Panic Attacks and Panic Disorder - Treatment Overview

Treatment Overview

Panic disorder can be controlled with medications (such as antidepressants) and professional counseling (such as cognitive-behavioral therapy). Successful treatment reduces the number and frequency of panic attacks, lowers the anxiety you feel because of the fear of future attacks, and improves the quality of your life.

If your panic attacks were caused by a specific trigger, such as a medication reaction, you may not need treatment after the trigger has been removed, which in this case would mean stopping the medication with the help of your health professional. However, sometimes panic attacks caused by outside factors can continue after the trigger has been removed and may develop into panic disorder.

Initial treatment

Initial treatment for panic disorder depends upon how bad your panic attacks are, how much fear or anxiety you feel about having another attack, and whether you have agoraphobia (avoiding situations or places that might trigger an attack) along with panic disorder.

Generally, initial treatment includes:

• Professional counseling.
  • Cognitive-behavioral therapy, which focuses on modifying certain thinking and behavior patterns, is the most effective type of therapy for panic disorder.
  • Exposure therapy is a type of cognitive-behavioral therapy that focuses on confronting a feared object or situation. It can be especially helpful in treating agoraphobia or anxiety linked to a particular place or situation.
• Medications.
  • The most common medications used to treat panic disorder are selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac), sertraline (Zoloft), or paroxetine (Paxil). If these medications are not effective or do not work because of their side effects, other antidepressants may be tried.
  • Antidepressants with mixed neurotransmitter effects, such as venlafaxine (Effexor) are sometimes used.⁷
  • Benzodiazepines such as alprazolam (Xanax), diazepam (for example, Valium), lorazepam (Ativan), or clonazepam (Klonopin) sometimes 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.
  • Other antidepressants used to treat panic disorder include tricyclic antidepressants (TCAs) such as imipramine (Tofranil), desipramine (Norpramin), or clomipramine (Anafranil) and monoamine oxidase inhibitors (MAOIs) such as isocarboxazid (Marplan), phenelzine (Nardil), or tranylcypromine (Parnate).

Your symptoms of panic disorder may start to improve within a few weeks after beginning medications. If improvement is not seen within 6 to 8 weeks, a higher dose or another medication may be needed.¹⁰

Should I take medication to treat panic disorder?

Ongoing treatment

Treatment for recurring or ongoing panic disorder usually consists of continuing or changing initial measures, which include professional counseling and medications.

During initial treatment, a short-term medication such as a benzodiazepine may be prescribed to help you deal with immediate symptoms. The short-term medication will likely need to be tapered off and stopped after long-term medications begin working and your symptoms improve.

You will be continually assessed to determine whether you have developed any other conditions associated with panic disorder, such as depression or problems with drugs or alcohol. These additional conditions will also need treatment.

An important part of ongoing treatment is making sure you are taking your medication as prescribed. Often people who feel better after using medication for a period of time may believe they are "cured" and no longer need treatment. But when medication is stopped, symptoms usually return, so it is important that you continue the treatment plan.

Recurrent panic attacks can be mild to severe and continue for years, especially if you also have agoraphobia (avoiding places where you fear another attack will occur).⁸ You may have long periods without panic attacks or times when attacks occur frequently. Even after treatment is stopped because the attacks appear to be under control, attacks can suddenly return. Learn to identify your early warning signs and triggers so you can seek treatment early.

Treatment if the condition gets worse

If your panic attacks become severe or continually recur, you may need to be hospitalized until they are under control. You also may need a brief hospital stay if you have panic attacks along with another health condition, such as agoraphobia or depression, because these conditions combined can be more difficult to treat.

If you are taking medications that do not seem to be helping, your doctor may prescribe a different medication or a combination of medications.

If medication is currently your only treatment, counseling may be added to your treatment. Counseling may include cognitive-behavioral therapy, which focuses on modifying certain thinking and behavior patterns, or exposure therapy, which focuses on confronting a feared object or situation. If you are in counseling, but it does not seem to be working, more intensive, more frequent, or a different type of counseling may be added to your treatment.

If counseling is currently your only treatment, medications may be added.

What To Think About

Although medications to treat panic disorder often may prevent another panic attack, they may not take away the fear of having another attack. Counseling can help you handle this fear. The fear of having an attack may actually bring on another attack.

It can take up to several weeks or longer before a medication becomes fully effective. You may need to try several medications or combinations before you find the one that works best for you.

People who have panic disorder may be at an increased risk for suicide if they also have depression or another mood or personality disorder. These conditions can also have a significant impact on social functioning and quality of life. Diagnosis and treatment of conditions that occur along with panic disorder are essential.