Treatments for Panic disorder
Treatment List for Panic disorder
The list of treatments mentioned in various sources
for Panic disorder
includes the following list.
Always seek professional medical advice about any treatment
or change in treatment plans.
Panic disorder: Is the Diagnosis Correct?
The first step in getting correct treatment is
to get a correct diagnosis.
Differential diagnosis list for Panic disorder may include:
Panic disorder: Research Doctors & Specialists
Research all specialists including ratings, affiliations, and sanctions.
Drugs and Medications used to treat Panic disorder:
Note:You must always seek professional medical advice about any prescription drug, OTC drug, medication, treatment
or change in treatment plans.
Some of the different medications used in the treatment of Panic disorder include:
- Alprazolam Intensol
- Xanax XR
- Xanx TS
Unlabeled Drugs and Medications to treat Panic disorder:
Unlabelled alternative drug treatments for Panic disorder include:
- PMS Imipramine
Latest treatments for Panic disorder:
The following are some of the latest treatments for Panic disorder:
Hospitals & Medical Clinics: Panic disorder
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for hospitals and medical facilities in specialties related to Panic disorder:
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More general information, not necessarily in relation to Panic disorder,
on hospital and medical facility performance and surgical care quality:
Medical news summaries about treatments for Panic disorder:
The following medical news items
are relevant to treatment of Panic disorder:
Discussion of treatments for Panic disorder:
Panic Disorder: NWHIC (Excerpt)
Studies have shown that proper treatment -- a type of psychotherapy
called cognitive-behavioral therapy, medications, or possibly a
combination of the two -- helps 70-80 percent of people with panic
disorder. Significant improvement is usually seen within 6-8 weeks.
Cognitive-behavioral approaches teach patients how to view the panic
situations differently and demonstrate ways to reduce anxiety, using
breathing exercises or techniques to refocus attention, for example.
Another technique used in cognitive-behavioral therapy, called exposure
therapy, can often help alleviate the phobias that may result from panic
disorder. In exposure therapy, people are very slowly exposed to the
fearful situation until they become desensitized to it.
Some people find the greatest relief from panic disorder symptoms when
they take certain prescription medications. Such medications, like
cognitive-behavioral therapy, can help to prevent panic attacks or reduce
their frequency and severity. Two types of medications that have been
shown to be safe and effective in the treatment of panic disorder are
antidepressants and benzodiazepines.
(Source: excerpt from Panic Disorder: NWHIC)
Getting Treatment for Panic Disorder: NIMH (Excerpt)
Unfortunately, some people are reluctant to pursue treatment. Perhaps
they think their condition is not serious. Perhaps they feel embarrassed.
They may blame themselves or have trouble asking for help. Perhaps they
dislike the idea of medication or therapy. Or, maybe they have sought help
but are frustrated because their condition was not diagnosed or treated
Do not let these or any other reasons stop you from getting proper
treatment. If you have panic disorder, you should get whatever help is
necessary to overcome it, just as you would for any serious medical
Do not be discouraged if some people say, "It's nothing to worry
about," "It's just stress," "It's all in your head," or "Snap out of it."
While they often mean well, the fact is that most people who do not have
panic disorder do not understand that it is REAL and, therefore, tend to
doubt its seriousness.
Most importantly, do not try to numb the effects of panic attacks with
alcohol or other drugs. This will only make the problem worse. (Source: excerpt from Getting Treatment for Panic Disorder: NIMH)
Getting Treatment for Panic Disorder: NIMH (Excerpt)
Treatment for panic disorder can consist of taking a medication to
adjust the chemicals in your body—just as you might take medicine to
correct a thyroid imbalance.
Or treatment might involve working with a psychotherapist to gain more
control over your anxieties--just as some people work with specialists to
learn techniques to control migraine headaches or lower their blood
Research shows that both kinds of treatment can be very effective. For
many patients, the combination of medication and psychotherapy appears to
be more effective than either treatment alone. Early treatment can help
keep panic disorder from progressing.
Cognitive-behavioral therapy (CBT) teaches you to anticipate and
prepare yourself for the situations and bodily sensations that may trigger
panic attacks. CBT usually includes the following elements:
- A therapist helps you identify the thinking patterns that lead you
to misinterpret sensations and assume "the worst" is happening. These
patterns of thinking are deeply ingrained, and it will take practice to
notice them and then to change them.
- A therapist can teach you breathing exercises that calm you and that
can prevent the overbreathing, or hyperventilation, that often occurs
during a panic attack.
- A therapist can help you gradually become less sensitive to the
frightening bodily sensations and feelings of terror. This is done by
helping you, step-by-step, to safely test yourself in the places and
situations you've been avoiding.
CBT generally requires at least 8 to 12 weeks. Some people may need a
longer time in treatment to learn the skills and put them into practice.
