Panic Attack Medicine: Tips on What works

Half the people who have panic disorder don’t seek help, and when they do seek help, they often go to the emergency room, or to medical professionals. Why is this? Panic is easily confused with having a heart attack. It’s so physical in nature, that the even the professionals rarely diagnosis it appropriately.

Panic disorder wreaks havoc on the lives of those who suffer from it. It is chronic and it’s long lasting. It can develop into other issues such as depression and it also associated with suicidal ideation although we don’t fully understand this connection.

Learn more about panic disorder on these pages

• • panic and your heart
  • Learn about panic attacks and the thyroid here
  • Learn about cognitive behavioral therapy for panic
  • Learn about caffeine and panic attacks
  • What the symptoms of panic attack mean
  • Panic and pregnancy
  • Tips for getting through a panic attack
  • what causes a panic attack
  • symptoms of a panic attack

This page is a summary of evidenced based best practice for panic disorder medicine as described in the research journals. It may have changed by the time your read it. I am not a psychiatrist or doctor, and your doctor may explain things differently or give you contrary information. The important thing is that you understand from YOUR  doctor why medications are prescribed and can make sense of the plan that you are currently on or the information you are offered. If you have panic attacks use this as a guide to ask thoughtful questions of your doctor about why you are prescribed the medications you are and/ or about what the next steps are if your panic attack medicine isn’t working.

Possible choices of panic attack medicine

Antidepressants.  Selective serotonin reuptake inhibitors (SSRI’s)

SSRI’s are those  meds that act on the serotonergic system. these include:

• Citalopram( Celexa)
• Fluvoxamine (Luvox)
• Fluoxetine ( Prozac)
• Sertraline ( Zoloft)
• Paroxetine ( Paxil)
• Paroxetine CR
• Escitolopram ( Lexapro)

Tricyclic antidepressants(TCA’s)

• Imipramine
• Clomipramine.

SNRI

• Venlafaxine XR( Effexor)

MAOI

• Phenelzine ( Nardil). 

Benzodiazapines 

• Alprazolam Xanex
• Clonazepam Klonapin
• Diazepam Valium
• Lorazepam Ativan

Current evidence quickly summarized for First Line Pharmacotherapy ( First choice ) 

Below summarizes what the research says a doctor should likely consider when first deciding what medication to take for your panic attacks.

BENZo’s

Benzodiazepines  work very quickly and most people will continue to take them despite the side effects. However, they are ineffective with other conditions such as depression and can cause dependence ( addiction).

They are not recommended in the literature guidelines generally as a first choice of treatment for panic attacks. Of course, we find they are often prescribed.   

TCA’s

TCA’s take a longer time than SSRI’s to begin working,have worse side effects and are less safe. More people who take TCA’s will discontinue therapy when they are prescribed them. They are not recommended in guidelines as a first choice for evidence based practice.

Phenelzine has serious side effects , many risks and high drop out rates so would not be considered unless other medicines had been tried and failed. 

SSRI’s and SNRI’s

SSRI’s or SNRI’s ( Venlafaxine). The side effect profile, success in long treatment, success in treating comorbid depression, all suggest these two would be the first choices for a person presenting at the doctor’s office for medications for panic disorder. Generally, these are recommended as the best practice for panic attack medicines. However…

What if my medication doesn’t work ?

If you go for treatment and you don’t respond to your doctors choices of medications, you fall into a special category called treatment refractory. Then the doctor can make some special choices. The doctor might

Switch

• Up your dosage
• Switch you to different drugs within the class of medication you are taking ( for example swap out one SSRI for another)
• Swap you an SSRI for A TCA
• Try some drugs not on this list, including drugs in categories not on this list, such as an antipsychotic or an anticonvulsant.

Augment

• Add another drug to the drug you are already taking
• Add a Benzodiazepine to your antidepressant
• Add an antipsychotic to your antidepressant.
• Recommend you add therapy to your medication if you aren’t already going

Note it may be important to ask your doctor about the medication choices and your other diagnosis. If you have a diagnosis in addition to panic disorder, and your panic attacks are  a part of that disorder, it will change how your medicine is prescribed.

Resources

Batelaan, N., Van Balkom, A., & Stein, D. (2011). Evidence-based pharmacotherapy of panic disorder: an update.  The International Journal Of Neuropsychopharmacology, 15 (03), 403-415. doi: 10.1017/s1461145711000800

Medical information obtained from this website is not intended as a substitute for professional care. If you have or suspect you have a problem, you should consult a healthcare provider.