Panic Disorder Treatment: Therapy and Medications

Panic disorder treatment is available and can be very successful. That's important because panic disorder can be a debilitating mental illness that prevents people from going to work, driving, being alone or certainly living a full life.

Treatment for panic disorder comes in two forms:

1. Medications for panic disorder
2. Therapy for panic disorder

It may be either acute or ongoing. If a panic attack is in progress, a person may be taken to the emergency room for acute panic attack treatment. In the most severe cases, oxygen will be administered and vital signs will be monitored. Medication may also be given intravenously at this time. Constant reassurance and explanation of what's going on is an important part of this type of panic disorder treatment.¹

Once the acute phase of treatment is over, ongoing treatment is necessary and is normally handled by a psychiatrist. Depending on the severity of the symptoms, a doctor may recommend medications and therapy for panic disorder (either or both).

Medications for Panic Disorder

There are multiple types of medications for panic disorder – several kinds of antidepressants and sedatives. Some medication for panic disorder is used short-term, such as in the presence of a panic attack, while others are ongoing and designed to treat panic disorder long-term. If one medication is not effective in treating panic disorder, the doctor may switch to another type of medication.

The following are the typical types of medications used in panic disorder treatment:²

• Selective serotonin reuptake inhibitors (SSRIs)– this type of antidepressant medication for panic disorder has the lowest risk of side effects and so is normally the first choice for treatment. SSRIs that have been FDA-approved in the treatment of panic disorder include:
  • Fluoxetine (Prozac, Prozac Weekly)
  • Paroxetine (Paxil, Paxil CR, Pexeva)
  • Sertraline (Zoloft)
• Serotonin-norepinephrine reuptake inhibitors (SNRIs) – this type of antidepressant medication is similar to SSRIs and is also a popular treatment for panic disorder. Venlafaxine (Effexor) is approved for panic disorder treatment.
• Tricyclic antidepressants (TCAs)– an older type of antidepressant, while effective, has a greater risk of side effects than SSRIs or SNRIs. No FDA-approved drugs are in this class but doctors sometimes prescribe these drugs in the treatment of panic disorder:
  • Imipramine (Tofranil, Tofranil-PM)
  • Desipramine (Norpramin)
  • Clomipramine (Anafranil)
• Monoamine oxidase inhibitors (MAOIs)– another older type of antidepressant which may be effective in treating panic disorder. However, this type of medication can cause severe side effects and require strict dietary restrictions and so they are used as a last resort. No MAOIs have been specifically approved for use in treating panic disorder but these two medications are sometime prescribed:
  • Phenelzine (Nardil)
  • Tranylcypromine (Parnate)
• Benzodiazepines – these are sedating medications for panic disorder. Benzodiazepines are often used short-term in the presence of a panic attack but, long-term, there are concerns about tolerance and dependence on this type of medication. FDA-approved benzodiazepine medication for panic disorder include:
  • Alprazolam (Xanax)
  • Clonazepam (Klonopin)

Therapy for Panic Disorder

Psychotherapy is often recommended. Typically, this is cognitive behavioral therapy, but psychodynamic (talk) therapy may also be used. Cognitive behavioral therapy for panic disorder is associated with a high success rate, low dropout rate and relatively low cost when compared to treatment with medication.

Cognitive behavioral therapy for panic disorder treatment includes:

• Analyzing thought and action processes; ascertaining triggers to panic attacks
• Changing thoughts and behaviors to reduce panic disorder symptoms
• Learning about anxiety and panic coping techniques
• Breathing and relaxation exercise
• Education about panic disorder
• Panic symptoms may be recreated in a safe space in order to teach coping techniques and master control over panic symptoms

Psychodynamic therapy for panic disorder is different in that it seeks to understand the underlying causes of panic disorder. Psychodynamic therapy works to help you understand your unconscious thoughts and emotional conflicts that contribute to the panic disorder. Based on these thoughts, new healthy ways of coping with panic disorder are identified.

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