These Medications Can Help Treat Panic Attacks
Medically reviewed by Erika Prouty, PharmD
Medications can help treat panic attacks, which are unexpected, intense episodes of fear and discomfort often manifesting through physical symptoms.
Several classes of drugs can treat panic attacks, including:
Benzodiazepines
Tricyclic antidepressants (TCAs)
Each of these medication classes works differently. It's important to note that the effectiveness of a particular drug may vary from person to person, and it's best to work with your healthcare provider to find the right treatment plan for your individual needs.
This article discusses the different types of medications used to treat panic attacks.
Getty Images / Yurii Yarema
What Is a Panic Attack?
A panic attack is a sudden onset of intense physical and mental anxiety symptoms that may occur unexpectedly or be triggered by specific cues. Typically, a panic attack reaches its peak within minutes. The person may feel a sense of urgency to do something (such as escaping to a safe place).
Panic attacks often manifest with physical symptoms that might feel similar to a heart attack, such as:
Chest pain
Chills
Difficulty breathing
Pounding or racing heart
Stomach pain or nausea
Sweating
Tingly or numb hands
Trembling
Weakness or dizziness
Experiencing a panic attack can be frightening, but not everyone who experiences one will develop panic disorder. Panic disorder is characterized by recurring, unexpected panic attacks that can occur several times a day or as infrequently as a few times a year. People with panic disorder may worry about having another attack and may significantly alter their lives to avoid such episodes.
In contrast, panic attacks experienced by people with other anxiety disorders usually are triggered by the anticipation or direct exposure to feared situations and may be considered expected rather than unexpected. Differentiating panic disorder from panic attacks associated with other mental health conditions includes assessing whether the person's concerns are persistent or arise when anticipating or experiencing a feared situation.
Medications to Treat Panic Attacks
Treatment options for panic disorder include:
Medication
The combination of CBT and medication
Different medication classes are effective, including:
Antidepressants, such as SSRIs, SNRIs, TCAs, and MAOIs
Beta blockers
Antianxiety medications, such as benzodiazepines
SSRIs/SNRIs
SSRIs and SNRIs are commonly prescribed for anxiety and depression, but they can also be effective in treating panic disorder. In fact, they are the first-line drug treatment for panic disorder.
However, these medications do not provide immediate relief and may take a few weeks to start working. Therefore, they are not suitable for use in acute situations.
While SSRIs and SNRIs can be effective, they may also cause adverse effects such as headaches, nausea, or difficulty sleeping. These side effects are usually mild, especially if the dose is started low and increased slowly over time. Talk to your healthcare provider about any side effects you may experience.
Examples of SSRIs include:
Celexa (citalopram)
Luvox (fluvoxamine)
Lexapro (escitalopram)
Paxil (paroxetine)
Prozac (fluoxetine)
Examples of SNRIs include:
Cymbalta (duloxetine)
Effexor (venlafaxine)
Related: How Do Selective Serotonin Reuptake Inhibitors (SSRIs) Work?
Benzodiazepines
Benzodiazepines are antianxiety medications. They can be very effective in rapidly reducing panic attack symptoms. While these drugs provide fast relief for acute symptoms, they don't address the underlying causes. Benzodiazepines should not be used long-term as there’s a risk of dependence.
In the emergency room setting, benzodiazepines may sometimes be considered to stop an acute attack, for example, if the patient's agitation or anxiety is particularly severe.
Examples of benzodiazepines are:
Ativan (lorazepam)
Klonopin (clonazepam)
Serax (oxazepam)
Xanax (alprazolam)
Tricyclic Antidepressants
Tricyclic antidepressants (TCAs) are sometimes used off-label for panic disorder treatment. Off-label, or unapproved, use means that a drug is prescribed for a condition it has not been given approval by the Food and Drug Administration (FDA) to treat but may be effective for based on clinical studies.
TCAs are considered second-line options for people whose conditions have failed to respond to one or more SSRI treatments or those with neuropathic pain. However, tricyclic antidepressants are not as well tolerated as SSRIs and SNRIs due to a higher incidence of adverse effects.
Examples are:
Anafranil (clomipramine)
Tofranil (imipramine)
Monoamine Oxidase Inhibitors
MAOIs are FDA-approved for only treating major depressive disorder but may be used off-label for panic disorder.
Despite their effectiveness, their use is limited due to safety concerns. People who take MAOIs must adhere to a low-tyramine diet. This is because MAOIs prevent the breakdown of tyramine in the body. Although found naturally in the body, tyramine is also produced in foods from the breakdown of the amino acid tyrosine. Some foods high in tyramine include aged cheese, alcohol, and cured and processed meat.
