What are the best medicines for panic attacks?

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Medically reviewed by Dr. Ola Tarabzuni

Overview

Anxiety and panic hits us in our daily routine, from something as small as receiving a notification on our phone to something as big as losing yourself while dealing with difficult situations in life. The fear of uncertainty and the unknown has been running in our blood since the start of the world. Only if the panic attack becomes frequent and uncontrolled it transition to panic disorder, affecting about 6 million adults in the U.S., with women being twice as likely as men to develop it.

Around 5% of U.S. adults may experience panic disorder at some point in their lives. While panic attacks themselves aren’t life-threatening, they can significantly impact one’s quality of life. Thankfully, effective treatments are available to help manage this condition.

What is a panic attack?

Panic disorder is a type of anxiety disorder characterized by recurrent panic attacks, persistent concern about having more attacks and their potential consequences, or significant behavioural changes to avoid situations where previous attacks occurred. It’s important to note that experiencing a single panic attack doesn’t necessarily mean you have a panic disorder. A panic attack is a singular event marked by intense fear and physical symptoms. In contrast, panic disorder involves frequent, unexpected panic attacks that profoundly affect daily life due to the ongoing fear of future episodes.

A psychotherapist at Brigham Women’s Hospital, Gabe Gruner, says, 

“Anxiety and panic are interrelated, and both contribute to panic disorder.” 

What triggers panic attacks?

Panic attacks can be triggered by various factors such as over-breathing, prolonged stress, and activities that cause intense physical reactions like exercise or excessive coffee consumption. They can also be caused by physical or sudden environmental changes after an illness.

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What are the best medications for panic disorder?

Medications that are FDA-approved to treat panic disorder fall into three classes, including selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and benzodiazepines. Each class works differently to help manage symptoms and improve the quality of life for those with panic disorder.

Selective serotonin reuptake inhibitors (SSRIs)

SSRIs are the first-choice medications for treating panic disorder. These drugs increase serotonin levels in the brain, a neurotransmitter that helps regulate mood. While the exact link between serotonin and anxiety disorders is not fully understood, SSRIs are effective in reducing the symptoms of panic disorder. They are also used to treat other mental health conditions, such as depression and other anxiety disorders. Three SSRIs are FDA-approved specifically for panic disorder:

Healthcare providers may also prescribe other SSRIs off-label, which means they are not specifically FDA-approved for panic disorder but are still effective based on clinical guidelines.

Serotonin and norepinephrine reuptake inhibitors (SNRIs)

SNRIs function similarly to SSRIs but affect both serotonin and norepinephrine, another neurotransmitter linked to anxiety. The only FDA-approved SNRI for panic disorder is:

  • Venlafaxine Extended-Release (Effexor XR)

Venlafaxine is available in immediate-release tablets, extended-release tablets, and extended-release capsules, but only the extended-release capsule is FDA-approved for treating panic disorder. Other SNRIs have been studied less for this condition.

Benzodiazepines

Benzodiazepines are often used for short-term relief of panic disorder symptoms because they work quickly to calm the central nervous system. However, due to the risk of physical dependence, they are generally prescribed for short periods (ideally no more than 2 to 4 weeks). The FDA-approved benzodiazepines for panic disorder are:

  • Alprazolam (Xanax)
  • Clonazepam (Klonopin)

Benzodiazepines are particularly useful during an active panic attack due to their fast-acting nature. However, they are less preferred for long-term treatment compared to SSRIs and SNRIs due to the potential for dependence and withdrawal symptoms.

Other medications

Aside from SSRIs, SNRIs, and benzodiazepines, treatment guidelines also suggest the use of tricyclic antidepressants (TCAs) for panic disorder. These include:

  • Imipramine
  • Clomipramine (Anafranil)
  • Nortriptyline (Pamelor)

Although effective, TCAs are not FDA-approved for panic disorder and often cause more side effects compared to SSRIs and SNRIs.

Choosing the right medication

Selecting the appropriate medication involves considering several factors, including the severity of the panic disorder, the presence of other health conditions, and potential side effects. Finding the most effective medication with the fewest side effects often requires trial and error.

Treatment aims to reduce the frequency and intensity of panic attacks, improving daily functioning. Both psychotherapy and medications are common treatment options, and they are often used together for better results. Discuss with your healthcare provider to determine the best treatment plan tailored to your needs.

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Which medication works the fastest to stop a panic attack?

For immediate relief of panic attack symptoms, benzodiazepines are the fastest-acting option. They work quickly to calm the central nervous system, making them effective for short-term relief of anxiety symptoms during an active panic attack. This rapid onset is why benzodiazepines are commonly used to manage acute episodes of panic.

How long can a panic attack last?

Panic attacks generally last from a few minutes to half an hour, but their physical and emotional impacts can persist for several hours. They are quite common, with as many as 35% of people experiencing at least one panic attack in their lifetime.

What are the major side effects of panic disorder medications?

Though effective, medications for panic disorder can come with side effects. SSRIs, venlafaxine ER, and benzodiazepines can all cause common issues like diarrhea, nausea, and drowsiness. However, each class of medication has its unique profile of side effects and risks.

SSRIs and Venlafaxine ER

SSRIs and Venlafaxine ER often take longer to show effects compared to benzodiazepines, typically requiring 4 to 6 weeks of daily use to become fully effective. These medications can also cause side effects such as sweating and sexual dysfunction, which are not usually seen with benzodiazepines.

