Prescriptions for Panic: A Closer Look at Medications Used to Treat Panic Disorder

Panic Disorders

Panic disorder is a type of anxiety disorder characterized by recurrent and unexpected panic attacks. Panic attacks are episodes of intense fear and discomfort that can last several minutes, and are accompanied by a range of physical symptoms, including palpitations, sweating, trembling, chest pain, and shortness of breath.

The fear of experiencing a panic attack or the fear of its consequences (such as embarrassment or a perceived loss of control) can lead to anticipatory anxiety, which can in turn trigger more panic attacks, creating a cycle of fear and avoidance.

The causes of panic disorder are not well understood, but it is believed to be a complex interaction between genetic, environmental, and psychological factors.

Treatment for panic disorder often involves a combination of medication (such as antidepressants or benzodiazepines) and psychotherapy (such as cognitive-behavioral therapy or exposure therapy), which can help individuals learn to manage and overcome their fears and symptoms.

If you or someone you know is experiencing panic attacks or symptoms of panic disorder, it is important to seek professional help from a mental health provider. With appropriate treatment and support, most people with panic disorder can lead full and productive lives.

Treatment of Panic Disorders

The goals are complete resolution of panic attacks, marked reduction in anticipatory anxiety, elimination of phobic avoidance, and resumption of normal activities.

SSRIs( selective serotonin re-uptake inhibitors)  are first-line agents for panic disorder. Most patients without agoraphobia improve with pharmacotherapy alone, but if agoraphobia is present, Cognitive Behavioral Therapy( CBT )typically is initiated concurrently. Patients treated with CBT are less likely to relapse than those treated with imipramine alone. For patients who cannot or will not take medications, CBT alone is indicated.

Educate patient to avoid caffeine, nicotine, alcohol, drugs of abuse, and stimulants. If pharmacotherapy is used, antidepressants, especially the SSRIs, are preferred in elderly patients and youth. The benzodiazepines are second line in these patients because of potential problems with disinhibition.

Usually patients are treated for 12 to 24 months before discontinuation is attempted over 4 to 6 months. Many patients require long-term therapy. Single weekly doses of fluoxetine have been used for maintenance.

Antidepressants

Stimulatory side effects (eg, anxiety, insomnia, jitteriness) can occur in Tricyclic antidepressants (TCA)– and SSRI-treated patients. This may hinder compliance and dose escalation. Low initial doses and gradual dose titration may eliminate these effects.

Imipramine blocks panic attacks within 4 weeks in 75% of patients, but reducing anticipatory anxiety and phobic avoidance requires 8 to 12 weeks. 25% of panic disorder patients discontinue TCAs because of side effects.

SSRIs eliminate panic attacks in 60% to 80% of patients within about 4 weeks, but some patients require 8 to 12 weeks.
Approximately 54% to 60% of patients became panic-free on extended-release venlafaxine, 75 mg or 150 mg.

Benzodiazepines

Benzodiazepines are second-line agents for panic disorder except when rapid response is essential. Avoid benzodiazepine monotherapy in patients with panic disorder who are depressed or have a history of depression. Avoid benzodiazepines in patients with a history of alcohol or drug abuse. They are often used concomitantly with antidepressants in the first 4 to 6 weeks to achieve a more rapid antipanic response.
Relapse rates of 50% or higher are common despite slow drug tapering.

Alprazolam and clonazepam are the most frequently used benzodiazepines. Therapeutic response typically occurs within 1 to 2 weeks. With alprazolam, there may be breakthrough symptoms between doses. The use of extended-release alprazolam or clonazepam avoids this problem.

Dosing and Administration

The starting dose of clonazepam is 0.25 mg twice daily, with a dose increase to 1 mg by the third day. Increases by 0.25 to 0.5 mg every 3 days to 4 mg/day can be made if needed.

The starting dose of alprazolam is 0.25 to 0.5 mg three times daily (or 0.5 mg once daily of extended-release alprazolam), slowly increasing over several weeks as needed. Most patients require 3 to 6 mg/day.

KEYWORDS

• Panic disorder medication
• Antidepressants
• Benzodiazepines
• Treatment options for panic attack
• panic attack medication side effects
• Panic attacks
• Panic disorder therapy
• Panic disorder symptoms
• Panic disorder causes
• Panic disorder prevention
• Panic disorder management

REFERENCE

• https://www.mayoclinic.org/diseases-conditions/panic-attacks/diagnosis-treatment/drc-20376027#:~:text=SSRIs%20approved%20by%20the%20Food,are%20another%20class%20of%20antidepressants.
• https://www.goodrx.com/conditions/panic-disorder/medications-for-panic-disorder
• https://www.aafp.org/pubs/afp/issues/1998/0515/p2405.html
• https://www.verywellmind.com/medications-for-panic-disorder-2584307
• https://www.medicalnewstoday.com/articles/best-medication-for-panic-attacks
• https://www.nps.org.au/australian-prescriber/articles/treatment-of-panic-disorder
• https://www.webmd.com/anxiety-panic/guide/understanding-panic-attack-treatment
• https://www.drugs.com/condition/panic-disorder.html