If you have been taking benzodiazepines regularly for a few weeks or more, check with your doctor before reducing or stopping your medication.
Most often, benzodiazepines are prescribed to help people get through stressful situations or to provide relief while waiting for other treatment to take effect. When used in this way, on occasion or daily for a few weeks, most people can stop taking them without difficulty or withdrawal effects.
Stopping use can, however, be hard for some people, even when the use is short term. Problems are most likely to occur when:. People who wish to stop using benzodiazepines after using them regularly over a longer term will need to cut back their use gradually over an extended period of time.
This approach reduces withdrawal effects and helps ensure success in stopping. Because the ideal process for cutting down varies depending on the benzodiazepine you are taking, the dose and the length of time you have been taking it, ask your doctor to help you set up a schedule. If the long-term use has been at high doses, stopping use requires medical supervision.
These drugs may interact with other medications. If your doctor or dentist prescribes any medication, inform him or her about the drug you are taking.
Check with your pharmacist before using any over-the-counter medication, including herbal products, cold or allergy tablets, or cough syrups. When taken on their own, the risk of overdose with benzodiazepines is low; however, combining these drugs with other sedatives, such as alcohol, or with medications containing codeine or other opioid drugs, can result in overdose and possible death.
Symptoms of overdose include slurred speech, confusion, severe drowsiness, weakness and staggering, slow heartbeat, breathing problems and unconsciousness. Benzodiazepines can be dangerous when combined with alcohol. Benzodiazepines increase the effects of alcohol, making you more sleepy, dizzy or lightheaded.
One danger of this is the increased risk of stumbling, falling and related injuries. Another is the increased risk of overdose. Both alcohol and benzodiazepines slow down the central nervous system, which controls breathing.
In overdose, breathing can stop. Drinking too many caffeinated beverages i. Street drugs, such as marijuana or cocaine, have effects that can worsen symptoms of anxiety and interfere with sleep—making you feel worse, rather than better.
Taking benzodiazepines to enhance the effect of other sedative drugs, such as opioids, is dangerous and increases the risk of overdose and injury. Benzodiazepines can affect your ability to drive a vehicle and increase the risk of a crash, especially if taken in combination with alcohol or other sedative drugs.
The risk is highest when you first start taking benzodiazepines, before you are used to their effect. After an initial evaluation, he or she may refer you to a mental health professional for treatment.
Ask a trusted family member or friend to go with you to your appointment, if possible, to lend support and help you remember information. Your primary care provider or mental health professional will ask additional questions based on your responses, symptoms and needs.
Preparing and anticipating questions will help you make the most of your appointment time. Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission.
Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. This content does not have an English version. This content does not have an Arabic version. Diagnosis Your primary care provider will determine if you have panic attacks, panic disorder or another condition, such as heart or thyroid problems, with symptoms that resemble panic attacks.
To help pinpoint a diagnosis, you may have: A complete physical exam Blood tests to check your thyroid and other possible conditions and tests on your heart, such as an electrocardiogram ECG or EKG A psychological evaluation to talk about your symptoms, fears or concerns, stressful situations, relationship problems, situations you may be avoiding, and family history.
More Information Electrocardiogram ECG or EKG. More Information Cognitive behavioral therapy Psychotherapy. Request an appointment. Thank you for subscribing! Sorry something went wrong with your subscription Please, try again in a couple of minutes Retry. By Mayo Clinic Staff.
Show references Panic disorder. In: Diagnostic and Statistical Manual of Mental Disorders DSM Arlington, Va. Accessed April 12, Roy-Byne PP. Panic disorder: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis.
Accessed March 16, Panic disorder: When fear overwhelms. National Institute of Mental Health. Answers to your questions about panic disorder. American Psychological Association. Craske M. Psychotherapy for panic disorder with or without agoraphobia in adults.
Natural Medicines. Gaudlitz K, et al. Aerobic exercise training facilitates the effectiveness of cognitive behavioral therapy in panic disorder. Depression and Anxiety. Vorkapic CF, et al. Reducing the symptomatology of panic disorder: The effects of a yoga program alone and in combination with cognitive-behavioral therapy.
Frontiers in Psychiatry. Roy-Byrne PP. Pharmacotherapy for panic disorder with or without agoraphobia in adults. Alprazolam, clonazepam, venlafaxine hydrochloride, fluoxetine hydrochloride, sertraline hydrochloride, paroxetine hydrochloride, paroxetine mesylate.
Micromedex 2. Roy-Byne PP, et al. A diagnosis of panic disorder is made if the patient has experienced recurrent, unexpected panic attacks and shows at least one of the following characteristics: 1 persistent concern about having another attack anticipatory anxiety ; 2 worry about the implications of an attack or its consequences e.
In clinical populations, panic disorder is usually accompanied by agoraphobia. Agoraphobia refers to avoidance behavior motivated by fear of having another panic attack. Table 2 lists common types of agoraphobic fear and avoidance.
Patients presenting with panic-like symptoms should receive a thorough initial evaluation that goes beyond assessment of their primary somatic complaints. Areas of initial evaluation are outlined in Table 3. Several authors 3 , 4 have recommended a specific work-up for these patients to reduce unnecessary assessments.
Panic disorder can be treated effectively with pharmacotherapy, cognitive and cognitive-behavioral therapies or a combination of therapies. The National Institutes of Health Consensus Development Conference on Treatment of Panic Disorder 5 recommends that patients who are diagnosed with panic disorder should be provided with a description of indicated treatment options and the advantages and disadvantages of each option.
Treatment selection should then be made with the patient's input and in consideration of the severity of the presenting complaints, and the patient's specific history and preferences.
The following sections outline treatment options for patients with panic disorder and their known advantages and disadvantages. Considerations for selecting treatment also are presented. Table 4 lists pharmacologic agents used to treat panic disorder and their common therapeutic dosage ranges.
Imipramine Tofranil is the medication for panic disorder that has been most thoroughly studied, with at least 10 double-blind, placebo-controlled studies supporting its efficacy in the acute treatment of panic disorder.
Other tricyclic antidepressants that have shown promise are listed in Table 4. The onset of therapeutic action for tricyclic antidepressants typically takes three to four weeks. The average length of treatment is approximately six months but depends on several factors, including the efficiency with which panic suppression is achieved and agoraphobic avoidance, if any, is overcome.
In obtaining an optimal response, the physician may find it helpful to assess plasma levels. For example, a therapeutic response should be evident at a level greater than ng per mL imipramine and desipramine [Norpramin] combined in patients receiving imipramine.