One serious but rare complication of SSRIs and venlafaxine ER is serotonin syndrome, a potentially life-threatening condition caused by excess serotonin in the body. Symptoms of serotonin syndrome include:

  • Fever
  • Stiff or rigid muscles
  • Vomiting
  • Tremors (uncontrollable shaking)
  • Unexplained agitation, confusion, or restlessness
  • Excessive sweating

Immediate medical attention is necessary if these symptoms occur.

Benzodiazepines

Benzodiazepines, while effective for rapid relief, carry a risk of dependence. Regular use can lead to withdrawal symptoms such as nausea, shaking, and anxiety if the dosage is reduced or the medication is stopped. These withdrawal symptoms can sometimes mimic the symptoms of a panic attack.

If you experience increased panic attack symptoms while reducing your benzodiazepine dose, contact your healthcare provider, who may need to adjust your dosage reduction schedule to minimize withdrawal symptoms. It’s crucial to never change your benzodiazepine dosage without consulting your healthcare provider, who can provide a safe and appropriate tapering plan.

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Are there any safe alternatives to panic disorder medication?

Psychotherapy, commonly known as talk therapy, is considered a safe and effective alternative to medication for treating panic attacks and panic disorders. Through psychotherapy, individuals can gain a deeper understanding of their panic symptoms and develop coping strategies to manage them effectively. While medications can help reduce the onset of panic attacks, psychotherapy answers the reason for the onset of such attacks for more effective management and complete eradication. 

Cognitive Behavioral Therapy (CBT) is a specific type of psychotherapy that has been particularly successful in treating panic disorder. CBT helps individuals recognize and challenge negative thought patterns and beliefs that contribute to panic attacks. By gradually exposing patients to feared situations in a controlled environment, therapists help desensitize them to triggers, reducing the frequency and intensity of panic attacks over time.

Overcoming panic disorder through psychotherapy requires commitment and effort, but the results can be significant. Many individuals begin to notice a reduction in panic symptoms within several weeks of starting therapy, with further improvement over several months. Maintenance visits may be scheduled to ensure continued management of panic attacks and address any recurrences effectively.

There are several effective psychological treatments for anxiety disorders, each tailored to individual needs and preferences. Some of the most widely recognized and researched approaches include:

  • Psychodynamic therapy helps dive into the unconscious roots of anxiety to resolve underlying conflicts.
  • Dialectical behavior therapy (DBT) integrates cognitive-behavioral techniques with mindfulness to regulate emotions and enhance interpersonal relationships.
  • Exposure therapy gradually exposes individuals to feared stimuli to reduce anxiety responses.
  • Acceptance and commitment therapy (ACT) fosters acceptance of distressing thoughts while aligning behaviors with personal values.
  • Counseling provides a supportive environment to explore feelings and develop coping strategies.
  • Eye movement desensitization and reprocessing (EMDR) utilizing bilateral stimulation to process traumatic memories and alleviate anxiety symptoms.
  • Interpersonal psychotherapy enhances relationships and communication patterns to reduce anxiety.
  • Mindfulness and deep breathing promote present-moment awareness, acceptance, and relaxation techniques.
  • Online therapies and relaxation techniques offer accessible and effective interventions for remote support and stress reduction.

You can reclaim control over your life from the clutches of anxiety and panic disorders by talking to a therapist and getting a personalized treatment option for yourself or your family.

Consult a doctor

If you’ve experienced signs or symptoms of a panic attack, it’s essential to seek help from your primary care provider. Your doctor can conduct an initial evaluation to assess your symptoms and determine the appropriate course of action. Depending on your needs, they may refer you to a mental health therapist for further evaluation and treatment. Don’t hesitate to reach out for support—effective treatment is available to help manage panic attacks and improve your quality of life.

FAQs about panic disorder medications

What is the most effective psychological treatment for anxiety?

Among psychological treatments for anxiety disorders, Cognitive Behavioral Therapy (CBT) reigns supreme as the most effective form of psychotherapy. Typically administered over a short-term period, CBT focuses on imparting specific skills to enhance symptom management and facilitate a gradual return to activities that have been avoided due to anxiety.

What is the most prescribed drug for panic attacks?

The most commonly prescribed drugs for panic attacks are benzodiazepines, including alprazolam (Xanax) and clonazepam (Klonopin), which the FDA approves for the treatment of panic disorder. However, benzodiazepines are typically used on a short-term basis due to their potential for habit formation, leading to mental or physical dependence.

Your Doctors Online uses high-quality and trustworthy sources to ensure content accuracy and reliability. We rely on peer-reviewed studies, academic research institutions and medical associations to provide up-to-date and evidence-based information to the users.

  • National Institute of Mental Health. Panic Disorder: When Fear Overwhelms
  • Cackovic C, Nazir S, Marwaha R. Panic Disorder. [Updated 2023 Aug 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430973/
  • Imai H, Tajika A, Chen P, Pompoli A, Furukawa TA. Psychological therapies versus pharmacological interventions for panic disorder with or without agoraphobia in adults. Cochrane Database of Systematic Reviews 2016, Issue 10. Art. No.: CD011170. DOI: 10.1002/14651858.CD011170.pub2. Accessed 24 June 2024.
  • Sub Laban T, Saadabadi A. Monoamine Oxidase Inhibitors (MAOI) [Updated 2023 Jul 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539848/
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