Anxiety attacks, formally known as panic attacks, are a hallmark symptom of panic disorder. Panic attacks are usually accompanied by increased heart rate, sweating, shakiness, faintness, derealization (feelings of unreality) and depersonalization (feeling detached from oneself). Many medications can be prescribed to treat panic effectively. Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa) and escitalopram (Lexapro), are the first-line choice of treatment for panic attacks. Severe or treatment-refractory cases that do not respond to SSRIs may respond to one of the following alternative prescription medications.
Tricyclics/MAOIs
Like SSRIs, tricyclics and monoamine oxidase inhibitors MAOIs are antidepressants; however, they are prescribed less often because of the increased risk of severe side effects, such as heart arrhythmias, hypotension, blurred vision and shaking. Tricyclics with proven efficacy in treating panic include imipramine (Tofranil), nortriptyline (Aventyl or Pamelor), amitriptyline (Elavil), desipramine (Norpramin) and doxepin (Sinequan or Adapin). MAOIs used to treat panic include phenelzine (Nardil), tranylcypromine (Parnate) and isocarboxazid (Marplan).
Benzodiazepines
Among the prescribed medications available to treat severe anxiety and panic attacks, benzodiazepines provide the most rapid onset of symptom reduction. However, long-term use can lead to problems, such as abuse, dependence and withdrawal risk, so your physician should closely monitor your use of the drug and gradually taper you off the medication at a clinically appropriate time. Benzodiazepines that have demonstrated proven effectiveness at relieving panic symptoms include diazepam (Valium), alprazolam (Xanax), clonazepam (Klonopin) and lorazepam (Ativan).
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. Gabapentin (Neurontin) is another anticonvulsant that is efficacious in treating other types of anxiety and has shown mixed results in reducing panic.
Combination Therapies
A 2001 review published in "Psychopharmacology Bulletin" indicates that patients who have not responded to adequate trials of one or more SSRIs may benefit from combination treatment with a benzodiazepine, tricyclic antidepressant, or the beta-blocker pindolol.
A clinical trial concluding in 2007 sponsored by the National Institute of Mental Health and led by principal investigator Naomi M. Simon MD, MSc from Massachusetts General Hospital lends support to the potential efficacy of combined psychopharmacological treatment with SSRIs and benzodiazepines. One group of treatment-refractory panic disorder patients who were taking sertraline were given an additional dose of clonazepam, resulting in significant improvement in self-reported anxiety symptoms. Another group who were taking sertraline participated in only 12 weeks of cognitive behavioral therapy. The effect was not as large, but participants again showed significant self-reported improvement in anxiety.
Beta-blockers
Beta-blockers act on the physical symptoms that are associated with panic and anxiety, such as increased heart rate, perspiration, hyperventilation and trembling. Those who are troubled by severe and persistent physical symptoms such as these may respond to beta-blockers such as propranolol (Inderal) and atenolol (Tenormin).
References
- National Institute of Mental Health: Medications to Treat Anxiety Disorders
- "Psychopharmacology Bulletin;" Management of Treatment-refractory Panic Disorder; Mathew SJ et al.; 2001
- Clinicaltrials.gov: Therapies for Treatment-resistant Panic Disorder
