The goal of treatment is to eliminate all of your panic attack symptoms. With effective treatment, most people are eventually able to resume everyday activities.
The main treatment options for panic attacks are psychotherapy and medications. Both are effective. Your doctor likely will recommend one or both types of treatment, depending on your preference, your history, the severity of your panic disorder and whether there are therapists with special training in panic disorders in your area.
Psychotherapy, also called talk or behavior therapy, is considered an effective first choice treatment for panic attacks and panic disorder. Psychotherapy can help you understand panic attacks and panic disorder and learn how to cope with them.
Cognitive behavioral therapy can help you learn through your own experience that panic symptoms are not dangerous. During therapy sessions, your therapist will help you gradually re-create the symptoms of a panic attack in a safe, supportive setting. Once the physical sensations of panic no longer seem threatening, the attacks begin to resolve. Successful treatment can also help you overcome fears of situations that you've been avoiding because of panic attacks.
Your therapist may suggest weekly meetings when you begin psychotherapy. You may start to see improvements in panic attack symptoms within several weeks, and often symptoms decrease significantly or go away within several months.
As your symptoms improve, you and your therapist will develop a plan to taper off therapy. You may agree to schedule occasional maintenance visits to help ensure that your panic attacks remain under control.
Medications can help reduce symptoms associated with panic attacks as well as depression if that's an issue for you. Several types of medication have been shown to be effective in managing symptoms of panic attacks, including:
- Selective serotonin reuptake inhibitors (SSRIs). Generally safe with a low risk of serious side effects, SSRI antidepressants are typically recommended as the first choice of medications to treat panic attacks. SSRIs approved by the Food and Drug Administration (FDA) for the treatment of panic disorder include fluoxetine (Prozac), paroxetine (Paxil, Pexeva) and sertraline (Zoloft).
- Serotonin and norepinephrine reuptake inhibitors (SNRIs). These medications are another class of antidepressants. The SNRI drug called venlafaxine hydrochloride (Effexor XR) is FDA approved for the treatment of panic disorder.
- Benzodiazepines. These mild sedatives belong to a group of medicines called central nervous system depressants. Benzodiazepines may be habit-forming (causing mental or physical dependence), especially when taken for a long time or in high doses. Benzodiazepines approved by the FDA for the treatment of panic disorder include alprazolam (Niravam, Xanax), clonazepam (Klonopin) and lorazepam (Ativan). If you seek care in an emergency room for signs and symptoms of a panic attack, you may be given a benzodiazepine to help stop the attack.
If one medication doesn't work well for you, your doctor may recommend switching to another or combining certain medications to boost effectiveness. Keep in mind that it can take several weeks after first starting a medication to notice an improvement in symptoms. All medications have a risk of side effects, and some may not be recommended in certain situations, such as pregnancy. Talk with your doctor about the possible side effects and risks.
May. 31, 2012
- Panic attack. In: Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR. 4th ed. Arlington, Va.: American Psychiatric Association; 2000. http://www.psychiatryonline.com. Accessed March 6, 2012.
- Hales RE, et al. The American Psychiatric Publishing Textbook of Psychiatry. 5th ed. Washington, D.C.: American Psychiatric Association; 2008. Accessed March 7, 2012.
- Panic disorder. National Institute of Mental Health. http://www.nimh.nih.gov/health/publications/anxiety-disorders/panic-disorder.shtml. Accessed March 6, 2012.
- Answers to your questions about panic disorder. American Psychological Association. http://www.apa.org/topics/anxiety/panic-disorder.aspx. Accessed March 6, 2012.
- Practice guideline for the treatment of panic disorder, Second edition. Arlington, Va.: American Psychiatric Association. http://psychiatryonline.org/content.aspx?bookid=28§ionid=1680635. Accessed March 6, 2012.
- Inositol. National Medicines Comprehensive Database. http://naturaldatabase.com. Accessed Feb. 20, 2012.
- Smits JA, et al. The interplay between physical activity and anxiety sensitivity in fearful responding to carbon dioxide challenge. Psychosomatic Medicine. 2011;6:498.
- Saeed SA, et al. Exercise, yoga and meditation for depressive and anxiety disorders. American Family Physician. 2010;8:981.
- Panic disorders. In: Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR. 4th ed. Arlington, Va.: American Psychiatric Association; 2000. http://www.psychiatryonline.com. Accessed March 6, 2012.
- Katon W, et al. Panic disorder: Epidemiology, clinical manifestations, and diagnosis. http://www.uptodate.com/index. Accessed March 7, 2012.
- Roy-Byrne PP. Pharmacotherapy for panic disorder. http://www.uptodate.com/index. Accessed March 7, 2012.
- Whiteside SP (expert opinion). Mayo Clinic, Rochester, Minn. April 24, 2012.
- Moore KM (expert opinion). Mayo Clinic, Rochester, Minn. May 17, 2012.
- Fluoxetine (Prozac, Prozac Weekly), paroxetine (Paxil, Paxil CR, Pexeva) and sertraline (Zoloft), alprazolam (Xanax), clonazepam (Klonopin) and lorazepam (Ativan). Micromedex Healthcare Series. http://www.micromedex.com. Accessed March 8, 2012 and May 23, 2012.