Panic Treatment

The goal of treatment is to eliminate all of your panic attack symptoms. With effective treatment, most people are eventually able to resume everyday activities.

The main treatment options for panic attacks are medications and psychotherapy. Both are effective. Your doctor likely will recommend starting with just one type of treatment, depending on your preference and whether there are therapists with special training in panic disorders in your area.

Your doctor may recommend a combination of medication and psychotherapy if you:

Have severe panic disorder
Have panic disorder along with another major mental health diagnosis, such as depression or post-traumatic stress disorder
Have already tried one type of treatment and haven’t improved
Medications
Medications can help reduce symptoms associated with panic attacks, as well as depression if that’s an issue for you. Several types of medication have been shown to be effective in managing symptoms of panic attacks, including:

Selective serotonin reuptake inhibitors (SSRIs). Because these antidepressant medications are generally safe and have a low risk of causing serious side effects, SSRIs are typically recommended as the first choice in medication options to treat panic attacks. Drugs in this class that have been approved by the Food and Drug Administration (FDA) for the treatment of panic disorder include fluoxetine (Prozac, Prozac Weekly), paroxetine (Paxil, Paxil CR, Pexeva) and sertraline (Zoloft).Serotonin and norepinephrine reuptake inhibitors (SNRIs). These medications are another class of antidepressants. The SNRI drug called venlafaxine (Effexor XR) is FDA-approved for the treatment of panic disorder.Tricyclic antidepressants (TCAs). While effective, these antidepressants pose a risk of serious side effects, including heart and blood sugar problems. No TCAs are FDA-approved specifically for the treatment of panic disorder.Benzodiazpines. These medications are mild sedatives. They belong to the group of medicines called central nervous system (CNS) depressants. Benzodiazepines may be habit-forming (causing mental or physical dependence), especially when taken for a long time or in high doses. Benzodiazepines that have been FDA-approved for the treatment of panic disorder include alprazolam (Xanax) and clonazepam (Klonopin). If you seek care in an emergency room for signs and symptoms of a panic attack, you may be given a benzodiazepine to help stop the attack.Monoamine oxidase inhibitors (MAOIs). Because these antidepressants can cause life-threatening side effects and require strict dietary restrictions, they’re not commonly prescribed. No MAOIs are FDA-approved specifically for the treatment of panic disorder.If one medication doesn’t work well for you, your doctor may recommend switching to another or combining certain medications to boost their effectiveness. Keep in mind that it can take several weeks after first starting a medication to notice an improvement in your symptoms. All medications have a risk of side effects, and some may not be recommended in certain situations, such as pregnancy. Be sure to talk to your doctor about the possible side effects and risks.

Psychotherapy
Psychotherapy, also called counseling or talk therapy, can help you understand panic attacks and panic disorder and how to cope with them. The main type of psychotherapy used to treat panic attacks and panic disorder is cognitive behavioral therapy. Your doctor also may recommend a type of psychotherapy called psychodynamic psychotherapy.

Cognitive behavioral therapy. Cognitive behavioral therapy can help you change thinking (cognitive) patterns that trigger your fears and panic attacks. It can also help you change the way you react (behave) to anxious or fearful situations. During therapy sessions, you learn to recognize things that trigger your panic attacks or make them worse, such as specific thoughts or situations. You also learn ways to cope with the anxiety and physical symptoms associated with panic attacks.

These may include breathing and relaxation techniques. In addition, working carefully with your therapist, you may re-create the symptoms of panic attacks in the safety of his or her office. This is an important step because it can help you learn to control and master the symptoms so that they don’t continue to be a source of intense fear. Doing this can also help you overcome fear of certain situations that you may avoid, such as crowded malls or driving.
Psychodynamic psychotherapy. Psychodynamic psychotherapy focuses on increasing your awareness of your unconscious thoughts and behaviors. Unlike cognitive behavioral therapy, this approach doesn’t intentionally re-create panic symptoms. Instead, your therapist helps you investigate your mind to identify internal emotional conflict that may play a role in your panic and avoidance reactions.

Based on your findings, your therapist will help you develop healthier ways to respond to conflict. Early study results suggest that psychodynamic psychotherapy focused on panic reactions may be an effective short-term treatment option for panic disorder. More research is needed to fully understand how this type of therapy compares with other treatments for panic disorder.
Your therapist may suggest weekly meetings when you begin psychotherapy. You may start to see improvements in panic attack symptoms within several weeks, and often symptoms go away within several months.

As your symptoms improve, you and your therapist will develop a plan to taper off therapy. You may agree to schedule occasional maintenance visits to help ensure that your panic attacks remain under control.

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