Good News: Panic Disorder is a Well Known Medical Condition
The last thing that anyone wants is a medical problem about which no one knows anything. (If you go to your doctor with a case of Kuru *, you’re in real trouble. She won’t know what’s wrong with you.) But if you see your doctor for arthritis she will know what to do. And so it is with panic disorder. Every family doctor, general internist, psychiatrist, nurse practitioner, and physician’s assistant knows about panic disorder. It’s not new, it’s not rare, and it’s not fatal. And all of these doctors know a lot about what it is, how to treat it, what works well, and what doesn’t work.
More Good News: With Panic Disorder Treatment You Will Get Better
Okay, we’ll crank that back a little. We can’t guarantee that you’ll get better with panic disorder treatment. But panic disorder can be treated and the treatments are straightforward. The problem part with panic disorder is the first few panic attacks. They’re awful and they’re frightening. But after those first few you know what’s happening to you and you’re on the way to wellness. And with medication and therapy, as time goes by, you’re back in control.
Is Panic Disorder Treatment Really That Easy?
Well, no. Straightforward, yes, easy, no. The first task is finding you’re best doctor. Then you and your doctor need to work together to find the best medication for you. We have to offer this one statement of cheerleading and encouragement: don’t give up. It’s almost certain that something will work for you. It might not be a straight line from today to success. You might need to try several medications to find the best one. The same with therapists and therapies. Try several until you find the one therapist who’s on your side and the one therapy that works for you.
Being Generally Healthy Does Help with Controlling Panic Disorder
Good general health means that your body is well, you feel good, and you’re in control. When you’re healthy it’s easier to find the right medication and therapist. So if you’re not already in good physical shape, work to improve your health and protect it. Take care of yourself in every way that you can. Eat a healthy, balanced diet (fruits, vegetables, fish). Get at least minimal-to-moderate regular exercise (at least 20 minutes a day 5 days a week). Work with your schedule to get a good night’s sleep (7 hours) most nights.
A Reader Asks:
My wife has panic attacks. She takes a Xanax and the attack goes away. Why would she take anything different?
It could be that your wife is fine treating her panic disorder with Xanax® (alprazolam). It depends on how often and what dose she takes, how long she has used it, and how well it treats her panic attacks. If she takes a 0.5 mg tablet a couple times a month and it does the job, maybe fine. If she takes a 1 mg tablet four times a day, maybe not so fine. Alprazolam can be a helpful medication or a hellish addiction. It’s a topic for her and her doctor. Though alprazolam is FDA-approved for panic disorder, there probably are better solutions (see the information below). That said, we do need to add our usual caution. See our disclaimers under Legal. In short, we’re not able to be your wife’s doctor.
Fast (Medication) Plus Slow (Therapy) Means Sure and Steady Success
Taking medication without any therapy gives faster relief than therapy by itself. Therapy without using any medication will take longer to work. But with the therapy, when you stop, it keeps working because you’ve learned things. The best plan to follow, though, is to do both at once. Medication plus psychotherapy build on each other. The combination works far better than either one alone, and because of the medication you feel better sooner. The combo works better because each part, the medication and the therapy, helps in very different ways. In addition, the benefit lasts longer through your life because the therapy is an education that stays with you.
The Many Good Medications for Panic Disorder Treatment
There many good medications of several different types to overcome panic disorder and get control over the panic attacks. The question you need to answer for yourself is which of them, for you, works the best and has the fewest side effects.
Why Take Antidepressants for Panic Disorder?
Panic disorder is not depression. Panic disorder is a whole different medical condition from depression. So many people are upset (and offended?) when offered a medication usually used for depression to help treat their panic attacks. Many years ago people noticed, at first accidently, that these medications for depression did help treat panic disorder and lessen panic attacks. Later this question was rigorously studied and it proved to be true. Our brains are our most complex organ. There’s a lot we don’t understand so there are these occasional surprises.
