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Panic attacks and panic disorder - Diagnosis and treatment

Diagnosis

Your primary care provider will determine if you have panic attacks, panic disorder or another condition, such as heart or thyroid problems, with symptoms that resemble panic attacks.

To help pinpoint a diagnosis, you may have:

  • A complete physical exam
  • Blood tests to check your thyroid and other possible conditions and tests on your heart, such as an electrocardiogram (ECG or EKG)
  • A psychological evaluation to talk about your symptoms, fears or concerns, stressful situations, relationship problems, situations you may be avoiding, and family history

You may fill out a psychological self-assessment or questionnaire. You also may be asked about alcohol or other substance use.

Criteria for diagnosis of panic disorder

Not everyone who has panic attacks has panic disorder. For a diagnosis of panic disorder, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, lists these points:

  • You have frequent, unexpected panic attacks.
  • At least one of your attacks has been followed by one month or more of ongoing worry about having another attack; continued fear of the consequences of an attack, such as losing control, having a heart attack or "going crazy"; or significant changes in your behavior, such as avoiding situations that you think may trigger a panic attack.
  • Your panic attacks aren't caused by drugs or other substance use, a medical condition, or another mental health condition, such as social phobia or obsessive-compulsive disorder.

If you have panic attacks but not a diagnosed panic disorder, you can still benefit from treatment. If panic attacks aren't treated, they can get worse and develop into panic disorder or phobias.

More Information

  • Electrocardiogram (ECG or EKG)

Treatment

Treatment can help reduce the intensity and frequency of your panic attacks and improve your function in daily life. The main treatment options are psychotherapy and medications. One or both types of treatment may be recommended, depending on your preference, your history, the severity of your panic disorder and whether you have access to therapists who have special training in treating panic disorders.

Psychotherapy

Psychotherapy, also called talk therapy, is considered an effective first choice treatment for panic attacks and panic disorder. Psychotherapy can help you understand panic attacks and panic disorder and learn how to cope with them.

A form of psychotherapy called cognitive behavioral therapy can help you learn, through your own experience, that panic symptoms are not dangerous. Your therapist will help you gradually re-create the symptoms of a panic attack in a safe, repetitive manner. Once the physical sensations of panic no longer feel threatening, the attacks begin to resolve. Successful treatment can also help you overcome fears of situations that you've avoided because of panic attacks.

Seeing results from treatment can take time and effort. You may start to see panic attack symptoms reduce within several weeks, and often symptoms decrease significantly or go away within several months. You may schedule occasional maintenance visits to help ensure that your panic attacks remain under control or to treat recurrences.

Medications

Medications can help reduce symptoms associated with panic attacks as well as depression if that's an issue for you. Several types of medication have been shown to be effective in managing symptoms of panic attacks, including:

  • Selective serotonin reuptake inhibitors (SSRIs). Generally safe with a low risk of serious side effects, SSRI antidepressants are typically recommended as the first choice of medications to treat panic attacks. SSRIs approved by the Food and Drug Administration (FDA) for the treatment of panic disorder include fluoxetine (Prozac), paroxetine (Paxil, Pexeva) and sertraline (Zoloft).
  • Serotonin and norepinephrine reuptake inhibitors (SNRIs). These medications are another class of antidepressants. The SNRI venlafaxine (Effexor XR) is FDA approved for the treatment of panic disorder.
  • Benzodiazepines. These sedatives are central nervous system depressants. Benzodiazepines approved by the FDA for the treatment of panic disorder include alprazolam (Xanax) and clonazepam (Klonopin). Benzodiazepines are generally used only on a short-term basis because they can be habit-forming, causing mental or physical dependence. These medications are not a good choice if you've had problems with alcohol or drug use. They can also interact with other drugs, causing dangerous side effects.

If one medication doesn't work well for you, your doctor may recommend switching to another or combining certain medications to boost effectiveness. Keep in mind that it can take several weeks after first starting a medication to notice an improvement in symptoms.

All medications have a risk of side effects, and some may not be recommended in certain situations, such as pregnancy. Talk with your doctor about possible side effects and risks.