Approximately one fourth of patients cannot tolerate the side effects of tricyclic antidepressants. Side effects are commonly anti-cholinergic constipation, dry mouth, blurred vision and urinary retention , histaminergic sedation and weight gain or adrenergic orthostatic hypotension.
The syndrome often can be mitigated by education, reassurances and initiating a low starting dosage e. An increment of 25 mg every two to four days from that point is usually well tolerated.
Since patients with panic disorder are often very sensitive to side effect symptoms, they may need more reassurance throughout pharmacotherapy than other patients. Physicians should also be aware that a withdrawal syndrome following abrupt cessation of these agents has been described.
Imipramine and clomipramine are considered first-line treatment options for panic disorder. Some advantages and disadvantages of these agents are listed in Table 5. Although clinical trials have demonstrated the effectiveness of selective serotonin reuptake inhibitors SSRIs in treating depression, initial acceptance of these agents for treating panic disorder preceded well-designed studies that supported their efficacy.
Fluvoxamine Luvox has shown strong improvement rates in several double-blind and placebo-controlled studies of patients requiring acute treatment. Fewer patients drop out of SSRI therapy than tricyclic antidepressant therapy, suggesting that the SSRIs are slightly better tolerated than the tricyclics.
Common side effects of SSRIs include sleep disturbance, headaches, gastrointestinal problems and sexual dysfunction.
As with tricyclic antidepressants, beginning with a low starting dosage e. A withdrawal reaction has occasionally been described with abrupt cessation of SSRI therapy. The SSRIs are considered appropriate first-line treatment for panic disorder, especially in patients with comorbid depression.
The monoamine oxidase inhibitors MAOIs are known for their effectiveness in treating atypical depression and social phobia, but they also have shown benefit in treating anxiety states, including panic disorder.
Phenelzine Nardil , in particular, has been proved efficacious in both controlled and open trials. Side effects of MAOIs include orthostatic hypotension, weight gain, sexual dysfunction and insomnia. When taking any nonspecific irreversible MAOI, patients must maintain a restrictive tyramine-free diet, and hypertensive crisis is risked if adherence to that diet is not maintained.
The MAOIs also introduce a risk for serious drug-drug interactions e. These risks lead many patients to refuse treatment with MAOIs, and many physicians reserve MAOIs for use in patients who do not respond to other therapies. Although MAOIs are not regarded as a first-line treatment for panic disorder, they are considered appropriate therapy for patients who do not respond to other first-line agents like tricyclic antidepressants or SSRIs, and for patients with panic disorder accompanied by atypical depression or comorbid social anxiety.
Large-scale, controlled outcome studies have shown that benzodiazepines are clinically effective in the treatment of panic disorder. Another advantage of benzodiazepines may be their broader spectrum of anxiolytic action, which extends beyond the suppression of panic attacks to amelioration of generalized anxiety.
The principal drawback of benzodiazepines, particularly short-acting medications such as alprazolam Xanax , involves their ability to produce physical dependency, 18 manifested by a withdrawal syndrome on abrupt discontinuation. Even with gradual tapering, it may be difficult for some patients to discontinue benzodiazepine therapy.
Although benzodiazepines are considered an appropriate first-line treatment in certain cases of panic disorder e. The most common use for benzodiazepines is to stabilize severe initial symptoms until another treatment e. Benzodiazepines are not indicated for use in patients who have a history of substance abuse or dependence, or as a first-line, sole intervention in patients with comorbid depression.
Advantages and disadvantages of benzodiazepines in the treatment of panic disorder are summarized in Table 5. Several other agents have been studied and have shown poor to mixed results or are undergoing empiric study for the treatment of panic disorder.
Table 6 20 — 27 lists these agents and briefly summarizes the evidence for their efficacy. Not all agents indicated for the treatment of panic disorder have been subjected to head-to-head comparison. A recent meta-analysis 28 of 32 randomized, prospective, double-blind, placebo-controlled studies of imipramine, clomipramine, alprazolam, fluvoxamine, paroxetine and zimelidine found that all of these agents have proved to be superior to placebo.
The SSRIs produced an effect size score that was significantly superior to that of imipramine and alprazolam. A trend favoring alprazolam over imipramine was also evident, although the trend did not reach statistical significance.
These and other data have led some investigators 12 to suggest that SSRIs are emerging as the drugs of first choice in the treatment of panic disorder.
Contrary to common clinical practice, existing evidence does not indicate that general, supportive psychotherapy used alone is an appropriate intervention in the treatment of panic disorder. Although a particular form of psychotherapy called emotion-focused treatment has shown initial promise in a recent empiric study, 29 it warrants further, controlled study before it can be recommended as an evidence-based treatment option for panic disorder.
Cognitive 30 and cognitive-behavioral therapies 31 have received strong empiric support through numerous controlled clinical trials and are the psychotherapeutic treatments of choice for patients with panic disorder.
With few exceptions, acute treatment improvement rates associated with these therapies range from 80 to 90 percent of patients.
The major components of cognitive-behavioral therapies are outlined in Table 7. Earlier behavior treatments tended to emphasize situational exposure aimed at reducing agoraphobic avoidance, rather than the panic attacks themselves. Newer treatments target both. Recent meta-analyses 33 of cognitive-behavioral therapy quote an effect size 0.
Although various approaches to cognitive-behavioral therapy are available, those involving cognitive restructuring and exposure in vivo to feared stimuli have yielded the strongest effect sizes effect size: 0. A recent review of long-term studies reported that approximately 75 percent of treated patients remained improved years after treatment had ended.
Advantages and disadvantages of cognitive-behavioral therapy are summarized in Table 5. Debate continues about whether panic disorder should be treated initially with cognitive therapy or cognitive-behavioral therapy, pharmacotherapy or a combined approach.
Although acute treatment effect sizes may vary between treatment options, physicians and patients must consider several factors that go beyond success rates in acute treatment when selecting treatment. These decisions involve weighing the advantages and disadvantages of each treatment option and how well the options match the patient's presentation, preferences, and personal and financial resources.
Although treatment selection guidelines vary, some considerations can be offered. Regarding the choice of pharmacologic treatment, an evidenced-based approach suggests that the SSRIs are an appropriate first consideration. Although tricyclic antidepressants show similar success rates for acute treatment, their side-effect burden has been greater than that of SSRIs.
A high-potency benzodiazepine given at the minimum therapeutic dose may be a useful adjunct to antidepressant therapy if prompt relief is indicated. However, the treatment plan should include discontinuing the benzodiazepine when the antidepressant's maximal effects are expected i.