The SSRIs for Panic Disorder Treatment
Most doctors treating panic attacks will first ask a person to try an SSRI (selective serotonin reuptake inhibitor) to see if it helps. In fact, three of them, sertraline (Zoloft®), fluoxetine (Prozac®), and paroxetine (Paxil®, Pexeva®) are actually FDA-approved for panic disorder. But there are several other SSRIs, and one or more of them might be useful. Your doctor can work with you to find the best one for you.
Other SSRIs are: citalopram (Celexa®, Cipramil®), escitalopram (Lexapro®, Cipralex®), and fluvoxamine (Luvox®, Faverin®).
The SNRIs
One of the SNRIs (serotonin–norepinephrine reuptake inhibitors), venlafaxine (Effexor XR®), is FDA-approved for panic disorder. But just as with the SSRIs, there are several other SNRIs that could work really well.
Other SNRIs are desvenlafaxine (Pristiq®), duloxetine (Cymbalta®), levomilnacipran (Fetzima®), and milnacipran (Ixel®, Savella®).
Bupropion – A Unique Medication
Then there’s bupropion (Wellbutrin®), a somewhat unique medication. Some think it is an odd one to choose to treat panic disorder. Odd because some think that bupropion might make “anxiety” worse. It doesn’t, or at least it only occasionally does as a side effect. Also, “anxiety” can mean many things. Panic disorder is a very specific medical condition. Some individuals find that bupropion is quite effective for panic disorder, lessening panic attacks with few side effects. For one thing, bupropion usually doesn’t ruin sexual interest, a problem with the SSRIs and SNRIs. If the SSRI or SNRI that you try first does not work for you or causes bad side effects, talk to your doctor about trying bupropion.
The Good Old Reliable Tricyclics
These grand old workhorse medications have been used by doctors for 60 years. They’re used less often now. One reason they’re less popular is just that they’re less popular. Everybody wants “that new one I saw on TV”. But they’re good medications and when they work, they often work really well. And, since cost at times does matter, they’re inexpensive. If none of the newer medications are right for you, talk to your doctor about trying a tricyclic. A good middle-of-the-road one that your doctor might suggest you try first is nortriptyline (Pamelor®). Here are the names of a few more of the tricyclics: amitriptyline (can be sedating), clomipramine (also can be sedating), doxepin, nortriptyline, and desipramine (can boost energy or be “activating”).
Benzodiazepines Tempting But Risky for Panic Disorder Treatment
Well, you see, there’s this dilemma, as we touched upon in the reader’s question above. Some people might feel that the benzodiazepines are the “magic bullets” for panic attacks. Because a “benzo” might calm a panic attack in a few minutes. All the other medications listed above are different. You have to take them every day and it takes a week or two or more for them to start working. In fact, two of the benzos, alprazolam (Xanax®) and clonazepam (Klonopin®), are FDA-approved to treat panic disorder. The other benzos might work as well.
There are too many benzos to list them all. A few others that your doctor might think about are chlordiazepoxide (Librium®), clorazepate (Tranxene®), and diazepam (Valium®).
The Trouble with Benzos
Here’s the dilemma. Benzos can be dangerous. It’s possible to become addicted to them and dependent on them. A benzo might work really well at first and then work less and less over time. Even if they seem to keep working, if used frequently and regularly for a long time they can start changing your emotions, making you a dull person. They can change your thinking, making you “feel stupid”, and can make your life feel gray, dull, and flat. Some people say that they can make a person act like a zombie. Benzos might even create a mental state that feels like depression.
How to Best Use Benzodiazepines
So, if the benzodiazepines are used at all, they are best used only now and then, as needed, as a rescue medication for a panic attack. They should be used along with a medication taken every day to lessen chance of a panic attack, like one of the medications mentioned above. And they should be used along with this daily medication and psychotherapy. Therapy will help you get control of the attacks so you’ll automatically need a benzodiazepine less often. Many people with panic disorder keep a benzodiazepine in reserve for rare use in specific situations. For example, a situation that you know might trigger an attack.