Most panic disorder patients are successful in controlling or preventing
their panic attacks after completing treatment with CBT.
CBT requires a motivated patient and a specially trained therapist.
Make sure any therapist you work with has proper training and experience
in this method of panic disorder treatment. Indeed, in some parts of
the country, you may find limited access to professionals trained and
experienced in CBT.
Several types of medication that alter the ways chemicals interact in
the brain can reduce or prevent panic attacks and decrease anxiety. Two
major categories of medication that have been shown to be safe and
effective in the treatment of panic disorder are antidepressants and
Each medication works differently. Some work quickly and others more
gradually. All of them have to be taken on a regular basis. Usually,
treatment with medication lasts at least 6 months to a year. But within 8
weeks, you and your doctor should be able to assess whether it's
effectively blocking the panic attacks. More details on medications can be
found in the brochure "Understanding Panic
Clinical experience suggests that for many patients with panic
disorder, a combination of CBT and medication may be the best treatment.
The National Institute of Mental Health (NIMH) is conducting a large study
to confirm this and to help determine the kinds of patients most likely to
need combined therapy (Source: excerpt from Getting Treatment for Panic Disorder: NIMH)
Getting Treatment for Panic Disorder: NIMH (Excerpt)
From the beginning, it is important to be a full participant in your
treatment. Be active and assertive. Ask questions. Maintain open
communication with your treatment professional and let him or her know
Every patient responds differently, but it is important to know that
none of the treatments for panic disorder works instantly. So, you must
stick with a particular treatment for at least 8 weeks to see if it works.
If you do not see significant improvement within that time, you and your
treatment professional can adjust your treatment plan. It may take a bit
of trial and error before you find what works best for you. Be patient and
be sure to communicate with your treatment professional. Of course, if at
any time you feel uncomfortable with the professional you have chosen or
don't think your treatment is going well, you should feel free to consider
seeking a second opinion or even changing providers.
If your treatment involves medication, talk with your doctor about how
often and in what manner your dosage will be monitored. No matter what
medication you are taking, your doctor is likely to start you on a low
dose and gradually increase it to the full dose. You should know that
every medication has side effects, but they usually become tolerated or
diminish with time. If side effects become a problem, the doctor may
advise you to stop taking the medication and to wait a week or so before
trying another medication. When your treatment is near an end, your doctor
will taper the dosage gradually. (Source: excerpt from Getting Treatment for Panic Disorder: NIMH)
Understanding Panic Disorder: NIMH (Excerpt)
Before undergoing any treatment for panic disorder, a person should
undergo a thorough medical examination to rule out other possible causes
of the distressing symptoms. This is necessary because a number of other
conditions, such as excessive levels of thyroid hormone, certain types of
epilepsy, or cardiac arrhythmias, which are disturbances in the rhythm of
the heartbeat, can cause symptoms resembling those of panic disorder.
Several effective treatments have been developed for panic disorder and
agoraphobia. In 1991, a conference held at the National Institutes of
Health (NIH) under the sponsorship of the National Institute of Mental
Health and the Office of Medical Applications of Research, surveyed the
available information on panic disorder and its treatment. The conferees
concluded that a form of psychotherapy called cognitive-behavioral therapy
and medications are both effective for panic disorder. A treatment should
be selected according to the individual needs and preferences of the
patient, the panel said, and any treatment that fails to produce an effect
within 6 to 8 weeks should be reassessed.
Cognitive-Behavioral Therapy. This is a combination of
cognitive therapy, which can modify or eliminate thought patterns
contributing to the patient's symptoms, and behavioral therapy,
which aims to help the patient change his or her behavior.
Typically the patient undergoing cognitive-behavioral therapy meets
with a therapist for 1 to 3 hours a week. In the cognitive portion of the
therapy, the therapist usually conducts a careful search for the thoughts
and feelings that accompany the panic attacks. These mental events are
discussed in terms of the "cognitive model" of panic attacks.
The cognitive model states that individuals with panic disorder often
have distortions in their thinking, of which they may be unaware, and
these may give rise to a cycle of fear. The cycle is believed to operate
this way: First the individual feels a potentially worrisome sensation
such as an increasing heart rate, tightened chest muscles, or a queasy
stomach. This sensation may be triggered by some worry, an unpleasant
mental image, a minor illness, or even exercise. The person with panic
disorder responds to the sensation by becoming anxious. The initial
anxiety triggers still more unpleasant sensations, which in turn heighten
anxiety, giving rise to catastrophic thoughts. The person thinks "I am
having a heart attack" or "I am going insane," or some similar thought. As
the vicious cycle continues, a panic attack results. The whole cycle might
take only a few seconds, and the individual may not be aware of the
initial sensations or thoughts.
