Panic Disorder Treatment Options

Treatment Options for Panic Disorder from Therapy to Medications

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What treatments are available for panic disorder?. Istockphoto.com/Stock Photo©kieferpix

Panic Attacks and Panic Disorder

A panic attack is a sudden episode of intense fear that triggers severe physical reactions such as a rapid heart rate and shortness of breath, when there is no real danger or apparent cause. Many people have just one or two panic attacks in their lifetimes, and the problem goes away. But if you've had recurrent, unexpected panic attacks and spent long periods in constant fear of another attack, you may have a condition called panic disorder.

Panic disorder is an anxiety disorder marked by frequent and often extreme panic attacks. These panic attacks are followed by intense feelings of anxiety and apprehension, and often interfere with daily through attempts to reduce the risk of having the attacks.

Thankfully, even though panic attacks are frightening and panic disorder can impact every area of your life, treatment can be very effective in both reducing the number of attacks and in restoring your quality of life.

Treatment Options

There are several options for treating panic disorder, and most often a combination of these is most effective. Treatments may include different types of psychotherapy, medications, lifestyle changes and stress relief.

Psychotherapy

Psychotherapy is the backbone of treatment for panic disorder, and is the best treatment for reducing the incidence of panic attacks in the future.

The first step in psychotherapy is simply education; explaining what is happening during a panic attack.

Clearly, based on the number of people who seek emergency attention for panic attacks, you may feel physical sensations that are of great concern. A therapist will begin by explaining what is occurring in the body, and how the "fight or flight" reflex causes these symptoms.

Psychotherapy approaches that have been successful in treating panic disorder include:

Cognitive Behavioral Therapy

The American Psychiatric Association suggests that a form of psychotherapy called cognitive-behavioral therapy (CBT) is the most effective for panic disorder.

Cognitive-behavioral therapy reflects the importance of both behavioral and thought processes in understanding and controlling anxiety and panic attacks. The focus of treatment is on inadequate, obstructive, and damaging behaviors and irrational thought processes that contribute to the continuation of symptoms.

CBT involves two basic steps when treating panic disorder. The first is to recognize negative thoughts and behaviors. This can be done in a number of different ways with journaling sometimes playing a big role.

Once these negative thought and behavior patterns are identified, you may begin building healthy coping methods to change negative behaviors and thoughts. One method used often with panic is desensitization. In this technique a person is slowly exposed more and more to a panic inducing stimulus until it no longer stimulates a panic response.

Panic-Focused Psychodynamic Pscyhotherapy

Panic-focused pscyhodynamic therapy is also effective in treating panic disorder. Psychodynamic therapy is rooted in Freud’s psychoanalytic theories. The focus of treatment is to help clients become aware of their unconscious conflicts and fantasies, and to identify defense mechanisms that influence the continuation of symptoms. Unlike CBT, the focus of this therapy is to unearth the unconscious part of the mind where painful thoughts and memories are stored.

Working with a Therapist

Psychotherapy is usually performed by an experienced counselor, social worker, psychologist or psychiatrist. Keep in mind that just as there are many different personalities among physicians, there are just as many personalities among mental health providers. Sometimes people need to "interview" more than one provider (get a second opinion) in order to find the best therapist to guide them. Panic disorder treatment isn't a "quick fix" and a supportive relationship with a therapist will go a long way in helping you do the work needed to restore your life.

Medications

The medications used more often for panic disorder include antidepressants and anti-anxiety drugs. It's important to note that if an antidepressant is recommended, it does not mean that your doctor believes you are depressed. All antidepressants work by altering one or more of the following brain chemicals (neurotransmitters):

  • Serotonin. This brain chemical plays a role in modulating anxiety, mood, sleep, appetite and sexuality.
  • Norepinephrine, which influences sleep and alertness, is believed to be correlated to the fight or flight stress response.
  • Dopamine influences body movement and is also believed to be involved in motivation, reward, reinforcement and addictive behaviors. Many theories of psychosis suggest that dopamine plays a role in psychotic symptoms.

Antidepressants

Antidepressants used to treat panic disorder are broken down into four main categories. The most commonly prescribed drugs are SSRIs, with MAOIs being used only infrequently, when other medications have failed.

  • Selective serotonin reuptake inhbitors (SSRIs) - SSRIs work by increasing the level of serotonin in the brain. Examples include Paxil (paroxetine), Zoloft (sertraline),and Prozac (fluoxetine).
  • Serotonin-norepinephrine reuptake inhibitors (SNRIs) - SNRIs work on both serotonin and norepinephrine in the brain. Examples include Effexor (venlafaxine), and Cymbalta (duloxetine).
  • Tricyclic antidepressants (TCAs) - TCAs affect serotonin, norepinephrine, and to a less extent, dopamine. Examples include imipramine and amitriptyline.
  • Monoamine oxidase inhibitors (MAOIs) - MAOIs also inhibit panic by altering brain chemicals. examples include Nardil (phenelzine) and Parnate (tranylcypromine). MAOIs can be difficult to use and require people to adhere to a very strict diet as the medication may dangerously interact with some foods, beverages, and other medications.

Anti-Anxiety Medications

Antianxiety medications such as benzodiazepines are occasionally used short term for panic attachs, but can easily become habit forming.

Medications to treat panic disorder may be prescribed by a psychiatrist or a primary care physician. The length of medication therapy varies greatly from individual to individual. It may be necessary for some to continue a medication regimen throughout their lives.

Getting Help and Resources

Panic disorder is a treatable condition and most people will experience significant symptom reduction with therapy. The sooner treatment begins, the less likely you are to develop agoraphobia, and the sooner you can get back on your feet and really start living again. Learn about the common barriers to seeking help as well as the help and resources available for people with panic disorder

Sources:

Bighelli, I., Trspidi, C., Castellazzi, M. et al. Antidepressants and Benzodiazepines for Panic Disorder in Adults. Cochrane Database of Systematic Reviews. 2016. 9:CD0011567.

Cujpers, P., Gentili, C., Banos, R. et al. Relative Effects of Cognitive and Behavioral Therapies on Generalized Anxiety Disorder, Social Anxiety Disorder and Panic Disorder: A Meta-Analysis. Journal of Anxiety Disorders. 2016. 43:79-89.

Imai, H., Tajika, A., Chen, P., Pompoli, A., and T. Furukawa. Psychological Therapies Versus Pharmacological Interventions for Panic Disorder with or without Agoraphobia in Adults. Cochrane Database of Systematic Reviews. 2016. 10:CD011170.

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