Panic Disorder Treatment

From Psychotherapy to Medications

A panic attack is a sudden episode of intense fear that triggers severe physical reactions 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.

Although panic attacks themselves aren't life-threatening, they can be frightening and significantly affect your quality of life.

But treatment can be very effective.


Studies have shown that psychotherapy is an important component in panic disorder treatment. The American Psychiatric Association suggests 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.

Several studies have shown panic-focused psychodynamic psychotherapy is also effective in treating panic disorder. Psychodynamic theory 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.

Psychotherapy is usually performed by an experienced counselor, social worker, psychologist or psychiatrist.


The usual medications to treat panic disorder are antidepressants and anti-anxiety drugs. Antidepressants may be prescribed even if the individual does not have clinical depression because many antidepressants also inhibit panic attacks.

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.

The following are types of antidepressants that are used in treating the symptoms of panic disorder:

  1. Selective serotonin reuptake inhibitors SSRIs (such as Paxil, Prozac, amd Zoloft) work by increasing the level of serotonin in the brain.
  2. Serotonin-norepinephrine reuptake inhibitors (SNRIs) (such as Effexor and Cymbalta) work on both serotonin and norepinephrine.
  3. Tricyclic antidepressants (TCAs) (such as Anafranil and Elavil) affect serotonin, norepinephrine and to a lesser extent, dopamine.
  1. Monoamine oxidase inhibitors (MAOIs) (such as Nardil, Parnate) also inhibit panic by altering brain chemicals.

The most common class of antidepressants used to treat panic disorder is selective serotonin reuptake inhibitors (SSRIs). MAOIs are generally used as a last resort because the patient must adhere to strict dietary requirements as these medications may dangerously interact with some foods, beverages and other medications.

Benzodiazepines (anti-anxiety drugs), such as Xanax, Ativan, or Klonopin, may also be prescribed. These medications are usually used sparingly because they may 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.

The Importance of Getting Help Early

Panic disorder is a treatable condition. Most people with panic disorder will experience significant symptom reduction with treatment. The sooner treatment begins after the onset of panic disorder, the less likely one is to develop agoraphobia, which greatly complicates recovery.


Mayo Clinic. Panic attacks and panic disorder.

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