We’ve all had times of panic, like when we got lost in a city or ran into something stressful out of the blue. We all react in these ways to fear and worry all the time. What we call panic attacks, on the other hand, happen when fear strikes out of the blue. If these attacks happen often, they might be a sign of panic disorder.
About 6 million adults in the U.S. have panic disorder, which is an anxiety condition. Women are twice as likely as men to get it. About 5% of people in the U.S. are thought to have panic disorder at some point in their lives. Let’s learn more about panic disorder, including its most common signs and symptoms and what medication for panic attacks is most effective.
What is a Panic Attack?
Panic disorder is a specific anxiety disorder characterized by recurrent panic attacks accompanied by one of the following:
- Constant worry about having more panic attacks and the bad things that might happen if they do.
- Changes in behavior because of panic attacks, such as staying away from places where they happened.
There is a chance that someone does not have panic disorder even if they have had one panic attack. People are said to have panic disorder when these sudden panic attacks happen a lot and make it hard for them to go about their daily lives.
What are the Symptoms of Panic Attacks?
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the authoritative guide on mental health conditions and their associated symptoms, a panic attack typically involves a minimum of four of the following symptoms:
- Rapid or pounding heart rate.
- Excessive sweating.
- Trembling or shaking.
- Chest pain or discomfort.
- Nausea or abdominal pain.
- Dizziness, unsteadiness, lightheadedness, or fainting.
- The sensation of being too hot or too cold.
- Numbness or tingling sensations.
- Fear of losing control or dying.
- Experiencing detachment from oneself.
Panic attacks can manifest differently for each individual, with some experiencing a subset of these symptoms or additional sensations not listed here. If you believe you’ve had a panic attack, it’s crucial to consult your healthcare provider and provide a detailed description of your experience.
What is the Best Medication for Panic Attacks?
There are three main types of drugs that the FDA has allowed for panic disorder medication: benzodiazepines, selective serotonin reuptake inhibitors (SSRIs), and serotonin and norepinephrine reuptake inhibitors (SNRIs).
SSRIs are often the first choice when it comes to treating panic disorder with medicine. These drugs raise the amount of serotonin in the brain, which is a neurotransmitter that affects how we feel. The exact link between serotonin and anxiety illnesses is not fully understood, but SSRIs help people with panic disorder feel better. Here are the three SSRIs that the FDA has cleared for panic disorder:
- Fluoxetine (Prozac).
- Paroxetine (Paxil, Pexeva).
- Sertraline (Zoloft).
Healthcare providers may also prescribe other SSRIs off-label for panic disorder treatment, as they are considered similarly effective for this condition.
Another type of drug called SNRIs works like SSRIs, but it affects more neurons. Along with serotonin, SNRIs raise the brain’s norepinephrine levels, another neurotransmitter linked to nervousness. Extended-release (ER) venlafaxine (Effexor XR) is the only SNRI that the FDA has cleared for panic disorder. Other SNRIs have not been studied as much for treating panic disorder, but venlafaxine is allowed for this use.
Benzodiazepines as Fast Acting Medication for Panic Attacks
Benzos are used to treat several conditions, such as generalized anxiety disorder, panic disorder, and seizure disorders. These drugs calm down the central nervous system. The FDA has cleared two benzodiazepines for panic disorder: alprazolam (Xanax) and clonazepam (Klonopin). Because they are fast acting medication for panic attacks, they are most often used to treat ongoing panic attacks. Of course, they shouldn’t be used for too long—no more than two to four weeks at most—because they can make you physically dependent on them. Most of the time, SSRIs are the best long-term treatment for panic condition.