More Information

  • Cognitive behavioral therapy
  • Psychotherapy

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Lifestyle and home remedies

While panic attacks and panic disorder benefit from professional treatment, these self-care steps can help you manage symptoms:

  • Stick to your treatment plan. Facing your fears can be difficult, but treatment can help you feel like you're not a hostage in your own home.
  • Join a support group. Joining a group for people with panic attacks or anxiety disorders can connect you with others facing the same problems.
  • Avoid caffeine, alcohol, smoking and recreational drugs. All of these can trigger or worsen panic attacks.
  • Practice stress management and relaxation techniques. For example, yoga, deep breathing and progressive muscle relaxation — tensing one muscle at a time, and then completely releasing the tension until every muscle in the body is relaxed — also may be helpful.
  • Get physically active. Aerobic activity may have a calming effect on your mood.
  • Get sufficient sleep. Get enough sleep so that you don't feel drowsy during the day.

Alternative medicine

Some dietary supplements have been studied as a treatment for panic disorder, but more research is needed to understand the risks and benefits. Herbal products and dietary supplements aren't monitored by the Food and Drug Administration (FDA) the same way medications are. You can't always be certain of what you're getting and whether it's safe.

Before trying herbal remedies or dietary supplements, talk to your doctor. Some of these products can interfere with prescription medications or cause dangerous interactions.

Preparing for your appointment

If you've had signs or symptoms of a panic attack, make an appointment with your primary care provider. After an initial evaluation, he or she may refer you to a mental health professional for treatment.

What you can do

Before your appointment, make a list of:

  • Your symptoms, including when they first occurred and how often you've had them
  • Key personal information, including traumatic events in your past and any stressful major events that occurred before your first panic attack
  • Medical information, including other physical or mental health conditions that you have
  • Medications, vitamins, herbal products and other supplements, and the dosages
  • Questions to ask your doctor

Ask a trusted family member or friend to go with you to your appointment, if possible, to lend support and help you remember information.

Questions to ask your primary care provider at your first appointment

  • What do you believe is causing my symptoms?
  • Is it possible that an underlying medical problem is causing my symptoms?
  • Do I need any diagnostic tests?
  • Should I see a mental health professional?
  • Is there anything I can do now to help manage my symptoms?

Questions to ask if you're referred to a mental health professional

  • Do I have panic attacks or panic disorder?
  • What treatment approach do you recommend?
  • If you're recommending therapy, how often will I need it and for how long?
  • Would group therapy be helpful in my case?
  • If you're recommending medications, are there any possible side effects?
  • For how long will I need to take medication?
  • How will you monitor whether my treatment is working?
  • What can I do now to reduce the risk of my panic attacks recurring?
  • Are there any self-care steps I can take to help manage my condition?
  • Are there any brochures or other printed material that I can have?
  • What websites do you recommend?

Don't hesitate to ask any other questions.

What to expect from your doctor

Your primary care provider or mental health professional may ask:

  • What are your symptoms, and when did they first occur?
  • How often do your attacks occur, and how long do they last?
  • Does anything in particular seem to trigger an attack?
  • How often do you experience fear of another attack?
  • Do you avoid locations or experiences that seem to trigger an attack?
  • How do your symptoms affect your life, such as school, work and personal relationships?
  • Did you experience major stress or a traumatic event shortly before your first panic attack?
  • Have you ever experienced major trauma, such as physical or sexual abuse or military battle?
  • How would you describe your childhood, including your relationship with your parents?
  • Have you or any of your close relatives been diagnosed with a mental health problem, including panic attacks or panic disorder?
  • Have you been diagnosed with any medical conditions?
  • Do you use caffeine, alcohol or recreational drugs? How often?
  • Do you exercise or do other types of regular physical activity?

Your primary care provider or mental health professional will ask additional questions based on your responses, symptoms and needs. Preparing and anticipating questions will help you make the most of your appointment time.

By Mayo Clinic Staff

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What medications treat panic attacks, and which might suit me?

Panic attacks may be a symptom of panic disorder, which can severely affect a person’s quality of life. Medications and other treatments may help reduce the frequency and severity of panic attacks.

Panic attacks are sudden and intense feelings of fear or terror that occur without warning and can peak within minutes. People who experience them repeatedly may have panic disorder. Panic attacks are also known as anxiety attacks.