Proponents of this theory point out that, with the help of a skilled
therapist, people with panic disorder often can learn to recognize the
earliest thoughts and feelings in this sequence and modify their responses
to them. Patients are taught that typical thoughts such as "That terrible
feeling is getting worse!" or "I'm going to have a panic attack" or "I'm
going to have a heart attack" can be replaced with substitutes such as
"It's only uneasiness – it will pass" that help to reduce anxiety and ward
off a panic attack. Specific procedures for accomplishing this are taught.
By modifying thought patterns in this way, the patient gains more control
over the problem. (Source: excerpt from Understanding Panic Disorder: NIMH)
Understanding Panic Disorder: NIMH (Excerpt)
In cognitive therapy, discussions between the patient and
the therapist are not usually focused on the patient's past, as is the
case with some forms of psychotherapy. Instead, conversations focus on the
difficulties and successes the patient is having at the present time, and
on skills the patient needs to learn.
The behavioral portion of cognitive-behavioral therapy may involve
systematic training in relaxation techniques. By learning to relax, the
patient may acquire the ability to reduce generalized anxiety and stress
that often sets the stage for panic attacks.
Breathing exercises are often included in the behavioral
therapy. The patient learns to control his or her breathing and avoid
hyperventilation – a pattern of rapid, shallow breathing that can trigger
or exacerbate some people's panic attacks.
Another important aspect of behavioral therapy is exposure to internal
sensations called interoceptive exposure. During interoceptive
exposure the therapist will do an individual assessment of internal
sensations associated with panic. Depending on the assessment, the
therapist may then encourage the patient to bring on some of the
sensations of a panic attack by, for example, exercising to increase heart
rate, breathing rapidly to trigger lightheadedness and respiratory
symptoms, or spinning around to trigger dizziness. Exercises to produce
feelings of unreality may also be used. Then the therapist teaches the
patient to cope effectively with these sensations and to replace alarmist
thoughts such as "I am going to die," with more appropriate ones, such as
"It's just a little dizziness – I can handle it."
Another important aspect of behavioral therapy is "in vivo" or
real-life exposure. The therapist and the patient determine whether
the patient has been avoiding particular places and situations, and which
patterns of avoidance are causing the patient problems. They agree to work
on the avoidance behaviors that are most seriously interfering with the
patient's life. For example, fear of driving may be of paramount
importance for one patient, while inability to go to the grocery store may
be, at most, handicapping for another.
Some therapists will go to an agoraphobic patient's home to conduct the
initial sessions. Often therapists take their patients on excursions to
shopping malls and other places the patients have been avoiding. Or they
may accompany their patients who are trying to overcome fear of driving a
The patient approaches a feared situation gradually, attempting to stay
in spite of rising levels of anxiety. In this way the patient sees that as
frightening as the feelings are, they are not dangerous, and they do pass.
On each attempt, the patient faces as much fear as he or she can stand.
Patients find that with this step-by-step approach, aided by encouragement
and skilled advice from the therapist, they can gradually master their
fears and enter situations that had seemed unapproachable.
Many therapists assign the patient "homework" to do between sessions.
Sometimes patients spend only a few sessions in one-on-one contact with a
therapist and continue to work on their own with the aid of a printed
Often the patient will join a therapy group with others striving to
overcome panic disorder or phobias, meeting with them weekly to discuss
progress, exchange encouragement, and receive guidance from the therapist.
Cognitive-behavioral therapy generally requires at least 8 to 12 weeks.
Some people may need a longer time in treatment to learn and implement the
skills. This kind of therapy, which is reported to have a low relapse
rate, is effective in eliminating panic attacks or reducing their
frequency. It also reduces anticipatory anxiety and the avoidance of
Treatment with Medications. In this treatment approach,
which is also called pharmacotherapy, a prescription medication is
used both to prevent panic attacks or reduce their frequency and severity,
and to decrease the associated anticipatory anxiety. When patients find
that their panic attacks are less frequent and severe, they are
increasingly able to venture into situations that had been off-limits to
them. In this way, they benefit from exposure to previously feared
situations as well as from the medication.
The three groups of medications most commonly used are the tricyclic
antidepressants, the high-potency benzodiazepines, and the
monoamine oxidase inhibitors (MAOIs). Determination of which drug
to use is based on considerations of safety, efficacy, and the personal
needs and preferences of the patient. Some information about each of the
classes of drugs follows.
The tricyclic antidepressants were the first medications shown to have
a beneficial effect against panic disorder. Imipramine is the tricyclic
most commonly used for this condition. When imipramine is prescribed, the
patient usually starts with small daily doses that are increased every few
days until an effective dosage is reached. The slow introduction of
imipramine helps minimize side effects such as dry mouth, constipation,
and blurred vision. People with panic disorder, who are inclined to be
hypervigilant about physical sensations, often find these side effects
disturbing at the outset. Side effects usually fade after the patient has
been on the medication a few weeks.
