Should I take medications to treat panic disorder?

Introduction

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This information will help you understand your choices, whether you share in the decision-making process or rely on your health professional's recommendation.

Key points in making your decision

Factors to consider when deciding whether to take medications to treat panic disorder include the how bad your symptoms are, whether you are taking medications for other conditions, and how you feel about taking medication. Think about the following when you are making your decision:

• Considering how much your symptoms bother you can help you decide whether medications are necessary. If your panic attacks and anxiety interfere with your daily living, taking medications may be a good choice for you.
• Two types of medications are effective for treating panic disorder. Benzodiazepines work to help symptoms of panic disorder right away and can be taken as needed. Antidepressants need to be taken every day for long-term treatment.
• If your symptoms are manageable, home treatments and professional counseling, such as cognitive-behavioral therapy (which focuses on modifying certain thinking and behavior patterns), may be enough to reduce your symptoms and manage your panic attacks.
• Medications will help control your symptoms of panic disorder if you are willing to take them as prescribed, to manage any uncomfortable side effects, and to continue taking the medications for the long term. If you have depression along with panic disorder, some medications can be helpful in treating both conditions.¹
• Although one type of treatment may work for you, for many people a combination of both medication and counseling is the most effective long-term treatment for panic disorder.²
• If you need medications to treat panic disorder, don't be ashamed about taking them. Panic disorder is a medical condition, not a character flaw or weakness. The medications will not alter your personality.

Medical Information

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What is panic disorder?

Panic disorder is a mental condition in which you have repeated, unexpected panic attacks and constantly worry about having another attack. A panic attack is a sudden feeling of extreme anxiety along with intense and frightening, but not life-threatening, physical symptoms. The strength of a panic attack usually peaks within 10 minutes, and most symptoms fade within 30 minutes.

For more information, see the topic Panic Attacks and Panic Disorder.

What are the risks of panic disorder?

Panic disorder can reduce your quality of life and interfere with your relationships and your ability to work. If you have panic disorder, you are more likely to develop certain other conditions such as depression or agoraphobia, which is a fear of being in public places or of being in situations from which it might be difficult to escape (such as crossing a bridge or standing in line).

What types of medications are used to treat panic disorder?

The two types of medications that are generally used to treat panic disorder are antidepressants and benzodiazepines. Sometimes a combination of both may be prescribed.

The most common medications used to treat panic disorder are selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac), sertraline (Zoloft), or paroxetine (Paxil). Other antidepressants such as tricyclic antidepressants (TCAs) or monoamine oxidase inhibitors (MAOIs) can also be effective. Antidepressants with mixed neurotransmitter effects, such as venlafaxine (Effexor), may also be used to treat panic disorder.

Sometimes benzodiazepines such as alprazolam (Xanax), diazepam (Valium), lorazepam (Ativan), or clonazepam (Klonopin) are prescribed, either alone or combined with an antidepressant. Benzodiazepines are most commonly used for rapid, short-term relief of symptoms and may also be used as a part of ongoing treatment either alone or combined with an antidepressant. Benzodiazepines work quickly to treat anxiety and may be especially helpful if you have agoraphobia. Unlike antidepressants, they can be taken as needed. However, symptoms often recur when you stop taking them, and they have the potential to cause addiction (dependence).

What to expect if you take medications to treat panic disorder

Antidepressants can help balance the chemicals in your brain (neurotransmitters) and reduce the intensity of your symptoms. It may take several weeks after starting antidepressants before you notice a significant change, but you should notice some improvement in 2 to 3 weeks and see the full effects in 8 weeks. Benzodiazepines provide more immediate relief for symptoms of anxiety and may be prescribed alone or combined with an antidepressant such as an SSRI.

It is important to remember that people respond differently to medications, and the first medication you try may or may not be effective in relieving your symptoms of panic disorder. If the medication is not effective after several weeks, you may need to try another medication.

Although antidepressant medications have potential side effects, these side effects are usually mild and may diminish after several weeks of therapy.

What to expect if you DO NOT take medications to treat panic disorder

Even if you decide not to take medication, it is wise to try professional counseling, such as cognitive-behavioral therapy, which focuses on modifying certain thinking and behavior patterns. Therapy can help you deal with immediate problems and learn ways to better cope with future anxiety and panic attacks. Other treatments, such as support groups, relaxation exercises, or mindfulness activities, can also be helpful. Untreated panic disorder may get worse or may be unmanageable without help, especially if you also have another condition that commonly occurs along with panic disorder such as agoraphobia or depression.