Doctors usually prescribe medication according to the severity of a person’s symptoms and the frequency of their panic attacks. People may also benefit from other treatments, such as therapy and relaxation techniques.

This article looks at the most common medications doctors prescribe for panic disorder. It also outlines other treatments, how to speak with a doctor, and the outlook for those with panic disorder.

Learn more about panic attacks and panic disorder here.

Taking medication is one way to mitigate the symptoms of anxiety.

Doctors most often prescribe antidepressants and benzodiazepines for people with panic disorder.

With all medications that affect serotonin levels, individuals should be aware of the risks of serotonin syndrome. This is a condition where an excess amount of serotonin, the chemical messenger in the brain, builds up in the body.

Symptoms of serotonin syndrome can include:

  • agitation
  • anxiety
  • disorientation
  • restlessness
  • sweating
  • tremors

Learn more about serotonin syndrome here.

Selective serotonin reuptake inhibitors (SSRIs)

SSRIs are the first-line medication for treating panic disorder. They increase synaptic serotonin, a neurotransmitter that has several different functions. However, there is some controversy among experts over the theory that anxiety and depression occur when serotonin levels are low. Recent research has cast doubt on exactly how SSRIs affect the brain.

Common SSRIs that doctors prescribe for panic attacks include:

  • citalopram (Celexa)
  • escitalopram (Lexapro)
  • fluoxetine (Prozac)
  • paroxetine (Paxil)
  • sertraline (Zoloft)

The possible side effects of medications feature on the drug’s label. A person can also discuss side effects with a doctor before taking a medication. Common side effects of SSRIs include:

  • agitation
  • nausea and vomiting
  • indigestion
  • diarrhea
  • constipation
  • loss of appetite and weight loss
  • headaches
  • blurred vision
  • excessive sweating
  • sexual dysfunction
  • dizziness
  • sleeping problems

Serotonin-norepinephrine reuptake inhibitors (SNRIs)

SNRIs are a class of antidepressants that work by increasing levels of synaptic serotonin and norepinephrine in the body. Doctors prescribe them to treat depression, anxiety, and other mood problems.

Doctors commonly prescribe the following SNRIs to treat panic disorder:

  • venlafaxine (Effexor)
  • desvenlafaxine (Pristiq)
  • duloxetine (Cymbalta)

At low doses, SNRIs can cause the following side effects:

  • nausea
  • diarrhea
  • fatigue
  • drowsiness

At higher doses, SNRIs can cause the following side effects:

  • mildly increased blood pressure
  • excessive sweating
  • fast heart rate
  • tremors
  • anxiety

Learn about the difference between SSRIs and SNRIs here.

Tricyclic antidepressants

Tricyclic antidepressants (TCAs) are a type of antidepressant that doctors prescribe to treat major depressive disorder and anxiety disorders.

TCAs work by blocking the reuptake of serotonin, norepinephrine, and dopamine in the brain. This helps increase levels of these neurotransmitters to help improve mood, relieve anxiety, and decrease feelings of fatigue.

Examples of TCAs include:

  • amitriptyline
  • clomipramine (Anafranil)
  • desipramine (Norpramin)
  • doxepin (Silenor)
  • imipramine (Tofranil)
  • nortriptyline (Aventyl)

TCAs may cause more side effects than SSRIs and SNRIs, so doctors usually prescribe other drugs before trying them. Side effects of TCAs include:

  • constipation
  • dizziness
  • dry mouth
  • blurred vision
  • confusion
  • urinary retention
  • fast heart rate

Learn more about TCAs here.

Monoamine oxidase inhibitors (MAOIs)

MAOIs are a class of antidepressants that work by increasing the levels of serotonin and norepinephrine in the brain. Doctors prescribe these drugs to treat panic attacks, mood swings, and depression.

Examples of MAOIs include:

  • isocarboxazid (Marplan)
  • phenelzine (Nardil)
  • tranylcypromine (Parnate)

MAOIs are not the first choice for treating panic disorder, as they can cause interactions with other drugs and certain foods. They also cause side effects, including:

  • dry mouth
  • nausea
  • diarrhea
  • constipation
  • drowsiness
  • insomnia
  • dizziness

Learn more about MAOIs here.