It usually takes several weeks for imipramine to have a beneficial
effect on panic disorder. Most patients treated with imipramine will be
panic-free within a few weeks or months. Treatment generally lasts from 6
to 12 months. Treatment for a shorter period of time is possible, but
there is substantial risk that when imipramine is stopped, panic attacks
will recur. Extending the period of treatment to 6 months to a year may
reduce this risk of a relapse. When the treatment period is complete, the
dosage of imipramine is tapered over a period of several weeks.
The high-potency benzodiazepines are a class of medications that
effectively reduce anxiety. Alprazolam, clonazepam, and lorazepam are
medications that belong to this class. They take effect rapidly, have few
bothersome side effects, and are well tolerated by the majority of
patients. However, some patients, especially those who have had problems
with alcohol or drug dependency, may become dependent on benzodiazepines.
Generally, the physician prescribing one of these drugs starts the
patient on a low dose and gradually increases it until panic attacks
cease. This procedure minimizes side effects.
Treatment with high-potency benzodiazepines is usually continued for 6
months to a year. One drawback of these medications is that patients may
experience withdrawal symptoms – malaise, weakness, and other unpleasant
effects – when the treatment is discontinued. Reducing the dose gradually
generally minimizes these problems. There may also be a recurrence of
panic attacks after the medication is withdrawn.
Of the MAOIs, a class of antidepressants which have been shown to be
effective against panic disorder, phenelzine is the most commonly used.
Treatment with phenelzine usually starts with a relatively low daily
dosage that is increased gradually until panic attacks cease or the
patient reaches a maximum dosage of about 100 milligrams a day.
Use of phenelzine or any other MAOI requires the patient to observe
exacting dietary restrictions, because there are foods and prescription
drugs and certain substances of abuse that can interact with the MAOI to
cause a sudden, dangerous rise in blood pressure. All patients who are
taking MAOIs should obtain their physician's guidance concerning dietary
restrictions and should consult with their physician before using any
over-the-counter or prescription medications.
As in the case of the high-potency benzodiazepines and imipramine,
treatment with phenelzine or another MAOI generally lasts 6 months to a
year. At the conclusion of the treatment period, the medication is
Newly available antidepressants such as fluoxetine (one of a class of
new agents called serotonin reuptake inhibitors) appear to be effective in
selected cases of panic disorder. As with other anti-panic medications, it
is important to start with very small doses and gradually increase the
Scientists supported by NIMH are seeking ways to improve drug treatment
for panic disorder. Studies are underway to determine the optimal duration
of treatment with medications, who they are most likely to help, and how
to moderate problems associated with withdrawal.
Combination Treatments. Many believe that a combination
of medication and cognitive-behavioral therapy represents the best
alternative for the treatment of panic disorder. The combined approach is
said to offer rapid relief, high effectiveness, and a low relapse rate.
However, there is a need for more research studies to determine whether
this is in fact the case.
Comparing medications and psychological treatments, and determining how
well they work in combination, is the goal of several NIMH-supported
studies. The largest of these is a 4-year clinical trial that will include
480 patients and involve four centers at the State University of New York
at Albany, Cornell University, Hillside Hospital/Columbia University, and
Yale University. This study is designed to determine how treatment with
imipramine compares with a cognitive-behavioral approach, and whether
combining the two yields benefits over either method alone.
Psychodynamic Treatment. This is a form of "talk therapy"
in which the therapist and the patient, working together, seek to uncover
emotional conflicts that may underlie the patient's problems. By talking
about these conflicts and gaining a better understanding of them, the
patient is helped to overcome the problems. Often, psychodynamic treatment
focuses on events of the past and making the patient aware of the
ramifications of long-buried problems.
Although psychodynamic approaches may help to relieve the stress that
contributes to panic attacks, they do not seem to stop the attacks
directly. In fact, there is no scientific evidence that this form of
therapy by itself is effective in helping people to overcome panic
disorder or agoraphobia. However, if a patient's panic disorder occurs
along with some broader and pre-existing emotional disturbance,
psychodynamic treatment may be a helpful addition to the overall treatment
program. (Source: excerpt from Understanding Panic Disorder: NIMH)
Understanding Panic Disorder: NIMH (Excerpt)
Self-help and support groups are the least expensive
approach to managing panic disorder, and are helpful for some people. A
group of about 5 to 10 people meet weekly and share their experiences,
encouraging each other to venture into feared situations and cope
effectively with panic attacks. Group members are in charge of the
sessions. Often family members are invited to attend these groups, and at
times a therapist or other panic disorder expert may be brought in to
share insights with group members. Information on self-help groups in
specific areas of the country can be obtained from the Anxiety Disorders
Association of America.
(Source: excerpt from Understanding Panic Disorder: NIMH)
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