MAOI users must also be aware of potential drug interactions. For example, MAOIs can interact with other antidepressants, so these medications shouldn't be taken within two weeks of each other.
Examples of MAOIs are:
Emsam (selegiline)
Marplan (isocarboxazid)
Nardil (phenelzine)
Parnate (tranylcypromine)
Beta-Blockers
Although beta-blockers are not commonly prescribed for panic disorder by healthcare providers, they are beneficial in certain situations that lead to a panic attack.
Beta-blockers can help control some physical symptoms of panic attacks, such as rapid heart rate, sweating, and tremors. For example, a beta-blocker called propranolol is sometimes prescribed to treat situational anxiety, such as symptoms of stage fright, and post-traumatic stress disorder (PTSD).
However, beta-blockers are generally not recommended for use, nor effective at treating, panic disorder.
Which Medication Is Right for You?
SSRIs, SNRIs, TCAs, and benzodiazepines all have roughly comparable efficacy (being able to produce a desired effect) in treating panic disorder, but SSRIs are typically the preferred option due to their favorable balance of effectiveness and adverse effects for most people. MAOIs also appear effective, but their safety profile limits use.
SSRIs or SNRIs usually are the best choice, though SSRIs have a larger body of evidence and are more likely to be chosen as a first-line therapy.
For those with depression, SSRIs, SNRIs, and TCAs are preferable to benzodiazepines when using only one drug to treat it (a monotherapy), while TCAs are preferred for those with nerve pain. When rapid symptom control is needed, benzodiazepines may be used with antidepressants, then tapered once the antidepressants take effect.
If you suffer from panic attacks or have been diagnosed with panic disorder, it is important to work closely with your healthcare provider to determine the most suitable treatment for you. Medication may or may not be included in your treatment plan, depending on your unique circumstances.
When selecting an appropriate medication, your provider will consider a range of factors, including:
Potential side effects
Cost
Your medical history
Other psychiatric conditions
Potential drug interactions
Pharmacokinetic parameters
Your age
Strength of evidence supporting the use of the medication to treat panic disorder
Nondrug Ways to Manage Panic Attacks
Cognitive behavioral therapy (CBT) has emerged as an effective treatment for managing panic disorder. It can be used with or without medication. During CBT sessions, a trained clinician helps you identify and analyze patterns of thinking that lead to worry and anxiety. The therapy also includes exposure to stressful situations and physical sensations and teaches relaxation techniques, such as breathing retraining.
It's important to consider lifestyle factors when trying to manage panic attacks. Some helpful habits include:
Exercising regularly
Reducing caffeine, tobacco, and alcohol consumption
Eating a healthy diet
Staying engaged in meaningful activities
Maintaining healthy social connections
Meditation can also be beneficial.
Lastly, your healthcare provider may assess you for comorbid conditions (e.g., thyroid disease) or medications that could be contributing to the problem so they can be treated or those medications discontinued accordingly.
Summary
Panic attacks are a sudden onset of intense physical and mental anxiety symptoms that can be triggered by specific cues or occur unexpectedly.
The treatment options for panic disorder include CBT, medication, or a combination of both. Several classes of drugs that can be used to treat panic attacks, including selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, benzodiazepines, tricyclic antidepressants, monoamine oxidase inhibitors, and beta-blockers.
However, it's important to note that each drug has its own benefits and side effects, and not all drugs may suit everyone. It is best to work with a healthcare provider to find the right treatment plan.
Frequently Asked Questions
What is the first-line treatment for panic attacks?
If you experience an isolated panic attack, the symptoms will subside soon. To cope with the situation, you can try strategies such as slowing your breathing, finding a quiet room, and seeking support from a loved one. Usually, no particular treatment is required unless you are diagnosed with panic disorder.
However, if your agitation or anxiety is severe, benzodiazepines may sometimes be used in the emergency room setting to relieve an acute attack.
In the case of panic disorders, studies have shown that self-help, CBT, and SSRIs/SNRIs are equally effective as first-line treatment options.
What is the most effective medication for panic attacks?
Results from research studies suggest that SSRIs, SNRIs, TCAs, and benzodiazepines all have roughly comparable efficacy in treating panic disorder. However, SSRIs are considered the most suitable treatment option for most patients due to their favorable balance of efficacy and minimal adverse effects.
Additionally, SSRIs are preferred as the first-line therapy due to their significant body of evidence supporting their effectiveness.
Read the original article on Verywell Health.