If you do not take medications to treat panic disorder, continuing to monitor how much your symptoms interrupt your life and the lives of those around you can be helpful. Some people are able to overcome panic disorder without taking medication. However, if other methods aren't effective enough, medications can be added to your treatment.

Your Information

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Your choices are as follows:

• Don't take medicine to treat panic disorder, but work on managing the symptoms of panic disorder with lifestyle changes, home treatment, or professional counseling.
• Take medicine to treat panic disorder. You can also take medicine while you work on managing the symptoms of panic disorder with lifestyle changes, home treatment, or professional counseling.

The decision about whether to take medicine to treat panic disorder takes into account your personal feelings and the medical facts.

Deciding about medications to treat panic disorder

Reasons to take medications

Reasons not to take medications

Your symptoms of panic disorder disrupt your daily living, your work, or your relationships. You would be willing to continue taking medications as prescribed for a period of at least several months. You have not been able to overcome symptoms of panic disorder with other treatment. Professional counseling alone is not effective enough or is not working quickly enough. You are willing to deal with potential side effects of medications. You have other conditions linked to panic disorder that could benefit from medications, such as depression or problems with drugs or alcohol. Are there other reasons you might want to take medications?

Your symptoms do not significantly disrupt your daily living, your work, or your relationships. You do not want to take medications for a long period of time. You have been able to control your symptoms through professional counseling. You have tried a number of different medications, and all of them cause intolerable side effects. You are taking medications for other health conditions that will interfere with antidepressants or benzodiazepines. Your panic disorder is not linked to other conditions that need treatment. Are there other reasons you might not want to take medications?

These personal stories may help you make your decision.

Wise Health Decision

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Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about taking medications to treat panic disorder. Discuss the worksheet with your health professional.

Circle the answer that best applies to you.

My symptoms of panic disorder interfere with my ability to enjoy my life and do daily activities.	Yes	No	Unsure
I think I can tolerate the side effects of the medications.	Yes	No	Unsure
I am willing to try more than one medication if the first one doesn't work for me.	Yes	No	Unsure
I will seek professional counseling to help with my panic disorder.	Yes	No	Unsure
I will modify my lifestyle, if needed, to include exercising, reducing stress, and eating a balanced diet.	Yes	No	Unsure
I am willing to take medication for at least several months.	Yes	No	Unsure
My panic disorder is not improving enough with professional counseling alone.	Yes	No	N/A*
I believe my symptoms may be worse than the potential, temporary side effects of the medication.	Yes	No	Unsure

*NA = Not applicable

Use the following space to list any other important concerns you have about this decision.

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to take or not take medications to treat your panic disorder.

Check the box below that represents your overall impression about your decision.

Leaning toward taking medications

Leaning toward NOT taking medications

FDA Advisories. The U.S. Food and Drug Administration (FDA) has issued:

• An advisory on antidepressant medicines and the risk of suicide in children and adults. The FDA does not recommend that people stop using these medicines, but to watch for warning signs of suicide in those using them. This is especially important at the beginning of treatment or when doses are changed.
• A warning about the antidepressants Paxil and Paxil CR and birth defects. Taking these medicines in the first 12 weeks of pregnancy may increase your chance of having a baby with a birth defect.

Return to the topic Panic Attacks and Panic Disorder.

References

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Citations

1. Hollander E, Simeon D (2003). Anxiety disorders. In Textbook of Clinical Psychiatry, 4th ed., pp. 543–565. Washington, DC: American Psychiatric Publishing.

2. Kumar S, Oakley-Browne M (2006). Panic disorder, search date May 2006. Online version of Clinical Evidence (15): 1–15.

Credits

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Author	Sabra L. Katz-Wise
Author	Ralph Poore
Editor	Susan Van Houten, RN, BSN, MBA
Associate Editor	Pat Truman
Primary Medical Reviewer	Adam Husney, MD - Family Medicine
Specialist Medical Reviewer	Lisa S. Weinstock, MD - Psychiatry
Last Updated	November 10, 2006