Panic Disorder (cont.)
What is the treatment for panic attacks?
Thanks to research, there are a variety of treatments available for controlling panic attacks, including several effective medications, and specific forms of psychotherapy. In terms of medications, specific members of the selective serotonin reuptake inhibitor (SSRI), the selective serotonin and norepinephrine reuptake inhibitors (SSNRI), and the benzodiazepine families of medications are approved by the U.S. Food and Drug Administration (FDA) for effective treatment of panic disorder. Examples of such medications include sertraline (Zoloft) and paroxetine (Paxil) from the SSRI group, duloxetine (Cymbalta) and venlafaxine (Effexor) from the SSNRI group, and clonazepam (Klonopin) and lorazepam (Ativan) from the benzodiazepine group. Although alprazolam (Xanax) is often used to treat panic attacks, its short duration of action can sometimes result in having to take it several times per day. Medications from the beta-blocker family (for example, propranolol [Inderal]) are sometimes used to treat the physical symptoms associated with a panic attack.
Before SSRIs and SSNRIs became available, medications from the group known as the tricyclic antidepressants (TCAs) were often used to address panic disorder. Although TCAs have been found to be equally effective in treating panic attacks, SSRIs and SSNRIs have been proven to be safer and better tolerated, therefore TCAs
are used much less often. When used in the appropriate person with close
monitoring, these medications can be quite effective as part of treatment for
panic disorder. However, as anything that is ingested carries risk of side
effects, it is important to work closely with the prescribing doctor to decide
whether treatment with medications is an appropriate intervention and if so,
which medication should be administered. The person being treated should be
closely monitored for the possibility of side effects that can vary from minor
to severe, and in some cases even be life-threatening. Due to the possible risks
to the fetus of a mother being treated for panic attacks with medication,
psychotherapy should be the first treatment tried when possible in pregnant
women. Some herbal supplements are being increasingly used to treat panic
disorder. While the supplement kava has been found to be effective and generally
safe for the treatment of mild to moderate panic disorder, care should be taken
when taking dietary supplements, since many supplements are not regulated in
terms of quality, content, or effectiveness.
The psychotherapy component of treatment for panic disorders is at least as important as medication treatment. In fact, research shows that psychotherapy alone or the combination of medication and psychotherapy treatment are more effective than medication alone in overcoming panic attacks. To address anxiety, cognitive behavioral therapy is widely accepted as an effective form of psychotherapy. This form of therapy seeks to help those with panic disorder identify and decrease the irrational thoughts and behaviors that reinforce panic symptoms. Behavioral techniques that are often used to decrease anxiety include relaxation techniques and gradually increasing exposure to situations that may have previously precipitated anxiety in the individual. Helping the anxiety sufferer understand the emotional forces that may have contributed to developing symptoms (panic-focused psychodynamic psychotherapy) has also been found to be effective.
Often, a combination of psychotherapy and medications produces good results. Improvement is usually noticed in a fairly short period of time, about two to three months. Thus, appropriate treatment for panic disorder can prevent panic attacks or at least substantially reduce their severity and frequency, bringing significant relief to 70%-90% of people with panic disorder.
There are also things that people with panic disorder can do to help make
treatment more effective. Since substances like caffeine, alcohol, and illicit
drugs can worsen panic attacks, those things should be avoided. Other tips for
managing panic attacks include engaging in aerobic exercise and
stress-management techniques like deep breathing and yoga, since these
activities have also been found to help decrease the frequency and severity of
panic attacks. Although many people breathe into a paper bag when afflicted by
the hyperventilation that can be associated with panic, the benefit received may
be the result of the individual believing it will help (placebo effect). Also,
breathing into a paper bag when one is having trouble breathing can make matters
worse when the hyperventilation is the result of conditions of oxygen
deprivation, like an asthma attack or a heart attack.
In addition, people with panic disorder may need treatment for other emotional problems. Depression has often been associated with panic disorder, as have alcohol and drug abuse. Recent research also suggests that suicide attempts are more frequent in people with panic disorder. Fortunately, these problems associated with panic disorder can be overcome effectively, just like panic disorder itself.
Sadly, many people with panic attacks do not seek or receive treatment.
Next: What happens if panic attacks are not treated? »
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