Medications can be helpful in two ways: First, they can reduce the number or panic attacks you have and how severe the panic attacks are. Second, they can help you relax so that you’re not worried about having a panic attack. When people find that their panic attacks are less frequent and severe, they are more able to approach situations that they have been avoiding.
Usually, doctors first prescribe a type of medication called serotonin selective reuptake inhibitors (SSRIs). Other common medications are the tricyclic antidepressants (TCAs), the monoamine oxidase inhibitors (MAOIs), and the benzodiazepines.
The choice of which drug to use is based on considerations of safety, efficacy, and on your personal needs and preferences. There are now many medications available to treat panic disorder. So if one medication is not right for you, there are usually others to try.
Most of the medications that are prescribed to panic disorder are usually started at a low dose and then the dose is gradually increased to the full dose. Every medication has side effects, but they usually become tolerated or diminish with time. If side effects become a problem, the doctor may advise you to stop taking the medication and to wait a week or longer for certain drugs before trying another one.
The SSRI medications include fluoxetine, paroxetine, sertraline, fluvoxamine, and citalopram. People with panic disorder are usually started on a low dose of these medications and the dose is usually gradually increased. Most people notice some improvement from these medications within 3-8 weeks of starting them.
Research studies are showing that some newer antidepressants may also be effective treatment options. A number of newer antidepressants including nefazodone, venlafaxine XR, mirtazapine, and reboxetine have been approved or may soon be approved for the treatment of panic disorder. These medications may be especially effective as "second-line" treatment in cases when a person has not responded that well to an SSRI.
Imipramine and clomipramine have been demonstrated to be effective in the treatment of panic. There is also some evidence for the efficacy of desipramine, doxepin, amitriptyline, and nortriptyline. Even thought they are effective, doctors usually don’t prescribe TCAs as a first option because of the side-effects reported. They are mostly a second- or third-line choice for treating panic disorder.
The MAOIs including phenelzine, tranylcypromide and isocarboxazidare, are effective in treating panic disorder. However, while effective, the MAOIs have side-effects that make them mostly a second- or third-line choice for treating panic disorder.
Benzodiazepine medications, including alpralozam and clonazepam are often used in combination with SSRIs. It often takes 3-8 weeks before people notice any benefit from the SSRI medications, but the benzodiazepines reduce anxiety right away. There are some disadvantages to benzodiazepine medications, like sedation and the danger of dependence and withdrawal. However, when used properly they can be helpful.
