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 Disoder

Cognitive Behavioral Therapy is the  most effective and well-documented psychotherapy for Panic Disorder. 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 Exposures. Relaxation Training teaches patients how to decrease anxiety by focusing on distractions.  Thought Restructuring teaches patients how to talk back to fearful thoughts that accompany panic attacks so that these thoughts decrease in intensity or frequency. Gradual Exposures involve focusing on anxious thought or feelings in such a way that your brain habituates/becomes numb to the anxiety. The entire treatment typically takes 10-16 weeks to complete and the longest follow-up study so far has shown that the results lasted 5 years later.

Medications for Panic Disorder

There are two types of medications that are effective for Panic Disorder: benzodiazepines and antidepressants.

Benzodiazepines are a group of medications that include Xanax, Ativan, Klonopin, and Valium.  They work quickly (about 20 minutes after you take them) and they last a different amount of time depending on the medication.  Xanax usually lasts about 5 hours, Ativan lasts about 7 hours and Klonopin and Valium last about 12 hours.  The downside of these medications is that if you take too much, you get too tired; and if you don’t take enough, they won't work.  So it make take a few days to find the right dose.  The other downside is that if you take these medications every day, then you might get used to them after 2-3 months - which is OK because you can go up on the dose, but once you get past a medium dose they can start to act as a depressant.  However, Panic Disorder is the one disorder where people can usually take benzodiazepines indefinitely without getting used to them.  So, for Panic Disorder specifically, you can usually take these medications on a daily basis.  There is a risk of addiction with these medications, but it is low.  It is unusual to get addicted to benzodiazepines in the sense of popping 5-10 pills a day because they produce so much sedation when used that way.  However, people who have a history of alcoholism are a at a higher risk of benzodiazepine addiction. Because benzodiazepines are so effective, work so quickly, and can work indefinitely, I usually use these medications first for patients with Panic Disorder.  

The other medications that work well for Panic Disorder are some of the antidepressants. The major caveat is that antidepressants should not initially be prescribed alone for patients with Panic Disorder or else they can actually increase panic symptoms.  The antidepressants that work well for Panic Disorder are basically Prozac and its copycats.  There are 8 of them now: Prozac, Zoloft, Lexapro, Celexa, Luvox, Paxil, Effexor, and Cymbalta.  Even though they are called antidepressants, they are actually misnamed because many of them work great for panic even if you are not depressed.   They are all equally effective and they all take a month to kick in.  They all have similar side effects.  They can cause headache, nausea, diarrhea the first few days. These side effects are mild for most people, but there’s no such thing as a mild side effect for patients with Panic Disorder.  That’s because people with Panic Disorder are so hypervigalent to their bodies, that the side effects that are “mild” for most people can actually trigger Panic Attacks for people with Panic Disorder.  For that reason, people with Panic Disorder should always be started on a benzodiazepine FIRST before starting an antidepressant to avoid triggering more Panic Attacks initially. 

Combining Medications and CBT for OCD

 The American Psychiatric Association's current practice guidelines for the treatment of Panic Disorder recommend medication treatment alone, CBT alone, or the combination of both types of treatment.  The decision is primarily based on patient preference.   I usually recommend a combination of medication treatment with a benzodiazepine to eliminate panic symptoms as soon as possible and the initiation of cognitive behavioral therapy to teach techniques to decrease the recurrence of panic attacks in the future and eliminate any agoraphobia that has developed.

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