Benzodiazepines

Doctors may also prescribe benzodiazepines to help people with anxiety disorders. These drugs reduce electrical activity in the brain and the intensity of anxiety symptoms.

Examples include:

  • alprazolam (Xanax)
  • clonazepam (Klonopin)
  • diazepam (Valium)
  • lorazepam (Ativan)

Benzodiazepine drugs are effective in the short term, but a person should not take them over long periods, as this may lead to addiction and withdrawal symptoms.

The most common side effects of benzodiazepines include:

  • breathing difficulties
  • severe drowsiness
  • slowed heart rate
  • low blood pressure
  • fainting

Learn more about benzodiazepines here.

Beta-blockers

Beta-blockers do not have approval from the Food and Drug Administration to treat anxiety disorders. However, doctors sometimes prescribe them off-label to control physical symptoms of panic disorder, such as shaking or a rapid heartbeat. Propranolol (Inderal) is one example of a beta-blocker.

Beta-blockers may cause side effects such as:

  • slow heart rate
  • high blood pressure
  • fatigue
  • dizziness
  • nausea
  • constipation
  • sexual dysfunction

These side effects are usually mild, but they may become more severe if people do not take the medication properly or if the dosage is too high.

Learn more about beta blockers here.

There are no specific tests doctors use to diagnose panic disorder. Therefore, doctors use criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR) to guide their diagnosis. They will diagnose panic disorder under the following circumstances:

  • panic attacks repeatedly occur, followed by 1 month or more of persistent concern about having another attack
  • a person changes their behavior to avoid situations they consider triggering, such as work or school
  • panic attacks do not happen solely as a result of substance use, medications, or other medical conditions
  • other diagnoses cannot better explain the symptoms
  • panic attacks are not always the result of a recognizable trigger
  • a person experiences anxiety both physically and mentally

Healthcare professionals must rule out other conditions before diagnosing panic disorder. Once they diagnose it, they may use rating scales to assess how severe the panic attacks are, which can inform the treatment they recommend.

Besides medication, there are other treatments for panic attacks. They include:

  • cognitive behavioral therapy
  • relaxation techniques, such as deep breathing, meditation, and yoga
  • dialectical behavioral therapy
  • exposure therapy
  • group therapy
  • hypnosis
  • staying physically active
  • eating a nutritious and balanced diet
  • taking herbal supplements

Learn how to treat anxiety naturally here.

Talking with a doctor about panic attacks can be difficult. Preparing questions before a doctor’s appointment may help a person get the most benefit.

An individual can ask about different types of treatment and whether another diagnosis could account for their symptoms. They may want to discuss practical measures they can take to reduce their symptoms.

It may also help to have a friend or family member at doctor’s appointments to hear the discussion.

If medications cause persistent adverse side effects, a person should discuss these with a doctor. The doctor may be able to adjust the medication or dose.

Many people with panic disorder also have other mental health conditions that complicate their recovery. Even after symptom-free periods, most individuals experience further panic attacks. Not sticking to medication or therapy regimens contributes to poorer outcomes.

According to a 2022 article, around 60% of people with panic disorder achieve remission of symptoms within 6 months.

Those with panic disorder are at higher risk of suicidal thoughts and decreased quality of life than people without the condition.

Suicide prevention

If you know someone at immediate risk of self-harm, suicide, or hurting another person:

  • Ask the tough question: “Are you considering suicide?”
  • Listen to the person without judgment.
  • Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
  • Stay with the person until professional help arrives.
  • Try to remove any weapons, medications, or other potentially harmful objects.

If you or someone you know is having thoughts of suicide, a prevention hotline can help. The 988 Suicide and Crisis Lifeline is available 24 hours a day at 988. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 988.

Click here for more links and local resources.

Panic attacks are the main symptom of panic disorder. They can happen suddenly without an obvious trigger and reach a peak within minutes.

Medications can help alleviate the symptoms of panic attacks and reduce the risk of a future attack. Examples include antidepressants, benzodiazepines, and beta blockers.