Although benzodiazepines are considered an appropriate intervention after SSRIs and tricyclic antidepressants have failed, they should not be prescribed if a history of or current comorbid substance abuse is suspected or if the patient shows comorbid depression. MAOIs are also an appropriate consideration when comorbid depression or social phobia is evident, although they remain a second choice given the risks they pose.
Cognitive-behavioral therapy is an appropriate first-line consideration in patients with mild to moderate panic disorder or panic disorder with situational avoidance. Although benzodiazepines can be combined temporarily with cognitive-behavioral therapy for prompt relief of severe symptoms, they have been known to interfere with cognitive-behavioral therapy, so their adjunctive use should be minimized.
In situations where severe agoraphobic avoidance precludes participation in cognitive-behavioral therapy, consideration should be given to the combined use of SSRI or tricyclic antidepressant pharmacotherapy with cognitive-behavioral therapy.
Cognitive-behavioral therapy has also been effective in patients who do not respond to pharmacotherapy and can be used in this role as well. Acute relapse is common when pharmacotherapy for panic disorder is discontinued. Other considerations for selecting a first-line treatment include the patient's preference for an approach that includes medication versus one that does not, as well as the availability of cognitive-behavioral treatment in the community.
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If you're considering taking medication for GAD, your GP attackks discuss the different options with you in detail before you start a course of treatment, including:. You should also have regular appointments with your doctor to assess your progress when you're taking medication for GAD.
These will usually take place every 2 to 4 weeks for the first 3 months, then every 3 months after that. Tell your GP if you think you may be experiencing side effects from your medication. They may be able to adjust your dose or prescribe an alternative medication.
In most cases, the first medication you'll be offered will be a type of antidepressant called a selective serotonin reuptake inhibitor SSRI. This type of medication works by increasing the level of a chemical called serotonin in your brain. SSRIs can be taken on a long-term basis but, as with all antidepressants, they can take several weeks to start working.
You'll usually be started on a low dose, which may be gradually increased as your body adjusts to the medication.
These side effects should improve over time, although some may be related to your underlying condition. If SSRIs don't help ease your anxiety, you may be prescribed a different type of antidepressant known as a serotonin and noradrenaline reuptake inhibitor SNRI.
This type of medication increases the amount of serotonin and noradrenaline in your brain. SNRIs can also increase your blood pressure, so your blood pressure will be monitored regularly during treatment. As with SSRIs, some of the side effects such as feeling sick, an upset stomach, problems sleeping and feeling agitated or more anxious are more common in the first 1 or 2 weeks of treatment, but these usually settle as your body adjusts to the medication.
If your medication is not helping after about 2 months of treatment or it's causing unpleasant side effects, your GP may prescribe an alternative medication.
When you and your GP decide it's appropriate for you to stop taking your medication, you'll normally have your dose slowly reduced over the course of a few weeks to reduce the risk of withdrawal effects.
Never stop taking your medication unless your GP specifically advises you to. If SSRIs and SNRIs aren't suitable for you, you may be offered pregabalin.
This is a medication known as an anticonvulsant, which is used to treat conditions such as epilepsybut it's also been found to be beneficial in treating anxiety. Benzodiazepines are a type of sedative that may sometimes be used as a short-term treatment during a particularly severe period of anxiety.
This is because they help ease the symptoms within 30 to 90 minutes of taking the medication. If you're prescribed a benzodiazepine, it'll usually be diazepam. Although benzodiazepines are very effective in treating the symptoms of anxiety, they can't be used for long periods.
This is because they can become addictive if used for longer than 4 weeks. Benzodiazepines also start to lose their effectiveness after this time. For these reasons, you won't usually be prescribed benzodiazepines for any longer than 2 to 4 weeks at a time. As drowsiness is a particularly common side effect of benzodiazepines, your ability to drive or operate machinery may be affected by taking this medication.
You should also never drink alcohol or use opiate drugs when taking benzodiazepine as doing so can be dangerous. If you have tried the treatments mentioned above and have significant symptoms of GAD, you may want to discuss with your GP whether you should be referred to a mental health specialist.
A referral will work differently in different areas of the UK, but you'll usually be referred to your community mental health team. An appropriate mental health specialist from your local team will carry out an overall reassessment of your condition.
They'll ask you about your previous treatment and how effective you found it. They may also ask about things in your life that may be affecting your condition, or how much support you get from family and friends. Your specialist will then be able to devise a treatment plan for you, which will aim to treat your symptoms.
As part of this plan, you may be offered a treatment you haven't tried before, which might be psychological treatments or medication. Alternatively, you may be offered a combination of a psychological treatment with a medication, or a combination of 2 different medications. Page last reviewed: 5 October Next review due: 5 October Home Mental health Mental health conditions Generalised anxiety disorder in adults Back to Generalised anxiety disorder in adults.
Treatment - Generalised anxiety disorder in adults. Psychological therapies for GAD If you have been diagnosed with GAD, you'll usually be advised to try psychological treatment before you're prescribed medication. Or your GP can refer you if you prefer.
Find an NHS talking therapies service. Video: Talking therapies for stress, anxiety and depression Animated video explaining self-referral to talking therapies services for stress, anxiety or depression.
