Treatment:

Anti-anxiety medications, antidepressants, and cognitive behavioral therapy (working with a therapist) have been successfully used to treat panic disorders.

Medications act on the central nervous system to reduce anxiety and related symptoms.

Benzodiazepines are a commonly-used class of anti-anxiety medications. They include aprolazam (Xanax). However, people can become dependent on or addicted to drugs in this class of medications. Ideally, these drugs are used only on a temporary basis.

Antidepressants called SSRIs (selective serotonin reuptake inhibitors) are the most commonly used medications for panic disorder. They include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), fluvoxamine (Luvox), cetalopram (Celexa), and escitalopram (Lexapro). If SSRIs do not help, longer-term use of benzodiazepines may be considered if you do not have a history of drug dependence and tolerance.

The monoaxmine oxidase inhibitors (MAOIs) such as phnelzine (Nardil) tranylcypramine (Parnate), and isocarboxazid (Marplan) are only used when none of the other drugs work. MAOIs are the most effective medications for panic disorder, but they have serious side effects and they can interact with other drugs and foods. They should only be prescribed by a psychiatrist who is experienced in their use.

Behavioral therapies should be used together with drug therapy. These include:

• Cognitive-behavioral therapy
• Cognitive restructuring (learning to recognize and replace panic-causing thoughts)
• Exposure
• Pleasant mental imagery
• Relaxation techniques

Behavioral treatment appears to have long-lasting benefits.

Regular exercise, adequate sleep, and regularly scheduled meals may help reduce the frequency of the attacks. Reduce or avoid the use of caffeine and other stimulants.

Expectations (prognosis):

Panic disorders may be long-lasting and difficult to treat. Some people with this disorder may not be cured with treatment. However, most people can expect rapid improvement with drug and behavioral therapies.

Complications:

Possible complications of this condition include:

• Avoiding situations or places that might bring on an attack
• Other anxiety and mood disorders

Dependence on anti-anxiety medications is a possible complication of treatment. Dependence involves needing a medication to be able to function and to avoid withdrawal symptoms. It is not the same as addiction, which involves the uncontrolled use of a substance despite negative results. Dependence and addiction often occur together, but dependence itself is not always a problem.

Calling your health care provider:

Call for an appointment with your health care provider if panic attacks are interfering with your work, relationships, or self-esteem.