Therapy Works as a Panic Disorder Treatment
Therapy works, and usually works well, for panic attacks. There are many different therapies for panic disorder. As with trying different medications, try different therapists and therapies and find the one that you like best and that helps you the most.
Therapy As Education
Some of the therapies teach tips and tricks on seeing an attack coming and learning to control it. The nice thing about these is once you learn how to do it, you know how forever. Like riding a bicycle. You learn how to become master of your panic disorder, and to take over if you feel an attack starting. Also, you have a chance to learn how to avoid having panic attacks.
Cognitive Behavioral Therapy Makes Sense of Panic Disorder
Cognitive behavioral therapy (CBT) is a popular form of therapy that works and has a specific method. People who see themselves as reasonable and logical thinkers, who have a need to understand, seem to like CBT. CBT is a great way to understand panic disorder, panic attacks, what goes wrong, and how to conquer the panic.
Relaxation and Meditation because It’s Hard to Panic When Relaxed
There are several relaxation methods that work to fight against panic attacks, make them come less often and make them milder if they happen. In the same way, there are styles of meditation that help. If practiced twice a day as is recommended, they help and are useful. Another way to beat panic disorder is with specific slow, deep-breathing exercises. These work best when learned from a skilled coach and then practiced regularly. These exercises are then a tool in your toolbox. They can then be used in any high anxiety situation for calm and a relaxed body.
More Ways to Beat Panic with Relaxation
The skill of relaxing your body with “progressive muscle relaxation” is another that can be learned. You learn about your body, where it’s tense and tight. Tension is a setup for a panic attack. Knowing how to get yourself to relax and “let it go” when a panic attack starts helps. There are others relaxation methods. Find one that works for you.
Group Therapy for Panic Disorder Treatment
Your doctor or therapist might refer you to supportive group therapy, usually run by a skilled licensed clinical psychologist. There’s a of people and conversation that works best. The psychologist has to be well-trained, skilled, and experienced. The other members of the group need to be screened by the psychologist and carefully chosen to fit together well and help each other. The psychologist will lead the conversation in the right direction so that each group member can lessen their panic attacks.
Individual Psychotherapy
Some individuals cannot “warm up” to the idea of sitting in a group and discussing their panic attacks. They might do better in individual “interpersonal psychotherapy”. The same caution is true for individual therapy as for group therapy. Find a skilled licensed clinical psychologist. Good person-to-person chemistry between you and the psychologist is really important here. You need to work with someone that you can trust and that is “with you” in your battle against panic disorder. You don’t need a “magical” therapist. The magic needs to be in the mixture, the combination of the two of you. If you feel you cannot “connect” emotionally with your therapist, pay attention to these feelings. Be good to yourself and seek out a different therapist.
Helpful links:
Clinical Studies Recruiting for Panic Disorder at Clinical Trials.gov
National Institute of Mental Health – Panic Disorder: When Fear Overwhelms
Anxiety and Depression Association of America – Understand the Facts: Panic Disorder
Mayo Clinic on Panic attacks and panic disorder
American Family Physician on Treatment of Panic Disorder
* Kuru has no known treatment. Prevention is straightforward; don’t eat dead relatives in New Guinea. It was discovered by Daniel Carleton Gajdusek, and in 1976 he won the Nobel Prize in Physiology or Medication for his research. Kuru’s a rare, incurable disorder found in the Fore people of Papua New Guinea. It’s transmitted by funerary cannibalism. When a family member died, their spirit is said to be set free by having the deceased cooked and eaten. An epidemic was started in the 1950s when a villager died of Creutzfeldt–Jakob disease, a fatal brain disease. When the villagers ate the brain, they contracted the disease. When they died, it was spread to other villagers who ate their infected brains. Kuru causes a person’s nervous system to fall apart, with headaches, tremors, muscle jerks, arm and leg pain, difficulty walking and swallowing, and severe, progressive loss of coordination.