What is the most important information I should know about panic attack medications?
If you are taking panic attack medications:
- do not suddenly stop taking your medicine or reduce your dose without talking to your doctor;
- some medications can cause serious or dangerous withdrawal symptoms.
Medication is one of the most popular and effective treatment options for panic disorder, panic attacks, and agoraphobia. Your doctor may prescribe panic attack medications to reduce the intensity of panic attacks, decrease overall feelings of anxiety, and potentially treat co-occurring conditions, such as depression.
Medications for panic disorder are typically from one of two categories: antidepressants and anti-anxiety drugs.1
This article discusses how medications are used to treat panic disorder and which medications are most often prescribed. It also covers some of the other treatment options that may be effective for panic symptoms.
Panic Disorder Treatment
Treatment for panic disorder may involve medication in addition to psychotherapy. In some cases, more than one medication may be prescribed to help manage symptoms of panic and anxiety.
For example, an antidepressant may be prescribed to help reduce the frequency of panic symptoms, while benzodiazepines may be used on an as-needed basis to help reduce the severity of panic attacks.
On-Label vs. Off-Label Medications
Medications that are FDA-approved to treat panic disorder include fluoxetine, sertraline, paroxetine, venlafaxine, clonazepam, and alprazolam.2 However, your doctor may prescribe other medications off-label depending on your specific needs.
Psychotherapy can also be effective in treating panic disorder. Types of psychotherapy that may be helpful include:
- Cognitive behavioral therapy (CBT)
- Exposure therapy
- Panic-focused psychodynamic psychotherapy (PFPP)
Antidepressant Medications for Panic Disorder
When first introduced in the 1950s, antidepressants were primarily used to treat mood disorders. However, it was later discovered that these medications effectively help reduce anxiety, lessen the symptoms of panic, and decrease the intensity and frequency of panic attacks.
Antidepressant medications are now commonly used to treat many anxiety disorders, including panic disorder and agoraphobia.3
Antidepressants affect the chemical messengers in the brain, known as neurotransmitters. There are thought to be many different types of these chemical messengers that communicate between brain cells.
Selective Serotonin Reuptake Inhibitors (SSRIs)
Selective serotonin reuptake inhibitors (SSRIs) are a popular class of antidepressants prescribed to decrease symptoms of anxiety and depression. Serotonin is a naturally occurring neurotransmitter in the brain.
These medications work by influencing only serotonin (“selective”) and by preventing serotonin absorption (“reuptake”) by the nerve cells in the brain.4 By balancing serotonin functioning, SSRIs are able to reduce anxiety and improve mood.
Common SSRIs include:
- Celexa (citalopram)
- Paxil (paroxetine)
- Prozac (fluoxetine)
- Zoloft (sertraline)
Studies have demonstrated the long-term effectiveness of SSRIs.5 These medications have also been found to cause limited side effects, making them the prescription medication of choice for panic disorder.
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
Serotonin-norepinephrine reuptake inhibitors (SNRIs) also block the reuptake of serotonin and norepinephrine. Norepinephrine is a neurotransmitter that plays a role in concentration and alertness.
Common SNRIs include:
- Cymbalta (duloxetine)
- Effexor XR (venlafaxine)
Research has found that SNRIs are effective for treating anxiety disorders, particularly social anxiety disorder.6 Side effects can occur while taking SNRIs and may include fatigue, insomnia, changes in appetite, and changes in sexual function.
Effexor XR is FDA-approved to treat panic disorder.7 While Cymbalta is not FDA-approved for this specific indication, doctors may still prescribe it off-label to treat the condition.
Tricyclic Antidepressants (TCAs)
Tricyclic antidepressants (TCAs) have become less popular in treating anxiety and mood disorders since SSRIs were introduced. However, TCAs can still be an effective treatment option for people with anxiety disorders.
Like SSRIs, TCAs work to block the reuptake of the chemical messenger serotonin. Additionally, many TCAs also prevent the reuptake of norepinephrine, another neurotransmitter in the brain that is often associated with the fight-or-flight stress response.
Common TCAs include:
- Adapin, Sinequan (doxepin)
- Asendin (amoxapine)
- Elavil (amitriptyline)
- Norpramin (desipramine)
- Pamelor (nortriptyline)
- Surmontil (trimipramine)
- Tofranil (imipramine)
- Vivactil (protriptyline)
Monoamine Oxidase Inhibitors (MAOIs)
Monoamine oxidase inhibitors (MAOIs) are one of the earliest developed antidepressants used to effectively treat mood and anxiety disorders. MAOIs work by inhibiting the activity of the enzyme monoamine oxidase.
This enzyme is involved in breaking down neurotransmitters like norepinephrine, serotonin, and dopamine. Dopamine helps regulate many functions, including movement, physical energy levels, and feelings of motivation.9
Common MAOIs include:
- Emsam (selegiline)
- Nardil (phenelzine)
- Marplan (isocarboxazid)
- Parnate (tranylcypromine)
Despite their effectiveness, MAOIs are prescribed less frequently due to necessary dietary restrictions when taking them and the potential for significant drug interactions that can occur when taking MAOIs with other medications.9
Anti-Anxiety Medications
Anti-anxiety medications are prescribed for their fast-acting relief of panic symptoms. These medications work to relax the central nervous system, which can lower the intensity of panic attacks and cause a person to feel calmer.10
Due to their tranquilizing effect and rapid relief, anti-anxiety medications are often prescribed to treat panic disorder.
Benzodiazepines
Benzodiazepines are the most commonly prescribed class of anti-anxiety medication for panic disorder. Known for their sedative effect, these medications can quickly reduce panic attack symptoms and induce a more relaxed state.
Benzodiazepines slow down the central nervous system by targeting the gamma-aminobutyric acid (GABA) receptors in the brain, inducing a sense of relaxation.11 In spite of the potential risks and side effects of these medications, benzodiazepines have been found to safely and effectively treat panic disorder.
Common benzodiazepines include:
- Ativan (lorazepam)
- Klonopin (clonazepam)
- Librium (chlordiazepoxide)
- Valium (diazepam)
- Xanax (alprazolam)
Benzodiazepines can be habit-forming, so they are typically prescribed for short-term relief of anxiety symptoms.
While effective, benzodiazepines can produce physical dependence. This means you may experience withdrawal symptoms when you stop taking them, even if you have been taking them exactly as prescribed.12
You should not stop taking benzodiazepines without talking to your doctor first. Benzodiazepine withdrawal can be dangerous.
It is important to gradually reduce your dose under the supervision of your doctor to avoid potential withdrawal complications.