Panic Disorder Treatment is Simple because it’s a Well Known Medical Condition
Humm. It’s been pointed out that “simple” might not be the correct word for panic disorder treatment. Straightforward, maybe, but not simple. Here’s what we mean. Every family doctor, general internist, psychiatrist, nurse practitioner, and physician’s assistant knows about panic disorder. It’s not new. This is good. In the great, wide world of medical care you want to have a common, well-known condition that everyone knows how to treat. (You do NOT want some mystery illness no one has ever heard of.) And, panic disorder is not fatal. Doctors know a lot about what it is, how to treat it, what works well, and what doesn’t.
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 is not fatal. The problem part is the first few panic attacks. They are awful and scary. But after those first few you know what you have and you’re on the way to wellness. And with medicine 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 medicine for you. We have to say one thing, though. One note of encouragement. Don’t give up. It is 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 medicines 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, you’re in control. When you’re healthy it’s easier to find the right medicine and therapist. So 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.
Fast (Medicine) Plus Slow (Therapy) Means Sure and Steady Success
Taking medicine without any therapy gives faster relief than therapy by itself. Therapy without using any medicine 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. Medicine plus psychotherapy build on each other. The combination works far better than either one alone, and because of the medicine you feel better sooner. The combo works better because each part, the medicine 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 Medicines for Panic Disorder Treatment
There many good medicines of several different types to overcome panic disorder and get control over the panic attacks. The questions 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 when offered a medicine usually used for depression to help treat their panic attacks. Many years ago people noticed, at first accidently, that these medicines for depression did help lessen panic attacks. Later it was studied and proven to be true. Our brains are our most complex organ. We don’t understand everything.
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 helpful, too. 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).
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 be helpful.
Other SNRIs are desvenlafaxine (Pristiq), duloxetine (Cymbalta), levomilnacipran (Fetzima), and milnacipran (Ixel, Savella).
Bupropion – A Unique Medicine
Then there’s bupropion (Wellbutrin), a somewhat unique medicine. 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, and 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 medicines have been used by doctors for 60 years. They are used less often now. One reason they are used less is because everybody wants “that new one I saw on TV”. But they are good medicines and when they work, they often work really well. And, since cost at times does matter, they’re inexpensive. If none of the newer medicines 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. 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 medicines 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 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 turn a person into a “zombie” person. Benzos might even create a mental state that feels like a bad 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 medicine for a panic attack. They should be used along with a medicine taken every day to lessen the panic attacks. Like one of the medicines mentioned above. And they should be used along with this daily medicine and psychotherapy. Therapy will help you get control of the attacks and make using a benzo less needed. We don’t know what medicine Barbra Streisand took (see below) before going onstage to lessen the chance of her having a panic attack. But, it might have been a benzodiazepine. It is that kind of rare use in a specific situation that is okay. A situation that you know might trigger an attack.
Therapy Works as a Panic Disorder Treatment
Therapy works for panic attacks. It usually works well. There are many different therapies for panic disorder. As with trying different medicines, 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, to take over if an attack starts. Also 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. 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 you’re supposed to do it, 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. Tense 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 mix that works best. The psychologist has to know what he or she is doing. The other members of the group need to be screened and chosen to fit 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.
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. Find a skilled licensed clinical psychologist. Good person-to-person chemistry 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 do not need a “magical” therapist. The magic needs to be in the mix 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.
Did You Know That… Barbra Streisand has panic disorder?
She’s one of the world’s greatest singers and performers. She has won so many Academy Awards, Grammy Awards, Emmy Awards, Peabody Awards, Golden Globe Awards, and Tony Awards that the list is too long to include them here. Hollywood insiders, the world of music production and performance, and many fans realize that she is reclusive. She talked about her situation with Oprah Winfrey in 2006, saying that she takes medicine for anxiety before going onstage. Her biggest scare and embarrassment was during a Central Park, New York City, performance of a concert in 1967. She forgot her lyrics mid-song. The resulting performance anxiety was so intense that for the next 27 years she refused public appearances, limiting her performance exposure to charity events and private venues. She sought treatment, saw a therapist, got the needed medicine, and pushed forward. Clearly, she won.
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