Media last reviewed: 14 March Media review due: 14 March
: Antidepressant for panic attacks| Medications for Treating Panic Disorder | Panic Antidrpressant may be Antideprressant symptom of panic disorder. Related Fo panic attacks: What causes them? Panic-related disorders: evidence for efficacy of Improving skin texture and tone antidepressants. Benzodiazepines such as alprazolam Xanax and clonazepam Klonopin are sometimes prescribed to treat short-term symptoms caused by panic disorder, but all benzodiazepines carry a boxed warning because of the risk of addiction and life threatening withdrawal if you stop using them. More in Pubmed. |
| Panic Disorder: Should I Take Medicine? | Animated video explaining self-referral to talking therapies services for stress, anxiety or depression. Atlantic diet may help prevent metabolic syndrome. You try counselling, such as cognitive behavioural therapy, to control your symptoms. They can happen suddenly without an obvious trigger and reach a peak within minutes. Benzodiazepines may work faster than antidepressants. |
| Panic Disorder Treatment | The SSRIs produced an effect size score that was significantly superior to that of imipramine and alprazolam. A trend favoring alprazolam over imipramine was also evident, although the trend did not reach statistical significance. These and other data have led some investigators 12 to suggest that SSRIs are emerging as the drugs of first choice in the treatment of panic disorder. Contrary to common clinical practice, existing evidence does not indicate that general, supportive psychotherapy used alone is an appropriate intervention in the treatment of panic disorder. Although a particular form of psychotherapy called emotion-focused treatment has shown initial promise in a recent empiric study, 29 it warrants further, controlled study before it can be recommended as an evidence-based treatment option for panic disorder. Cognitive 30 and cognitive-behavioral therapies 31 have received strong empiric support through numerous controlled clinical trials and are the psychotherapeutic treatments of choice for patients with panic disorder. With few exceptions, acute treatment improvement rates associated with these therapies range from 80 to 90 percent of patients. The major components of cognitive-behavioral therapies are outlined in Table 7. Earlier behavior treatments tended to emphasize situational exposure aimed at reducing agoraphobic avoidance, rather than the panic attacks themselves. Newer treatments target both. Recent meta-analyses 33 of cognitive-behavioral therapy quote an effect size 0. Although various approaches to cognitive-behavioral therapy are available, those involving cognitive restructuring and exposure in vivo to feared stimuli have yielded the strongest effect sizes effect size: 0. A recent review of long-term studies reported that approximately 75 percent of treated patients remained improved years after treatment had ended. Advantages and disadvantages of cognitive-behavioral therapy are summarized in Table 5. Debate continues about whether panic disorder should be treated initially with cognitive therapy or cognitive-behavioral therapy, pharmacotherapy or a combined approach. Although acute treatment effect sizes may vary between treatment options, physicians and patients must consider several factors that go beyond success rates in acute treatment when selecting treatment. These decisions involve weighing the advantages and disadvantages of each treatment option and how well the options match the patient's presentation, preferences, and personal and financial resources. Although treatment selection guidelines vary, some considerations can be offered. Regarding the choice of pharmacologic treatment, an evidenced-based approach suggests that the SSRIs are an appropriate first consideration. Although tricyclic antidepressants show similar success rates for acute treatment, their side-effect burden has been greater than that of SSRIs. A high-potency benzodiazepine given at the minimum therapeutic dose may be a useful adjunct to antidepressant therapy if prompt relief is indicated. However, the treatment plan should include discontinuing the benzodiazepine when the antidepressant's maximal effects are expected i. Although benzodiazepines are considered an appropriate intervention after SSRIs and tricyclic antidepressants have failed, they should not be prescribed if a history of or current comorbid substance abuse is suspected or if the patient shows comorbid depression. MAOIs are also an appropriate consideration when comorbid depression or social phobia is evident, although they remain a second choice given the risks they pose. Cognitive-behavioral therapy is an appropriate first-line consideration in patients with mild to moderate panic disorder or panic disorder with situational avoidance. Although benzodiazepines can be combined temporarily with cognitive-behavioral therapy for prompt relief of severe symptoms, they have been known to interfere with cognitive-behavioral therapy, so their adjunctive use should be minimized. In situations where severe agoraphobic avoidance precludes participation in cognitive-behavioral therapy, consideration should be given to the combined use of SSRI or tricyclic antidepressant pharmacotherapy with cognitive-behavioral therapy. Cognitive-behavioral therapy has also been effective in patients who do not respond to pharmacotherapy and can be used in this role as well. Acute relapse is common when pharmacotherapy for panic disorder is discontinued. Other considerations for selecting a first-line treatment include the patient's preference for an approach that includes medication versus one that does not, as well as the availability of cognitive-behavioral treatment in the community. Once treatment is selected, patients should be monitored periodically. When stabilized, patients should be encouraged to reenter previously avoided situations gradually, regardless of the treatment approach being used. If the treatment response is inadequate after approximately eight weeks of therapy, alternatives should be reconsidered. Finally, patients with panic disorder often need sensitive clinical management. Many of these patients have been ill for several years and tend to have a history of varied, ineffective and failed treatments. Establishing a therapeutic alliance with patients, as described in Table 8 , is an important aspect of any treatment selected. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. Washington, D. Katon W. Panic disorder: relationship to high medical utilization, unexplained physical symptoms, and medical costs. J Clin Psychiatry. United States Department of Health and Human Services, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, National Institute of Mental Health. Panic disorder in the medical setting. Rockville, Md. ADM Ballenger JC. Wolfe B, Maser JD. Treatment of panic disorder: a consensus development conference. Jefferson JW. Antidepressants in panic disorder. Kessel JB, Simpson GM. Tricyclic and tetracyclic drugs. In: Kaplan HI, Sadock BJ, eds. Comprehensive textbook of psychiatry. Black DW, Wesner R, Bowers W, Gabel J. A comparison of fluvoxamine, cognitive therapy, and placebo in the treatment of panic disorder. Arch Gen Psychiatry. den Boer JA, Westenberg HG, Kamerbeek WD, Verhoeven WM, Kahn RS. Effect of serotonin uptake inhibitors in anxiety disorders; a double-blind comparison of clomipramine and fluvoxamine. Int Clin Psychopharmacol. Hoehn-Saric R, McLeod DR, Hipsley PA. Effect of fluvoxamine on panic disorder. J Clin Psychopharmacol. de Beurs E, van Balkom AJ, Lange A, Koele P, van Dyck R. Treatment of panic disorder with agoraphobia: comparison of fluvoxamine, placebo, and psychological panic management combined with exposure and of exposure in vivo alone. Am J Psychiatry. Sheehan DV, Harnett-Sheehan K. The role of SSRIs in panic disorder. Lydiard RB, Ballenger JC. Panic-related disorders: evidence for efficacy of the antidepressants. Special issue: perspectives on panic-related disorders. J Anxiety Dis. Buigues J, Vallejo J. Therapeutic response to phenelzine in patients with panic disorder and agoraphobia with panic attacks. Drug treatment of panic disorder. Comparative efficacy of