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Top 10 Most Popular Medications for Panic Attacks
The top 3 most commonly prescribed medications for panic attacks, as fast acting drugs are:
1. Xanax (generic name: Alprazolam)
2. Klonopin (generic name: Clonazepam)
3. Ativan (generic name: Lorazepam)
However, many doctors choose SSRIs as the top option for treating panic disorder with medication as they are nonaddictive vs. Benzos, which have addictive risk profiles. For a more comprehensive look at the most popular medications for panic attack disorder, use the chart below to determine which drugs may be helpful to you or a loved one. If you have any questions about which panic attack disorder medication and treatment is most suited for your case, call the We Level Up Treatment Center network for a free consultation.
|Drug Name||Typical Dose||Use||Duration|
|Xanax||0.25-0.5mg||Short-term relief||4-6 hours|
|Klonopin||0.25-0.5mg||Short-term relief||4-6 hours|
|Ativan||1-2mg||Short-term relief||6-8 hours|
|Valium||2-10mg||Short-term relief||4-6 hours|
|Prozac||10-20mg||Long-term management||Several weeks to see full benefits|
|Zoloft||50-200mg||Long-term management||Several weeks to see full benefits|
|Paxil||10-60mg||Long-term management||Several weeks to see full benefits|
|Effexor||37.5-150mg||Long-term management||Several weeks to see full benefits|
|Celexa||20-40mg||Long-term management||Several weeks to see full benefits|
|Lexapro||10-20mg||Long-term management||Several weeks to see full benefits|
We Level Up FL Mental Health Center Tips To Manage Your Panic Disorder
Top 10 Treatment Options for Panic Attack Medications
Beyond medication, there are alternative treatment options to consider for managing panic attacks and panic disorder. While these may not be standalone treatments, they can complement conventional approaches. Here are some alternative options:
- Cognitive Behavioral Therapy (CBT): CBT is a structured form of psychotherapy that aims to help individuals identify and change negative thought patterns and behaviors. It is one of the most effective non-medication treatments for panic disorder.
- Exposure Therapy: CBT involves gradually exposing individuals to feared situations, objects, or thoughts. The goal is to reduce anxiety and avoidance behaviors associated with panic attacks.
- Mindfulness and Meditation: Mindfulness practices and meditation techniques can help individuals manage stress and anxiety. They focus on being present in the moment and developing relaxation skills.
- Yoga and Tai Chi: These mind-body practices combine physical postures, breathing exercises, and meditation. They can promote relaxation and reduce anxiety.
- Herbal Supplements: Some individuals explore using herbal remedies like kava, valerian root, or chamomile for anxiety relief. It’s essential to consult with a healthcare provider before using herbal supplements, as they may interact with medications.
- Breathing Exercises: Deep breathing and diaphragmatic breathing techniques can help manage anxiety and reduce the severity of panic attacks.
- Acupuncture: Traditional Chinese medicine involves the insertion of thin needles at specific points on the body to balance energy flow. Some people find acupuncture helpful for anxiety reduction.
- Diet and Lifestyle Modifications: A balanced diet, regular exercise, adequate sleep, and stress management can significantly impact anxiety and panic disorder symptoms.
- Biofeedback: This technique helps individuals gain awareness and control over physiological processes such as heart rate and muscle tension.
- Aromatherapy: Aromatherapy involves using essential oils to promote relaxation and reduce stress. Scents like lavender and chamomile are commonly associated with anxiety reduction.
When you experience symptoms resembling panic attacks, your primary care provider will conduct a thorough assessment to determine the cause. This will involve various steps, including:
- Physical examination: A comprehensive physical exam will rule out underlying medical conditions, such as thyroid or heart problems.
- Blood tests and heart tests: To further investigate potential medical causes, blood tests will be conducted to check your thyroid and other conditions. Additionally, tests on your heart, such as an electrocardiogram (ECG or EKG), may be done.
- Psychological evaluation: To gain a better understanding of your symptoms, fears, and concerns, a psychological assessment will be conducted. This will involve discussing stressful situations, relationship problems, situations you may avoid, and your family history.
- Self-assessment and substance use inquiry: You may be given a psychological self-assessment or questionnaire to fill out. Additionally, your provider may inquire about your alcohol or other substance use.
