Panic Disorder (cont.)
Roxanne Dryden-Edwards, MD
Roxanne Dryden-Edwards, MD
Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
In this Article
How is panic disorder diagnosed?
Some practitioners will administer a self-test of screening questions to individuals whom they suspect may be suffering from panic disorder. In addition to looking for symptoms of repeated panic attacks by asking detailed questions about the sufferer's history and conducting a mental-status examination, mental-health professionals will explore the possibility that the individual's symptoms are caused by another emotional illness instead of or in addition to the diagnosis of panic disorder. For example, people with an addiction often experience panic attacks, but those symptom characteristics generally only occur when the person is either intoxicated or withdrawing from the substance. The practitioner will also likely ensure that a physical examination and any other appropriate tests have been done recently to explore whether there is any medical problem that could be contributing to the occurrence of panic attacks.
What is the treatment for panic attacks? What medications treat panic attacks?
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Thanks to research, there are a variety of treatments available for controlling panic attacks, including several effective medical treatments, 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), paroxetine (Paxil), escitalopram (Lexapro), and citalopram (Celexa) 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, like racing heart rate associated with a panic attack. Some individuals who suffer from severe panic attacks may benefit from treatment with gabapentin (Neurontin), which was initially found to treat seizures, or benefit from a neuroleptic medication like risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel), aripiprazole (Abilify), paliperidone (Invega), asenapine (Saphris), iloperidone (Fanapt), or lurasidone (Latuda).
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, medications can be quite effective as part of treatment for panic disorder. However, as anything that is ingested carries a risk of side effects, it is important for the panic attack sufferer 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.
For individuals who may be wondering how to avoid panic attacks using treatment without prescribed medications, natural remedies may be an option. While herbal supplements that contain kava have been found to be helpful for some people with mild to moderate panic disorder, the research data is still considered to be too limited for many physicians to recommend treatment with other natural remedies like valerian or passionflower. Also, care should be taken when taking any dietary supplements, since 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. In fact, research shows that psychotherapy alone or the combination of medication and psychotherapy treatment are more effective than medication alone in the long-term management of panic attacks. In overcoming anxiety, cognitive behavioral therapy is widely accepted as an effective form of psychotherapy treatment, for both adults and children. This form of therapy seeks to help those with panic disorder identify and decrease the irrational thoughts and behaviors that reinforce panic symptoms and can be administered either individually, in group therapy, in partner-assisted therapy, and even over the Internet. 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 how to handle the emotional forces that may have contributed to developing symptoms (panic-focused psychodynamic psychotherapy) has also been found to be effective in teaching an individual with panic disorder how to prevent an anxiety attack or to decrease or stop a panic attack once it starts.
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 to prevent or manage panic attacks include engaging in aerobic exercise and stress-management techniques like deep breathing, massage therapy, and yoga, since these self-help 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 remedy the symptoms (placebo effect). Also, breathing into a paper bag when one is already 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.
People with panic disorder also may need treatment for other emotional problems. Depression has often been associated with panic disorder, as have alcohol and drug abuse. Fortunately, with proper treatment, 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.
Reviewed by Melissa Conrad Stöppler, MD on 9/10/2013
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