What are Antidepressants for Panic Disorder?

Medication for Panic and Anxiety

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Antidepressants can be used to help treat panic disorder. Microsoft

As the name implies, antidepressants were initially used for the treatment of depression. It soon became evident, however, that in addition to improving one’s mood, antidepressants had an anti-panic and anti-anxiety effect on those with anxiety-related problems. Today, antidepressants are the usual choice of medication intervention for anxiety disorders, including panic disorder.

How do Antidepressants Work?

It is believed that the brain contains several hundred different types of chemical messengers (neurotransmitters) that act as communication agents between different brain cells.

Serotonin is a neurotransmitter that is important in modulating a variety of body functions and feelings, including our mood. Low serotonin levels have been linked to certain mood disorders and panic disorder. Antidepressants are believed to increase the level of serotonin in the brain. The result is a better mood and less anxiety.

Common classes of antidepressants used to treat anxiety-related disorders include:

SSRIs

Selective serotonin reuptake inhibitors (SSRIs) are a fairly new class of antidepressants. In 1987, Prozac (fluoxetine), manufactured by Ely Lilly Company, was the first SSRI to enter the U.S. market as an approved treatment for depression. Since then, numerous other SSRIs have emerged and their proven effectiveness have gone beyond the treatment of depression. SSRIs have been useful in treating many anxiety-related illnesses including panic disorder and are usually the first choice of medication intervention prescribed for PD treatment.

Other commonly prescribed SSRIs include: 

TCAs

Tricyclic antidepressants (TCAs) are named after the drugs’ “three ringed” molecular structure. Prior to the introduction of SSRIs, TCAs were the medication of choice for the treatment of major depressive disorder, panic disorder and other anxiety disorders.

TCAs are also used to treat certain pain syndromes and nocturnal enuresis (bedwetting). 

Similar to SSRIs, TCAs impact serotonin levels. Additionally, TCA's impact norepinephrine, which is a neurotransmitter known to influence the fight-or-flight stress response. Some common TCAs include: 

  • Tofranil (imipramine)
  • Elavil (amitriptyline)
  • Norpramin (desipramine)

MAOIs

Monoamine oxidase inhibitors (MAOIs) are a class of antidepressants that were developed in the 1950s. They are effective in treating depression, panic disorder, and other anxiety disorders. Although they are generally as effective as SSRIs and TCAs, they are used less frequently because of necessary dietary precautions and risks of adverse reactions when mixed with certain drugs. 

Much like TCAs, MAOIs affect serotonin and norepinephrine. However, MAOIs also work to balance levels of the neurotransmitter dopamine, which is associated with energy levels and motivation. Some common MAOIs include: 

  • Parnate (tranylcypromine)
  • Nardil (phenelzine)
  • Marplan (isocarboxazid)

Side Effects of Antidepressants

One attraction of SSRIs is that they are believed to be safer and produce fewer unwanted side effects than other classes of antidepressants. But any antidepressant, including SSRIs, can cause some side effect complications, especially during the beginning of treatment.

Some common side effects of antidepressant use include:

  • Nausea
  • Sexual dysfunction, including reduced desire or orgasm difficulties
  • Headache
  • Stomach upset
  • Nervousness
  • Weight gain
  • Drowsiness
  • Insomnia

Some of these side effects will be eliminated after your body adjusts to the medication. If they don’t and are bothersome, your doctor may try another antidepressant. Although each class of antidepressants function by a similar mode of action, individually they are different.

Antidepressants and Suicide

The association of increased suicidal thoughts, especially among adolescents with antidepressant treatment, has been a center of attention and controversy in recent years. In response to the concerns suggested in case studies and some research, the U.S. Food and Drug Administration (FDA) issued a statement in 2007. The FDA proposed that makers of all antidepressant medications indicate a warning on their products about a possible increased risk of suicidal thinking and behavior in young adults, ages 18 to 24, during initial treatment.

So far, researchers have not found a definitive answer about the antidepressant-suicide connection. For the majority of people, antidepressants decrease depression and alleviate the helplessness and hopelessness that consumes their daily existence. But, for a small percentage of people taking antidepressants, this may not be the case. If you are concerned about this issue, be open with your doctor and don’t be afraid to ask questions.

Sources:

Antidepressant Use in Children, Adolescents, and Adults. Revisions to Product Labeling. U.S. Food and Drug Administration. May 2, 200

Kaplan, H.I. and Sadock, B.J. Synopsis of Psychiatry, Eighth Edition. Baltimore: Williams & Wilkins. 1998.

Silverman, Harold M. The Pill Book. 15th ed. New York, NY: Bantam Books, 2012.

United States Department of Veterans Affairs. Tricyclic Antidepressants. 19 Oct 2008.

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