Ocd-->Note: The following is presented for informational purposes only. Assessment and treatment should always be directed through one-on-one consultation with a trained professional.
There are two forms of effective treatment for Panic Disorder: Cognitive Behavioral Therapy (CBT) and Medications.
Cognitive Behavioral Therapy for Panic Disorder
The most effective and well-documented psychotherapy for Panic Disorder is Cognitive Behavioral Therapy. Approximately 80% of patients respond to CBT for Panic Disorder and the effects appear to be more robust and more long-lasting than medication treatment alone.
The main techniques used in CBT for Panic Disorder are Relaxation Training, Thought Restructuring, and Gradual Exposure. Relaxation Training teaches patients ways to relax their bodies through breathing or muscle relaxation. Thought Restructuring teaches patients how to talk back to anxiety producing thoughts so that these thoughts decrease in intensity or frequency. Gradual Exposure involves gently stimulating very mild physical sensations until the body habituates to them and "no longer cares". The entire treatment typically takes 10-16 weeks to complete.
I recently completed a treatment manual to help assist my patients when
we are using cognitive behavioral therapy for panic disorder. It is
called Panic Disorder: How to Fight Back and Win. You can view it by
clicking here.
Medications for Panic Disorder
Medications are also effective for Panic Disorder (i.e. ~80% of patients respond
to the first medication they try). The most frequently used medications are the
antidepressants known as Selective Serotonin Re-uptake Inhibitors (i.e. SSRI's).
There are currently 6 SSRI's: Prozac, Luvox, Paxil, Zoloft, Celexa, and Lexapro.
Each of these medications appears to be equally effective, so the choice of medication
is often based on other considerations (i.e. Is it sedating or energizing?, Does
it interact with other medications?). For Panic Disorder, these medications typically
take 2-6 weeks to kick-in.
A class of medications know as Benzodiazepines (i.e. Klonopin, Xanax, Ativan,
and Valium) are also effective in treating Panic Disorder. The main advantage
of Benzodiazepines is that they work quickly (i.e. within 30 minutes) and can
therefore be taken on an as-needed basis for panic attacks. The main drawbacks
of Benzodiazepines are that they can be habit forming and that patients can develop
tolerance to them (i.e. they may stop working) if patients use them on a daily
basis. For these reasons, I usually recommend Benzodiazepines only for patients
who are having severe and frequent panic attacks, and I typically prescribe them
for only 1-2 months while we are waiting for other treatments (ie. SSRI's or
CBT) to kick-in.
Combining Medications and CBT for Panic
Disorder
There are currently three well-controlled studies that indicate that the combination
of Medications and CBT is more effective than either treatment alone. The American
Psychiatric Association's current practice guidelines echo this fact but also
note that trying either treatment alone is a reasonable alternative.
I usually recommend that patients with mild Panic Disorder symptoms try CBT alone
first. In contrast, I usually advise patient with moderate to severe symptoms,
or patients who have not responded to CBT alone, or patients who want the best
chance of getting relief from their symptoms right off the bat to start both
medications and CBT, with the plan to taper off of medications once the CBT is
completed. If patients have a strong feeling about just trying CBT alone or just
trying Medications alone, I support whatever they want to try and give them feedback
on how things are progressing as we move along.