All medications can cause side effects, and a person must discuss these with a doctor before taking a drug.

Alternative treatments are available to treat panic disorder, such as therapy, relaxation techniques, and healthy lifestyle choices.

symptoms, causes of PA, does medication help panic disorder

Panic attack - is it a disease?

To answer these questions, we first need to clarify what panic attacks are and whether the word "cure" applies to them at all.

A panic attack is an attack of sudden anxiety, intense fear, accompanied by vivid physical symptoms characteristic of fright (rapid heartbeat, perspiration, chills, numbness of the limbs - the combination of them can be different). This state is accompanied by a feeling of loss of a sense of the reality of what is happening, the fear of death or insanity. nine0005

Read more about panic attacks here.

The physical well-being of a person experiencing a panic attack can be seriously frightening. And most likely, his first thought about his condition is that he has serious health problems. The symptoms are really similar to what a person feels during a heart attack, stroke, or other serious conditions.

However, there are many reasons that can cause this condition. The first is, in fact, there may be problems with the heart. The second is a sympathoadrenal crisis (this is what a panic attack looks like from a medical point of view) can be caused by some pathologies of the thyroid gland. Thirdly, it can be a consequence of the use of certain drugs or psychoactive substances. nine0005

And finally, this is the result of a long internal tension, life under pressure. Or the consequences of mental trauma or violence.

That is, the state looks the same, but there is a whole list of reasons that lead to it. A panic attack is not a disease, but a symptom caused by individual causes. Each case has its own story.

The first thing to know is that a person who has experienced such an attack needs to consult a good doctor. It will help to establish whether a panic attack has taken place or whether the patient's physical health is really at risk. nine0005

Unfortunately, there are still difficulties in diagnosing panic attacks in healthcare in general - it can take quite a long time until an assumption arises about the psycho-emotional nature of the attacks, and the patient is finally referred to mental health specialists (psychiatrist, psychologist or psychotherapist ).

Perhaps a medical examination will show that there are no abnormalities. Or find violations that every second has, but they do not cause panic attacks. But the idea that there is a problem, they just haven’t found it, has already settled in a person. Anxiety clung tightly to his psyche, so to speak. And panic attacks can become a habitual companion of his life, gradually changing its quality so that ordinary activities become inaccessible. nine0005

Therefore, as a recommendation, we will offer the following options: first, having experienced a state similar to the one we described earlier, independently apply not only to a therapist, but also to a psychiatrist; the second is to immediately seek help in clinics where doctors, psychiatrists and psychotherapists work together. This is the approach adopted in the MIPZ clinic.

If the patient really has panic attacks, his psyche requires attention - you need to figure out why the tension has arisen that causes attacks, in what environment he is on a daily basis, what tasks he solves. An additional focus is on what he does with his anxiety, how he acts in a situation of stress. nine0005

Pharmacotherapy (the same pills) on this path acts as an auxiliary tool - it helps at first to cope with severe anxiety and heavy thoughts, removes the intensity of symptoms. The leading role in getting rid of recurring panic attacks is still assigned to psychotherapy, aimed at correcting the emotional life and behavior of the patient.

Antidepressants (particularly serotonin reuptake inhibitors) and benzodiazepines are prescribed for patients with panic attacks. In each group, on average, there are about a dozen options for names - at the discretion of the psychiatrist. He will select a specific drug and the required dosage. nine0005

Self-medication with these groups of drugs is strictly prohibited. Medicines act differently on different patients, the doctor will need all the information about the patient's health status, about what other drugs he is taking, since not all of them are compatible with each other. Observing the dynamics of the patient's condition, it is possible that the doctor will change the dosage or even change the drug to another, in his opinion, more effective.

It must be remembered that it will take time for a noticeable effect to appear - it is worth being patient, not giving up treatment, even if it seems that things are moving very slowly or not moving at all. nine0005

Some anti-panic medications are addictive and should be used in limited time, your doctor will tell you how long it may take. After completing the pills, the patient will need to independently improve their emotional balance, using the skills gained during psychotherapeutic sessions.