Criteria for Panic Disorder Diagnosis
It’s important to note that not everyone who experiences panic attacks will have panic disorder. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published by the American Psychiatric Association, the following points are considered for a diagnosis of panic disorder:
- Frequent, unexpected panic attacks.
- At least one panic attack followed by one month or more of ongoing worry, fear about the consequences of an attack, or significant changes in behavior such as avoidance of triggering situations.
- Panic attacks are not attributed to substance use, medical conditions, or other mental health conditions.
Remember, even if you do not meet the criteria for panic disorder, seeking treatment for panic attacks is still beneficial. Untreated panic attacks can worsen and potentially lead to the development of panic disorder or phobias.
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What are the Side Effects of Panic Attack Medications?
Some people who take medicines to treat panic attacks and panic disorder may experience side effects, but not everyone will. Before starting or while taking these medicines. Here are some common side effects of different types of medicines for panic attacks:
|Medication Class||Common Side Effects|
|Selective Serotonin Reuptake Inhibitors (SSRIs)||Nausea or gastrointestinal upset, Headaches, Insomnia or drowsiness, Sexual dysfunction, Weight changes, Anxiety or restlessness, Sweating, Dry mouth, Dizziness, Tremors.|
|Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs)||Nausea, Dizziness, Dry mouth, Sweating, Insomnia or drowsiness, Changes in blood pressure, Sexual dysfunction, Anxiety or restlessness.|
|Benzodiazepines||Drowsiness, Dizziness, Impaired coordination, Memory problems, Fatigue, Changes in appetite, Mood changes, Dependence or withdrawal symptoms with prolonged use.|
|Tricyclic Antidepressants (TCAs)||Dry mouth, Drowsiness or insomnia, Weight changes, Constipation, Blurred vision, Urinary retention, Low blood pressure, Increased heart rate, Sexual dysfunction, Confusion (especially in older individuals).|
|Monoamine Oxidase Inhibitors (MAOIs)||Potentially severe interactions with certain foods, beverages, and other medications (requires strict dietary restrictions and monitoring), Dizziness, Insomnia, Weight changes, Dry mouth, Changes in blood pressure.|
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TCAs and MAOIs as Medication for Panic Attacks
Tricyclic Antidepressants (TCAs) and Monoamine Oxidase Inhibitors (MAOIs) are two classes of medications that have been used in the treatment of panic disorder and panic attacks. However, they are typically considered second or third-line therapies due to the availability of newer medications with fewer side effects.
Tricyclic Antidepressants (TCAs)
Tricyclic Antidepressants (TCAs) are a class of medications that work by increasing the levels of certain neurotransmitters, such as serotonin and norepinephrine, in the brain. This increase in neurotransmitters plays a role in mood regulation. Some commonly used TCAs for panic disorder include imipramine, clomipramine (Anafranil), and nortriptyline (Pamelor).
TCAs have shown effectiveness in reducing the frequency and severity of panic attacks in some patients. However, they come with a range of potential side effects, including dry mouth, drowsiness or insomnia, weight changes, and sexual dysfunction. Due to their side effect profile and overdose risk, TCAs are typically considered when other treatment options have not been effective.
Monoamine Oxidase Inhibitors (MAOIs)
Monoamine Oxidase Inhibitors (MAOIs) work by blocking the activity of an enzyme called monoamine oxidase, which breaks down neurotransmitters like serotonin and norepinephrine. This inhibition leads to increased levels of these neurotransmitters in the brain, helping regulate mood. Phenelzine (Nardil) and tranylcypromine (Parnate) are two common MAOIs used for panic disorder.
MAOIs are effective in reducing panic attacks and anxiety symptoms in some individuals. However, they come with unique dietary restrictions and the potential for severe interactions with certain foods and medications. Dizziness, insomnia, weight changes, and dry mouth are common side effects. MAOIs are typically reserved for individuals who have not responded to other medications and require strict monitoring due to potential complications.
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Search We Level Up FL Effective Medication for Panic Attacks & Panic Disorder Resources
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