alprazolam, imipramine, and placebo. Cross-National Collaborative Panic Study, Second Phase Investigators. Br J Psychiatry. Noyes R, DuPont RL, Pecknold JC, Rifkin A, Rubin RT, Swinson RP, et al. Alprazolam in panic disorder and agoraphobia: results from a multicenter trial. Patient acceptance, side effects, and safety. Davidson JR. The medicines may cause side effects, but these are usually mild. They may get better after a few weeks. You may have to try more than one medicine to find one that works. Your doctor may have you switch to another medicine if the first one doesn't help. Some people use counselling, such as cognitive behavioural therapy , to treat panic disorder. It can help you to:. Other treatments include support groups and exercises that help you relax, such as progressive muscle relaxation or meditation. These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions. I was having lunch with some friends and suddenly began to feel strange—like I couldn't breathe and my heart was pounding. I didn't know what was happening; I thought I was having a heart attack. Although the symptoms began to go away after about 10 minutes, I went to the emergency room, where they did some tests and didn't find anything wrong. A week later, the same thing happened in the middle of the night. I went to see my doctor, and she suggested I may have had a panic attack. Since then, the attacks have been occurring at least once a week, and I have been diagnosed with panic disorder. Although each attack is still a horrible experience, I now know what is happening and that I will get through it. I have been going to therapy for several weeks and am learning how to deal with the symptoms of panic attacks. They are less frequent now and less intense. I think I can get through this without taking any medicine. As an executive, I have to travel a lot for my job. A few months ago, I was boarding a plane for a business trip, and I began to feel very apprehensive. I felt trapped and got off the plane because I was shaking and sweating and my heart was pounding. I wasn't sure exactly what was wrong, but I felt like I was dying. I had a drink at the bar and was still shaky but took a later flight. After that I began to feel nervous if I even thought about flying, and I had several more similar attacks. Then I had an attack on the subway. I felt like everyone was watching me and there was no escape. I didn't even want to go to the office after that because I was afraid I could have an attack at any moment. My doctor says I have panic disorder and agoraphobia. I can hardly function, so I am going to take antidepressants and try exposure therapy. My doctor says a benzodiazepine would make the symptoms go away sooner. But I am worried they will make me too drowsy and they may be too hard for me to quit. When I divorced my wife, Celia, I began to feel down and very anxious. As a contractor, I have to deal with people every day, and it seemed very hard to do my job when I felt so stressed out and depressed. I had my first panic attack when my dog got lost at a job. I knew he was probably fine and would soon come back, but with the stress of everything else it just seemed like more than I could handle. I felt awful; I was choking and had bad stomach cramps. Since then, I have had attacks like this nearly every day and a lot of the time I feel down in the dumps. I have been diagnosed with panic disorder and depression. I am going to therapy, and it seems to help a little, but I still have panic attacks and often feel like life is not worth living, and I feel anxious about interacting with people at all. At first I didn't want to take any medicine. But after reading about it and talking it over with my doctor, I decided to start taking an antidepressant. Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements. I am willing to take medicine for at least several months, or longer if I need to. I want to continue counselling, without medicine, at least for a while. I think my symptoms may be worse than the possible side effects of the medicine. I think the side effects of the medicine would be worse than my symptoms. Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now. How sure do you feel right now about your decision? Use the following space to list questions, concerns, and next steps. Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision. There are two different kinds of medicines that I can take to help my panic disorder. Are you clear about which benefits and side effects matter most to you? Do you have enough support and advice from others to make a choice? Author: Healthwise Staff. Medical Review: Anne C. This information does not replace the advice of a doctor. Healthwise, Incorporated, disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. Learn how we develop our content. To learn more about Healthwise, visit Healthwise. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated. MAOIs are effective in treating anxiety-related conditions, but they pose a risk of serious side effects when taken alongside certain foods and medications. Benzodiazepines cause sedation and create a calming effect. They can lead to depression and drug dependency. People who have had a drug or alcohol use disorder in the past should talk with their healthcare professional before starting benzodiazepine treatment because of an increased risk of adverse effects. Benzodiazepines such as alprazolam Xanax and clonazepam Klonopin are sometimes prescribed to treat short-term symptoms caused by panic disorder, but all benzodiazepines carry a boxed warning because of the risk of addiction and life threatening withdrawal if you stop using them. Beta-blockers treat the physical symptoms associated with panic attacks. They also help lower blood pressure. Beta-blockers are traditionally prescribed for heart conditions. They have not been approved to treat panic disorder. There are other antidepressants available. Most work by stabilizing serotonin or norepinephrine levels. Panic attack medication is not available over the counter. You need to see a healthcare professional to obtain a prescription. While some natural remedies appear promising in treating panic attacks, more research is needed to explore potential risks. Keep in mind that the Food and Drug Administration FDA does not subject herbal remedies, dietary supplements , and essential oils to the same standards as medications. Natural remedies can interfere with other medications and cause side effects. Ask a doctor before taking a natural remedy for panic disorder. Research has shown that cognitive behavioral therapy CBT is the most effective form of therapy for panic disorder. It can be used alone or in combination with antidepressants. CBT is a practical form of therapy that encompasses a number of techniques. The goal is to adapt your thoughts and behavior to improve panic disorder symptoms. Other nonmedical treatments for anxiety include:. Treatment for children with panic disorder is similar to treatment for adults with panic disorder. Typical treatments include medication and therapy. SSRIs are among the most commonly prescribed drugs to treat panic disorder in children and adolescents. Since SSRIs are not effective right away, benzodiazepines are sometimes prescribed to manage panic attacks in the meantime. Panic disorder is characterized by recurring panic attacks. During a panic attack, you might experience the following symptoms:. They can help you determine the reason for your symptoms and distinguish between panic attacks, panic disorder, or another condition. In fact, panic disorder has the highest number of medical visits among all other anxiety disorders. Typically, people living with panic disorder have unexpected and routine panic attacks and spend a lot of time worrying about having additional attacks. The good news is that there is a wide range of resources when it comes to treating panic disorder. SSRIs and SNRIs are the most commonly prescribed medical treatments for panic disorder, but other medications are available. Lifestyle changes, such as therapy, can also prove helpful. If you think you have experienced panic attack symptoms, speak with a doctor about your treatment options. Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. VIEW ALL HISTORY. |
