Panic disorder is a condition that involves sudden and recurring panic attacks. A panic attack is an episode of intense anxiety that can sometimes come on without warning. Often, it does not have a clear trigger.
Panic attacks can cause intense emotions, such as a fear of dying or a sense of being detached from yourself. They also cause physical symptoms, including heart palpitations or shortness of breath.
Clear signs of a panic disorder are recurrent panic attacks, followed by a month or so of worrying about having more attacks and avoidance of certain situations that may cause them.
Treatment for panic disorder includes medication and therapy. Lifestyle changes may also help.
Medication can make it easier for some people to manage panic attacks and anxiety. Some medications treat a co-occurring condition, such as depression, simultaneously.
Selective serotonin reuptake inhibitors (SSRIs)
SSRIs are a type of antidepressant also used to treat anxiety and panic attacks. They increase serotonin levels in the brain. They do this by blocking the natural reabsoprtion cycle of serotonin into nerve cells, allowing more serotonin to flow through the brain.
Serotonin is a chemical messenger associated with mood regulation. Stabilizing serotonin levels helps to reduce anxiety and panic.
SSRIs have been widely studied. They carry a low risk of serious side effects and are effective long term. As a result, they’re one of the most commonly prescribed medications for panic disorder.
Some SSRIs commonly prescribed to treat panic disorder include:
- citalopram (Celexa)
- escitalopram (Lexapro)
- fluvoxamine (Luvox)
- paroxetine (Paxil)
- fluoxetine (Prozac)
- sertraline (Zoloft)
Serotonin-norepinephrine reuptake inhibitors (SNRIs)
SNRIs are another type of antidepressant. They prevent the absorption of both serotonin and norepinephrine, a chemical messenger involved in the body’s response to stress.
SNRIs pose a low risk of side effects. They’re among the most widely recommended medications for panic disorder.
Venlafaxine (Effexor) is currently the only FDA-approved SNRI for panic disorder.
Tricyclic antidepressants (TCAs)
TCAs are an older generation of antidepressants. Although they’ve become less common with the invention of SSRIs, research suggests they’re equally effective in treating panic disorder.
TCAs work by increasing levels of serotonin and norepinephrine and blocking acetylcholine, a neurotransmitter associated with anxiety symptoms.
Some TCAs commonly prescribed to treat panic disorder include:
- doxepin (Adapin, Sinequan)
- clomipramine (Anafranil)
- nortriptyline (Pamelor)
- amitriptyline (Elavil)
- desipramine (Norpramin)
- imipramine (Tofranil)
Monoamine oxidase inhibitors (MAOIs)
MAOIs were the first antidepressants. They work by blocking monoamine oxidase, an enzyme involved in the breakdown of serotonin and norepinephrine.
MAOIs are effective in treating anxiety-related conditions, but they pose a risk of serious side effects when taken alongside certain foods and medications. As a result, they’re less likely to be prescribed for panic disorder than SSRIs, SNRIs, and TCAs.
In cases where other antidepressants are ineffective, the following MAOIs may be prescribed:
- isocarboxazid (Marplan)
- phenelzine (Nardil)
- tranylcypromine (Parnate)
Benzodiazepines cause sedation and create a calming effect. They work by slowing down central nervous system function, though their exact mechanism isn’t known.
While benzodiazepines are effective in treating symptoms of a panic attack, they’re generally not recommended for long-term use. 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
Beta-blockers treat the physical symptoms associated with panic attacks.
They work by preventing adrenaline from reaching the heart’s beta receptors and making the heart beat faster. They also help lower blood pressure.
They do not treat the psychological underpinnings of panic disorder.
Beta-blockers are traditionally prescribed for heart conditions. They have not been approved to treat panic disorder. Still, a doctor might prescribe beta-blockers off-label if they think it’s best for you.
Some common beta-blockers include:
- acebutolol (Sectral)
- bisoprolol (Zebeta)
- carvedilol (Coreg)
- propranolol (Inderal)
- atenolol (Tenormin)
- metoprolol (Lopressor)
There are other antidepressants available. Most work by stabilizing serotonin or norepinephrine levels.
Other antidepressants include:
- duloxetine (Cymbalta)
- trazodone (Desyrel)
- mirtazapine (Remeron)
Medication side effects
No matter what type of medication your doctor decides to try, it’s important to keep in mind that all prescription medications can have side effects, even if they are mostly deemed “safe.” Talk with your doctor about any other medications you’re taking and what kinds of side effects you might experience with your new prescription.
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. As a result, it’s not always possible to know what you’re taking.
Natural remedies can interfere with other medications and cause side effects. Ask a doctor before taking a natural remedy for panic disorder.
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:
- lifestyle changes
- relaxation techniques
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:
- sweating, chills, or hot flashes
- racing heart
- difficulty breathing
- tightness in the airways or chest
- abdominal cramps
- numbness or tingling
- overwhelming anxiety or fear
- a fear of losing control
- a fear of death
- a sense of detachment from yourself or reality
If you’ve experienced a panic attack, you might fear having another one or even avoid places or situations where you’ve had a panic attack.
Panic attacks resemble the body’s natural response to danger. However, it’s unclear why they occur in nonthreatening situations.
Factors such as genetics, environment, and stress all play a role.
Some risk factors include:
- having a family history of anxiety disorder
- significant stress, such as the loss of a loved one, unemployment, or a major life change
- traumatic events
- drinking a lot of coffee
- childhood physical or sexual abuse
It’s important to see a doctor if you’re experiencing panic attack symptoms. They can help you determine the reason for your symptoms and distinguish between panic attacks, panic disorder, or another condition.
They might conduct the following tests to make a diagnosis:
- a comprehensive physical exam
- blood tests
- an electrocardiogram (ECG/EKG)
- a psychological evaluation, including questions about your symptoms, medical and family history, lifestyle, and childhood
Panic disorder is a fairly common issue, but that doesn’t mean it’s easy to deal with. 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.