Panic disorder is characterized by panic attacks that are accompanied by rapid heartbeat, dizziness, trembling and perspiration. It is one of several types of anxiety disorders, including generalized anxiety disorder (GAD), agoraphobia, social anxiety disorder (social phobia), specific phobia, posttraumatic stress disorder (PTSD), acute stress disorder and obsessive-compulsive disorder (OCD). Most anxiety disorders are treated with medication from one of a number of drug classes; however, drugs that are effective at treating panic may or may not be effective for treating other anxiety disorders. It is, therefore, best to work with a qualified, licensed health care professional to find the medication most targeted to your symptoms.
Benzodiazepines
Benzodiazepines provide rapid onset of symptom reduction; however, long term use can lead to problems such as abuse, dependence and withdrawal risk. Benzodiazepines that have demonstrated proven effectiveness at relieving panic symptoms include diazepam (Valium), alprazolam (Xanax), clonazepam (Klonopin) and lorazepam (Ativan).
Antidepressants
Selective serotonin reuptake inhibitors (SSRIs) are the first-line choice in psychopharmalogical treatment of anxiety disorders because they are effective, safer for long-term use and produce relatively fewer and more minor side effects. SSRIs that reduce symptoms of panic disorder include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa) and escitalopram (Lexapro). The serotonin norepinephrine reuptake inhibitor (SNRI) venlafaxine (Effexor) is similarly efficacious in treating panic.
Other antidepressants known as tricyclics and monoamine oxidase inhibitors (MAOIs) are less frequently prescribed because they have the potential to cause more serious side effects, including cardiac arrhythmias, hypotension, blurred vision and dizziness. The tricyclic imipramine (Tofranil) is useful in treating panic disorder, while Clomipramine (Anafranil) may be better targeted for OCD symptoms. Nortriptyline (Aventyl or Pamelor), amitriptyline (Elavil), desipramine (Norpramin) and doxepin (Sinequan or Adapin) are other tricyclics proven effective at treating panic. MAOIs used to treat panic and some forms of anxiety include phenelzine (Nardil), tranylcypromine (Parnate), and isocarboxazid (Marplan).
Beta-blockers
Beta-blockers act only on the body's physical symptoms that are associated with panic and anxiety and, as such, may keep anxiety at a manageable level or prevent a full-blown panic attack from occurring. They are often prescribed to individuals with social phobia. Increased heart rate, trembling and sweating may all be reduced by beta-blockers such as propranolol (Inderal) and atenolol (Tenormin).
Anticonvulsants
Once primarily used to control seizures among epileptic patients, anticonvulsants have since demonstrated efficacy in reducing symptoms of anxiety as well. Valproate and clonazepam are two commonly prescribed anticonvulsants used in the treatment of panic disorder. Combination psychopharmalogical treatment with both valproate and clonazepam may be efficacious in treatment-resistant panic disorder.
According to a 2007 review article in the "Journal of Clinical Psychopharmacology," the anticonvulsant pregabalin (Lyrica) is effective at treating social phobia and GAD, lamotrigine (Lamictal) is effective for PTSD, and gabapentin (Neurontin) is well-suited in treatment of social anxiety. Results regarding the impact of gabapentin on panic are mixed and require further research.
Buspirone (BuSpar)
Buspirone (BuSpar) is an anxiolytic (anti-anxiety drug) that does not belong to any of the above classes of drugs. It is thought to act on serotonin and dopamine levels in the brain, thus altering mood and anxiety. It appears to be most effective among patients with mild to moderate generalized anxiety symptoms. It has not been as effective among patients with panic disorder, severe anxiety or OCD.
References
- National Institute of Mental Health: Medications to Treat Anxiety Disorders
- Healthy Place: Common Medications for Anxiety Disorders
- Journal of Clinical Psychopharmacology; The Role of Anticonvulsant Drugs in Anxiety Disorders: A Critical Review of the Evidence; Mula, M et al.; June 2007