Why pills don't work

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"Medicines for panic attacks" - articles on the website Vapteke.ru

Panic attack is one of the types of neurotic disorders, which is manifested by a feeling of anxiety, an overwhelming feeling of fear, palpitations and can be repeated periodically. The disease manifests itself not only in people with pathologies of the central nervous system, but also in patients with disruption of other systems and organs. How can panic attacks be prevented, is medication effective in this case? nine0005

Types of drugs for the treatment of seizures

If a person is prone to panic attacks, a specialist can prescribe a whole range of drugs:

  1. Antidepressants stabilize the emotional state, improve sleep, relieve irritability, relieve feelings of anxiety.

  2. Antipsychotics are drugs that affect the activity of the central nervous system.

  3. Nootropic drugs normalize brain function. nine0005

  4. Sedative drugs relieve the feeling of fatigue, normalize sleep, and help normalize the emotional state.

  5. Tranquilizers normalize the heart rate, relieve tension. It is necessary to take such drugs only if an attack is approaching. Tranquilizers can be addictive, as well as slowing down the reaction and impaired concentration.

Popular Medicines for Panic Attacks

The most popular and proven medicines for panic attacks and other neurological disorders:

  1. Anaprilin is a broad-spectrum beta-blocker. The drug makes it possible to prevent an attack, as well as to cope with a panic attack that has already begun. This is an effective tool for the prevention of migraines, which has a pronounced antiarrhythmic effect.

  2. Adaptol is a tranquilizer that helps to cope with a feeling of inexplicable fear and anxiety. The drug enhances the effect of sleeping pills. nine0005

  3. Ataracas is a drug that helps to relax the smooth muscles of the body. This allows a person to relax and get rid of the feeling of tightness. The drug is rapidly absorbed, does not depress the central nervous system, does not impair memory.

  4. Afobazole is a medicine for panic attacks that relieves tension, irritability, does not depress the central nervous system. The drug is not addictive, and also does not adversely affect muscle tone and memory.

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  5. Gidazepam is a tranquilizer drug that helps to cope with neurotic asthenia, causeless anxiety and fear.

  6. Grandaxin stimulates the activation of the body's defenses to combat stress.

  7. Diazepam (Valium, Seduxen, Relanium) is injected into the body and has a pronounced sedative effect.

  8. Tenoten is a homeopathic remedy that normalizes the psycho-emotional background, relieves anxiety, improves memory and concentration. nine0005

  9. Midazolam (Dormicum) - helps fight panic attacks, has a mild hypnotic effect. It is administered intramuscularly.

  10. Phenazepam is a tranquilizer that has an anticonvulsant and muscle relaxant effect. Helps to effectively cope with feelings of anxiety and fear, has a calming effect on the central nervous system. Phenazepam also acts as a sleeping pill.

  11. Phenibut is a nootropic drug that stimulates mental activity and has a beneficial effect on memory. The drug improves blood circulation in the brain and normalizes metabolic processes. nine0005

Sedatives

Sedatives are indispensable medicines for panic attacks. They help to normalize sleep, relieve the feeling of fatigue, weakness, make it possible to put the work of the central nervous system in order. The most effective sedatives used in the complex treatment of panic attacks:

  1. Valerian extract in drops or tablet form.

  2. Motherwort drops are an effective natural sedative. nine0005

  3. Valocordin is a first aid remedy for a panic attack that has already begun.

  4. Eleutherococcus tincture is a natural drug with a pronounced sedative effect.

  5. Novo-Passit.

New generation antidepressants

New generation antidepressants are prescribed for patients with heart and respiratory pathologies, they rarely cause serious side effects:

  • Paroxetine (Paxil) stimulates the central nervous system, normalizes the emotional background.

  • Sertraline (Zoloft) has a positive effect on the emotional state.

  • Fluvoxamine (Fevarin) improves mood, helps fight panic attacks.

  • Fluoxetine (Prozac) reduces tension and anxiety.

  • Citalopram (Cipramil) relieves stress, helps fight fear. nine0005

Nootropics

Among the effective nootropic drugs for panic attacks, the following can be distinguished:

  • Glycine normalizes sleep, improves mood, helps to cope with vegetative-vascular disorders. The composition of the drug includes aminoacetic acid, which has an anti-anxiety and pronounced sedative effect.