| Do I need this treatment? | Your doctor will also check to see if your panic attacks can be explained by another mental health condition or if they could be a side effect of a drug or medication. There are many medications that can safely and effectively treat panic disorder. Medications for panic disorder fall into one of two categories:. These medications can be prescribed to lessen the severity of panic attacks and reduce general feelings of anxiety. Antidepressants were originally used to treat mood disorders, such as depression and depressive symptoms associated with bipolar disorder. It was later found that antidepressants could also help treat anxiety disorders, including panic disorder. Antidepressant medications have been found to effectively decrease the intensity of panic attacks and overall anxiety. Antidepressants are also often used when a person has a co-occurring condition, such as post-traumatic stress disorder PTSD or depression. The most commonly prescribed medications for panic disorder belong to a popular class of antidepressants known as selective serotonin reuptake inhibitors SSRIs. Like all antidepressants, SSRIs affect the chemical messengers in the brain, called neurotransmitters. In particular, SSRIs target the neurotransmitter called serotonin, which is associated with mood. Research has found that SSRIs can assist in reducing the intensity and frequency of panic attacks. Some of the most common SSRIs include:. There are some side effects associated with SSRIs. Anti-anxiety medications , sometimes referred to as tranquilizers, are recommended for their fast-acting relief and sedating effect. These medications slow down the central nervous system , which can make you feel calmer and more relaxed. By helping someone feel less fearful and anxious, anti-anxiety medications can greatly reduce the symptoms of panic disorder. Benzodiazepines are a commonly prescribed class of anti-anxiety medication that can help reduce the severity of panic attacks. These medications have a sedative effect that can help quickly reduce panic symptoms and elicit a more relaxed state. Some of the most popular benzodiazepines include:. There are some risks and potential side effects associated with these medications, including dependence and misuse. However, benzodiazepines have been found to be a safe and effective medication when used appropriately in the treatment of panic disorder. SSRIs and benzodiazepines are effective options for treating panic disorder. Both medications can reduce the severity of panic attacks, but benzodiazepines are typically faster-acting and used on a short-term basis whereas anti-depressants may be prescribed more long-term. Psychotherapy has also been found to effectively treat panic disorder and agoraphobia. Through psychotherapy, a mental health specialist can assist you in working through unresolved issues and feelings. Additionally, a therapist can help you develop healthier ways of thinking and behaving that will help you deal with your symptoms. Get our printable guide to help you ask the right questions at your next doctor's appointment. Learn the best ways to manage stress and negativity in your life. Cognitive behavioral therapy CBT is one form of psychotherapy that has been shown to effectively help treat panic disorder. One of the main goals of CBT is to develop coping skills by changing negative thinking patterns and unhealthy behaviors. For example, many people with panic disorder hold negative beliefs, or cognitive distortions , about themselves and the world around them. This faulty thinking often contributes to unhelpful behaviors, such as avoiding feared situations. CBT may help you overcome negative thinking patterns and develop healthier ways to manage your condition. Desensitization is a popular CBT technique used to help people overcome the feelings of fear and anxiety that are often associated with panic attacks. Through desensitization, your therapist gradually introduces you to anxiety-provoking situations while teaching you how to regain control of your anxiety. Gradually, you are introduced to more fear-inducing situations while you continue to learn how to manage your panic. The aim is to unlearn your fear and take on new ways of thinking and behaving. For instance, someone who has a fear of flying may begin desensitization by working on relaxation techniques while facing something that only causes a small amount of nervousness, such as images of airplanes. They may eventually advance to more fear-inducing situations, such as going to the airport or boarding an airplane. With each situation, they learn to manage their panic symptoms. Through continued practice, desensitization may help them overcome their fear of flying. Panic-focused psychodynamic psychotherapy PFPP is another therapeutic method used in the treatment of panic disorder. This form of psychotherapy aims to uncover past experiences and emotional conflicts that may have influenced the development of your panic and anxiety. PFPP helps you recognize unconscious conflicts—particularly around anger—and resolve these conflicts in less frightening and more constructive ways. By coming to better terms with certain conflicts, fantasies, and behaviors, you may be able to overcome your issues with panic disorder. Therapies like CBT and PFPP are effective treatments for panic disorder. CBT focuses on changing negative thinking patterns and developing healthy coping skills, while PFPP is intended to help you resolve unconscious emotional conflicts. Your doctor may determine that a combination of therapy and medication is best suited for you. Typically, this approach involves using SSRIs together with a form of therapy like CBT. This combination has been shown to be effective at treating panic disorder. Benzodiazepines may also be used as a short-term treatment to reduce anxiety symptoms. Making changes to your daily habits may also help you reduce symptoms of panic disorder. These changes could include:. Taking steps to manage your daily stress levels may also help. Practicing mindfulness meditation , yoga , or another calming activity may help control your anxiety levels and reduce your symptoms. There are treatment options available for panic disorder. These include:. You can also implement lifestyle changes to better control your daily stress levels and further reduce your symptoms. Avoiding dietary triggers like caffeine may help, as can making sure you get enough sleep and exercise. We've tried, tested, and written unbiased reviews of the best online therapy programs including Talkspace, BetterHelp, and ReGain. Find out which option is the best for you. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Washington, DC; Zugliani MM, Cabo MC, Nardi AE, Perna G, Freire RC. Pharmacological and neuromodulatory treatments for panic disorder: Clinical trials from to Psychiatry Investig. Breilmann J, Girlanda F, Guaiana G, et al. Benzodiazepines versus placebo for panic disorder in adults. Cochrane Database Syst Rev. Bighelli I, Castellazzi M, Cipriani A, et al. Antidepressants versus placebo for panic disorder in adults. Quagliato LA, Cosci F, Shader RI, et al. Selective serotonin reuptake inhibitors and benzodiazepines in panic disorder: A meta-analysis of common side effects in acute treatment. J Psychopharmacol. To provide you with the most relevant and helpful information, and understand which information is beneficial, we may combine your email and website usage information with other information we have about you. If you are a Mayo Clinic patient, this could include protected health information. If we combine this information with your protected health information, we will treat all of that information as protected health information and will only use or disclose that information as set forth in our notice of privacy practices. You may opt-out of email communications at any time by clicking on the unsubscribe link in the e-mail. You'll soon start receiving the latest Mayo Clinic health information you requested in your inbox. While panic attacks and panic disorder benefit from professional treatment, these self-care steps can help you manage symptoms:. Some dietary supplements have been studied as a treatment for panic disorder, but more research is needed to understand the risks and benefits. Herbal products and dietary supplements aren't monitored by the Food and Drug Administration FDA the same way medications are. You can't always be certain of what you're getting and whether it's safe. Before trying herbal remedies or dietary supplements, talk to your doctor. Some of these products can interfere with prescription medications or cause dangerous interactions. If you've had signs or symptoms of a panic attack, make an appointment with your primary care provider. After an initial evaluation, he or she may refer you to a mental health professional for treatment. Ask a trusted family member or friend to go with you to your appointment, if possible, to lend support and help you remember information. Your primary care provider or mental health professional will ask additional questions based on your responses, symptoms and needs. Preparing and anticipating questions will help you make the most of your appointment time. Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. This content does not have an English version. This content does not have an Arabic version. Diagnosis Your primary care provider will determine if you have panic attacks, panic disorder or another condition, such as heart or thyroid problems, with symptoms that resemble panic attacks. To help pinpoint a diagnosis, you may have: A complete physical exam Blood tests to check your thyroid and other possible conditions and tests on your heart, such as an electrocardiogram ECG or EKG A psychological evaluation to talk about your symptoms, fears or concerns, stressful situations, relationship problems, situations you may be avoiding, and family history. More Information Electrocardiogram ECG or EKG. More Information Cognitive behavioral therapy Psychotherapy. Request an appointment. Thank you for subscribing! Sorry something went wrong with your subscription Please, try again in a couple of minutes Retry. By Mayo Clinic Staff. Show references Panic disorder. In: Diagnostic and Statistical Manual of Mental Disorders DSM Arlington, Va. Accessed April 12, Roy-Byne PP. Panic disorder: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis. Accessed March 16, Panic disorder: When fear overwhelms. National Institute of Mental Health. Answers to your questions about panic disorder. American Psychological Association. Craske M. Psychotherapy for panic disorder with or without agoraphobia in adults. Natural Medicines. Gaudlitz K, et al. Aerobic exercise training facilitates the effectiveness of cognitive behavioral therapy in panic disorder. Depression and Anxiety. Vorkapic CF, et al. Reducing the symptomatology of panic disorder: The effects of a yoga program alone and in combination with cognitive-behavioral therapy. Frontiers in Psychiatry. Roy-Byrne PP. Pharmacotherapy for panic disorder with or without agoraphobia in adults. Alprazolam, clonazepam, venlafaxine hydrochloride, fluoxetine hydrochloride, sertraline hydrochloride, paroxetine hydrochloride, paroxetine mesylate. Micromedex 2. Roy-Byne PP, et al. Approach to treating panic disorder with or without agoraphobia in adults. Using dietary supplements wisely. National Center for Complementary and Integrative Health. Accessed March 19, Sawchuk CA expert opinion. Mayo Clinic, Rochester, Minn. April 6, Related Nocturnal panic attacks: What causes them? Associated Procedures Cognitive behavioral therapy Electrocardiogram ECG or EKG Psychotherapy. |
| These Medications Can Help Treat Panic Attacks | VIEW ALL HISTORY. Learn how to recognize a panic attack and get help to…. Panic attacks can be one of the scariest experiences to go through. The attacks can range from a sudden surge of fear that only lasts a few minutes to…. While stress and anxiety are very similar, they have a few key differences. Learn how each one shows up and how to manage symptoms. Does therapy for stress work? Yes, it can. Here's what to know and what you can do. Anxiety is a common symptom of trauma. Here's why. While we don't fully understand why, developing anxiety as a long COVID symptom is common. However, we do know how to treat it. AVPD and SAD overlap in symptoms, both impairing social functioning. If the anxiety of an upcoming surgery is disrupting your sleep and day-to-day life, it may be time to talk with your doctor about medications. A Quiz for Teens Are You a Workaholic? How Well Do You Sleep? Health Conditions Discover Plan Connect. Mental Well-Being. Treating Panic Attack Disorder. Medically reviewed by Marc S. Lener, MD — By Carly Vandergriendt — Updated on August 25, Panic attack medication list Are there OTC medications? Do home remedies work? Other treatments Treatment for children Symptoms Causes Diagnosis Summary Panic disorder is a condition that involves sudden and recurring panic attacks. Prescription medications for panic attacks and anxiety. Can you get panic attack medication over the counter? Panic attack natural medicine. Panic attack treatment without medication. Treating children with panic attack disorder. Panic disorder symptoms. Panic disorder causes. Diagnosing panic attack disorder. How we reviewed this article: Sources. Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references. You can learn more about how we ensure our content is accurate and current by reading our editorial policy. The two types of medicines used most often are antidepressants and benzodiazepines. Some people use both. Antidepressants should help you start to feel better within 1 to 3 weeks. But it can take as many as 6 to 8 weeks to see more improvement. The medicines may cause side effects, but these are usually mild. They may get better after a few weeks. You may have to try more than one medicine to find one that works. Your doctor may have you switch to another medicine if the first one doesn't help. Some people use counselling, such as cognitive behavioural therapy , to treat panic disorder. It can help you to:. Other treatments include support groups and exercises that help you relax, such as progressive muscle relaxation or meditation. These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions. I was having lunch with some friends and suddenly began to feel strange—like I couldn't breathe and my heart was pounding. I didn't know what was happening; I thought I was having a heart attack. Although the symptoms began to go away after about 10 minutes, I went to the emergency room, where they did some tests and didn't find anything wrong. A week later, the same thing happened in the middle of the night. I went to see my doctor, and she suggested I may have had a panic attack. Since then, the attacks have been occurring at least once a week, and I have been diagnosed with panic disorder. Although each attack is still a horrible experience, I now know what is happening and that I will get through it. I have been going to therapy for several weeks and am learning how to deal with the symptoms of panic attacks. They are less frequent now and less intense. I think I can get through this without taking any medicine. As an executive, I have to travel a lot for my job. A few months ago, I was boarding a plane for a business trip, and I began to feel very apprehensive. I felt trapped and got off the plane because I was shaking and sweating and my heart was pounding. I wasn't sure exactly what was wrong, but I felt like I was dying. I had a drink at the bar and was still shaky but took a later flight. After that I began to feel nervous if I even thought about flying, and I had several more similar attacks. Then I had an attack on the subway. I felt like everyone was watching me and there was no escape. I didn't even want to go to the office after that because I was afraid I could have an attack at any moment. My doctor says I have panic disorder and agoraphobia. I can hardly function, so I am going to take antidepressants and try exposure therapy. My doctor says a benzodiazepine would make the symptoms go away sooner. But I am worried they will make me too drowsy and they may be too hard for me to quit. When I divorced my wife, Celia, I began to feel down and very anxious. As a contractor, I have to deal with people every day, and it seemed very hard to do my job when I felt so stressed out and depressed. I had my first panic attack when my dog got lost at a job. I knew he was probably fine and would soon come back, but with the stress of everything else it just seemed like more than I could handle. I felt awful; I was choking and had bad stomach cramps. Since then, I have had attacks like this nearly every day and a lot of the time I feel down in the dumps. I have been diagnosed with panic disorder and depression. I am going to therapy, and it seems to help a little, but I still have panic attacks and often feel like life is not worth living, and I feel anxious about interacting with people at all. At first I didn't want to take any medicine. But after reading about it and talking it over with my doctor, I decided to start taking an antidepressant. Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements. I am willing to take medicine for at least several months, or longer if I need to. I want to continue counselling, without medicine, at least for a while. I think my symptoms may be worse than the possible side effects of the medicine. I think the side effects of the medicine would be worse than my symptoms. Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now. How sure do you feel right now about your decision? Use the following space to list questions, concerns, and next steps. Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision. There are two different kinds of medicines that I can take to help my panic disorder. Are you clear about which benefits and side effects matter most to you? Do you have enough support and advice from others to make a choice? Author: Healthwise Staff. Medical Review: Anne C. This information does not replace the advice of a doctor. Healthwise, Incorporated, disclaims any warranty or liability for your use of this information. Regarding the choice of pharmacologic treatment, an evidenced-based approach suggests that the SSRIs are an appropriate first consideration. Although tricyclic antidepressants show similar success rates for acute treatment, their side-effect burden has been greater than that of SSRIs. A high-potency benzodiazepine given at the minimum therapeutic dose may be a useful adjunct to antidepressant therapy if prompt relief is indicated. However, the treatment plan should include discontinuing the benzodiazepine when the antidepressant's maximal effects are expected i. Although benzodiazepines are considered an appropriate intervention after SSRIs and tricyclic antidepressants have failed, they should not be prescribed if a history of or current comorbid substance abuse is suspected or if the patient shows comorbid depression. MAOIs are also an appropriate consideration when comorbid depression or social phobia is evident, although they remain a second choice given the risks they pose. Cognitive-behavioral therapy is an appropriate first-line consideration in patients with mild to moderate panic disorder or panic disorder with situational avoidance. Although benzodiazepines can be combined temporarily with cognitive-behavioral therapy for prompt relief of severe symptoms, they have been known to interfere with cognitive-behavioral therapy, so their adjunctive use should be minimized. In situations where severe agoraphobic avoidance precludes participation in cognitive-behavioral therapy, consideration should be given to the combined use of SSRI or tricyclic antidepressant pharmacotherapy with cognitive-behavioral therapy. Cognitive-behavioral therapy has also been effective in patients who do not respond to pharmacotherapy and can be used in this role as well. Acute relapse is common when pharmacotherapy for panic disorder is discontinued. Other considerations for selecting a first-line treatment include the patient's preference for an approach that includes medication versus one that does not, as well as the availability of cognitive-behavioral treatment in the community. Once treatment is selected, patients should be monitored periodically. When stabilized, patients should be encouraged to reenter previously avoided situations gradually, regardless of the treatment approach being used. If the treatment response is inadequate after approximately eight weeks of therapy, alternatives should be reconsidered. Finally, patients with panic disorder often need sensitive clinical management. Many of these patients have been ill for several years and tend to have a history of varied, ineffective and failed treatments. Establishing a therapeutic alliance with patients, as described in Table 8 , is an important aspect of any treatment selected. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. Washington, D. Katon W. Panic disorder: relationship to high medical utilization, unexplained physical symptoms, and medical costs. J Clin Psychiatry. United States Department of Health and Human Services, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, National Institute of Mental Health. Panic disorder in the medical setting. Rockville, Md. ADM Ballenger JC. Wolfe B, Maser JD. Treatment of panic disorder: a consensus development conference. Jefferson JW. Antidepressants in panic disorder. Kessel JB, Simpson GM. Tricyclic and tetracyclic drugs. In: Kaplan HI, Sadock BJ, eds. Comprehensive textbook of psychiatry. Black DW, Wesner R, Bowers W, Gabel J. A comparison of fluvoxamine, cognitive therapy, and placebo in the treatment of panic disorder. Arch Gen Psychiatry. den Boer JA, Westenberg HG, Kamerbeek WD, Verhoeven WM, Kahn RS. Effect of serotonin uptake inhibitors in anxiety disorders; a double-blind comparison of clomipramine and fluvoxamine. Int Clin Psychopharmacol. Hoehn-Saric R, McLeod DR, Hipsley PA. Effect of fluvoxamine on panic disorder. J Clin Psychopharmacol. de Beurs E, van Balkom AJ, Lange A, Koele P, van Dyck R. Treatment of panic disorder with agoraphobia: comparison of fluvoxamine, placebo, and psychological panic management combined with exposure and of exposure in vivo alone. Am J Psychiatry. Sheehan DV, Harnett-Sheehan K. The role of SSRIs in panic disorder. Lydiard RB, Ballenger JC. Panic-related disorders: evidence for efficacy of the antidepressants. Special issue: perspectives on panic-related disorders. J Anxiety Dis. Buigues J, Vallejo J. Therapeutic response to phenelzine in patients with panic disorder and agoraphobia with panic attacks. Drug treatment of panic disorder. Comparative efficacy of alprazolam, imipramine, and placebo. Cross-National Collaborative Panic Study, Second Phase Investigators. Br J Psychiatry. Noyes R, DuPont RL, Pecknold JC, Rifkin A, Rubin RT, Swinson RP, et al. Alprazolam in panic disorder and agoraphobia: results from a multicenter trial. Patient acceptance, side effects, and safety. Davidson JR. Use of benzodiazepines in panic disorder. Owen RT, Tyrer P. Benzodiazepine dependence. A review of the evidence. Spiegel DA, Bruce TJ, Gregg SF, Nuzzarello A. Does cognitive behavior therapy assist slow-taper alprazolam discontinuation in panic disorder?. Ballenger JC, Lydiard RB, Turner SM. Panic disorder and agoraphobia. In: Gabbard GO, ed. Treatments of psychiatric disorders. Vol 2. DeMartinis NA, Schweizer E, Rickels K. An open-label trial of nefazodone in high comorbidity panic disorder. Geracioti TD. Venlafaxine treatment of panic disorder: a case series. Benjamin J, Levine J, Fux M, Aviv A, Levy D, Bel-maker RH. Double-blind, placebo-controlled, crossover trial of inositol treatment for panic disorder. Charney DS, Woods SW, Goodman WK, Rifkin B, Kinch M, Aiken B, et al. |
Steven Gans, MD Antidepressznt board-certified in psychiatry Antidepressant for panic attacks is an Carbohydrate loading strategy supervisor, teacher, and cor at Massachusetts General Hospital. Medication is one of the most Anttidepressant and panuc treatment options for panic disorder, panic attacks, and agoraphobia. Your doctor may prescribe panic attack medications to reduce the intensity of panic attacksdecrease overall feelings of anxiety, and potentially treat co-occurring conditions, such as depression. Medications for panic disorder are typically from one of two categories: antidepressants and anti-anxiety drugs. This article discusses how medications are used to treat panic disorder and which medications are most often prescribed.
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