Are Panic Attack Medications Right For You
Several kinds of medicine can be very helpful in controlling the symptoms of panic attacks, lessening their frequency and reducing the anticipatory anxiety of having another attack. However, it’s generally recognized that the medical approach is most effective when combined with therapeutic treatment as well—such as cognitive-behavior therapy, counseling and relaxation training. When the two approaches are combined, panic attack medications and cognitive-behavior therapy, long-term sustainable relief is much more likely to be achieved.
There are two distinct stages of panic: anticipatory anxiety and the panic attack itself. Therapy can help panic sufferers break patterns of negative thought and learn how to cope and calm themselves by focusing on (1) understanding and modifying the environmental or external conditions and situations that trigger the attacks, and (2) recognizing and controlling the immediate symptoms of panic at the onset and during an episode.
Different medications also address one or both of these stages. Two general categories of drugs are used to treat panic disorder—(1) antidepressants, including tricyclics, monoamine oxidase inhibitors (MAOIs), and selective serotonin reuptake inhibitors (SSRIs); and (2) benzodiazepines or anti-anxiety drugs. Sometimes both categories will be used in combination.
The anti-anxiety drugs are particularly effective against the immediate symptoms of a panic attack. They can be taken “on demand” and work quickly to shut down an impending panic attack. And while their main impact is on active symptoms, the benzodiazepines can indirectly help reduce anticipatory anxiety, because knowing they have a tool that can likely stop an attack quickly often gives patients a greater feeling of control.
The benzodiazepines most commonly prescribed for panic attacks are alprazolam (Xanax) and clonazepam (Klonopin). Alprazolam takes 15 to 20 minutes, sometimes less, to begin shutting down the symptoms of anxiety, so for some it can be quite effective when taken at the first sign of a panic episode. Both alprazolam and clonazepam block panic attacks quickly and have relatively few side effects compared to antidepressants. On the down side, they are also quicker to create dependency in the body and can lead to withdrawal symptoms when they are discontinued.
For 75 to 80 percent of patients, anti-depressants cause significant improvement in their symptoms. Antidepressants reduce the number and severity of panic attacks through continual action on the brain’s chemistry. The tricyclic antidepressant imipramine (Tofranil) has the longest track record for treating panic attacks, and among the MAOI antidepressants, clinical experience shows that phenelzine (Nardil) is the most effective. Recent studies show that the newer SSRI antidepressants (i.e., Prozac, Zoloft, and Paxil) have success rates equal to that of the tricyclic antidepressants.
Symptoms of panic disorder should show significant improvement within a few weeks after beginning these medications. If no improvement is achieved within two months, the patient may require either a higher dose or another medicine. Most of these drugs will need to be continued for a year or longer and then can be decreased gradually without the reemergence of symptoms. But some people may need to stay on medicines for a long time to keep their panic at bay.
