Introduction

This information will help you understand your choices, whether you share in the decision-making process or rely on your doctor's recommendation.

Key points in making your decision

Factors to consider when deciding whether to take medicines to treat panic disorder include the how bad your symptoms are, whether you are taking medicines for other conditions, and how you feel about taking medicine. Think about the following when you are making your decision:

• Considering how much your symptoms bother you can help you decide whether medicines are necessary. If your panic attacks and anxiety interfere with your daily living, taking medicines may be a good choice for you.
• Two types of medicines are effective for treating panic disorder. Benzodiazepines work to help symptoms of panic disorder right away and can be taken as needed. Antidepressants need to be taken every day for long-term treatment.
• If your symptoms are manageable, home treatments and professional counseling, such as cognitive-behavioral therapy (which focuses on modifying certain thinking and behavior patterns), may be enough to reduce your symptoms and manage your panic attacks.
• Medicines will help control your symptoms of panic disorder if you are willing to take them as prescribed, to manage any uncomfortable side effects, and to continue taking the medicines for the long term. If you have depression along with panic disorder, some medicines can be helpful in treating both conditions.¹
• Although one type of treatment may work for you, for many people a combination of both medicine and counseling is the most effective long-term treatment for panic disorder.²
• If you need medicines to treat panic disorder, don't be ashamed about taking them. Panic disorder is a medical condition, not a character flaw or weakness. The medicines will not alter your personality.

Medical Information

What is panic disorder?

Panic disorder is a mental condition in which you have repeated, unexpected panic attacks and constantly worry about having another attack. A panic attack is a sudden feeling of extreme anxiety along with intense and frightening, but not life-threatening, physical symptoms. An attack usually lasts from 5 to 20 minutes but may last even longer, up to a few hours. You feel most anxious about 10 minutes into the attack.

For more information, see the topic Panic Attacks and Panic Disorder.

What are the risks of panic disorder?

Panic disorder can reduce your quality of life and interfere with your relationships and your ability to work. If you have panic disorder, you are more likely to develop certain other conditions such as depression or agoraphobia, which is a fear of being in public places or of being in situations from which it might be difficult to escape (such as crossing a bridge or standing in line).

What types of medicines are used to treat panic disorder?

The two types of medicines that are generally used to treat panic disorder are antidepressants and benzodiazepines. Sometimes a combination of both may be prescribed.

The most common medicines used to treat panic disorder are selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac), sertraline (Zoloft), or paroxetine (Paxil). Other antidepressants such as tricyclic antidepressants (TCAs) or monoamine oxidase inhibitors (MAOIs) can also be effective. Antidepressants with mixed neurotransmitter effects, such as venlafaxine (Effexor), may also be used to treat panic disorder.

Sometimes benzodiazepines such as alprazolam (Xanax), diazepam (Valium), lorazepam (Ativan), or clonazepam (Klonopin) are prescribed, either alone or combined with an antidepressant. Benzodiazepines are most commonly used for rapid, short-term relief of symptoms and may also be used as a part of ongoing treatment either alone or combined with an antidepressant. Benzodiazepines work quickly to treat anxiety and may be especially helpful if you have agoraphobia. Unlike antidepressants, they can be taken as needed. But symptoms often recur when you stop taking them, and they have the potential to cause addiction (dependence).

What to expect if you take medicines to treat panic disorder

Antidepressants can help balance the chemicals in your brain (neurotransmitters) and reduce the intensity of your symptoms. You may start to feel better within 1 to 3 weeks of taking antidepressant medicine. But it can take as many as 6 to 8 weeks to see more improvement. If you have questions or concerns about your medicines, or if you do not notice any improvement by 3 weeks, talk to your doctor. Benzodiazepines provide more immediate relief for symptoms of anxiety and may be prescribed alone or combined with an antidepressant such as an SSRI.

It is important to remember that people respond differently to medicines, and the first medicine you try may or may not be effective in relieving your symptoms of panic disorder. If the medicine is not effective after several weeks, you may need to try another medicine.

Although antidepressant medicines have potential side effects, these side effects are usually mild and may diminish after several weeks of therapy.

What to expect if you DO NOT take medicines to treat panic disorder

Even if you decide not to take medicine, it is wise to try professional counseling, such as cognitive-behavioral therapy, which focuses on modifying certain thinking and behavior patterns. Therapy can help you deal with immediate problems and learn ways to better cope with future anxiety and panic attacks. Other treatments, such as support groups, relaxation exercises, or mindfulness activities, can also be helpful. Untreated panic disorder may get worse or may be unmanageable without help, especially if you also have another condition that commonly occurs along with panic disorder such as agoraphobia or depression.

If you do not take medicines to treat panic disorder, continuing to monitor how much your symptoms interrupt your life and the lives of those around you can be helpful. Some people are able to overcome panic disorder without taking medicine. But if other methods aren't effective enough, medicines can be added to your treatment.

Your Information

Your choices are as follows:

• Don't take medicine to treat panic disorder, but work on managing the symptoms of panic disorder with lifestyle changes, home treatment, or professional counseling.
• Take medicine to treat panic disorder. You can also take medicine while you work on managing the symptoms of panic disorder with lifestyle changes, home treatment, or professional counseling.

The decision about whether to take medicine to treat panic disorder takes into account your personal feelings and the medical facts.

These personal stories may help you make your decision.

Wise Health Decision

Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about taking medicines to treat panic disorder. Discuss the worksheet with your doctor.

Circle the answer that best applies to you.

*NA = Not applicable

Use the following space to list any other important concerns you have about this decision.

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to take or not take medicines to treat your panic disorder.

Check the box below that represents your overall impression about your decision.

FDA Advisories. The U.S. Food and Drug Administration (FDA) has issued:

• An advisory on antidepressant medicines and the risk of suicide in children and adults. The FDA does not recommend that people stop using these medicines. Instead, a person taking antidepressants should be watched for warning signs of suicide. This is especially important at the beginning of treatment or when doses are changed.
• A warning about the antidepressants Paxil and Paxil CR and birth defects. Taking these medicines in the first 12 weeks of pregnancy may increase your chance of having a baby with a birth defect.

Return to the topic Panic Attacks and Panic Disorder.