Panic Attacks Medication

Medications for Panic Disorder

Medications are often used to help reduce the severity and frequency of panic attacks, to help control the symptoms, and to reduce the fear of having another attack, which in itself can actually trigger one. The goal is to eventually remove all panic attack symptoms so that you can resume a normal life.

Although the use of psychotherapy alone should be the first line treatment for panic disorder, there are occasions when medication is prescribed along with therapy. This can be the case if your panic disorder is especially severe, you also have depression or other mental health issues, or, therapy on its own has not been effective enough.

There are several types of medications that have been shown to be effective in managing and controlling panic attack symptoms…

1. Selective Serotonin Reuptake Inhibitors (SSRIs)

SSRIs are antidepressants and normally the first choice medication for panic disorder because they are generally considered safe with a relatively low risk of serious side effects. They work by increasing the levels of serotonin in the brain. Serotonin is a chemical in your body that promotes a feeling of well-being and happiness. So SSRIs work by changing your ‘mood.’

Typical medicines in this class of drug are:

  • sertraline (Zoloft)
  • paroxetine (Paxil, Paxil CR, Pexeva)
  • fluoxetine (Prozac, Prozac Weekly)
  • fluvoxamine (Luvox)
  • citalopram (Cilexa, Cipramil)

And typical side effects are:

  • dry mouth
  • diarrhea
  • headache
  • drowsiness
  • insomnia
  • nausea
  • rash
  • erectile dysfunction
  • reduced sexual desire
  • weight gain
  • increased sweating
  • nervousness
  • restlessness
  • agitation

2. Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs)

SNRIs are another class of antidepressant used to improve your mood. Medicines in this group are sometimes also known as dual reuptake inhibitors because SNRIs increase the levels of two neurotransmitters in the brain, serotonin and norepinephrine, whereas SSRIs only work on one, serotonin.

SNRIs have been developed more recently than SSRIs so there are fewer of them. Typical of these are:

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

Typical side effects are:

  • dry mouth
  • headache
  • increased sweating
  • insomnia
  • drowsiness
  • fatigue
  • nausea
  • diarrhea
  • weight loss
  • loss of appetite
  • dizziness
  • erectile dysfunction
  • reduced sexual desire
  • restlessness

3. Tricyclic Antidepressants (TCAs)

These work in much the same way as SNRIs for a positive effect on your feelings and mood and were once widely used in the treatment for panic disorder. Although they are equally as effective as the preceding antidepressants, they have largely been overtaken by SSRIs and SNRIs which have fewer and less intense side effects. However, they may still be prescribed where the aforementioned drugs have proved ineffective or where those drugs are not suitable for the particular patient.

Typical medicines are:

  • imipramine (Tofranil, Janimine, Praminil)
  • clomipramine (Anafranil)
  • amitriptyline (Elavil)
  • nortriptyline( Aventyl, Pamelor)
  • doxepin (Sinequan, Adapin)

Typical side effects:

  • dry mouth
  • dizziness
  • constipation
  • drowsiness
  • difficulty urinating
  • headache
  • fatigue
  • low blood pressure
  • lightheadedness
  • blurred vision
  • low sex drive
  • weight gain
  • increased heart rate
  • sensitivity to sunlight

4. Benzodiazepines

These are mild sedatives belonging to the group of medicines called Central Nervous System Depressants (CNSDs). Their advantage is that they generally work faster than antidepressants. For example you are likely to be given a Benzodiazepine — often held under the tongue — were you to attend a hospital emergency room suffering from the symptoms of a panic attack, in order to shorten the length and severity of the attack. They can work to ease the symptoms within 30 to 90 minutes.

However, there is an ongoing debate about the long-term use of Benzodiazepine for panic disorders because of potential mental and physical dependency and withdrawal issues. This, coupled with the knowledge that they work no better than the previous three medications over the longer term, means that they are generally used for short-term symptom relief where such relief is indicated.

Typical medicines in this class for panic are;

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

Typical side effects here are:

  • loss of balance
  • memory loss
  • drowsiness
  • lightheadedness
  • confusion
  • upset stomach
  • headache
  • blurred vision
  • nightmares
  • fatigue
  • muscle weakness
  • slurred speech
  • loss of appetite

5. Monoamine Oxidase Inhibitors (MAOIs)

MAOIs were the first of the antidepressants to be developed. And although they are effective, they too have been overtaken by relatively safer antidepressants with fewer side effects, e.g. SSRIs and SNRIs.

One key issue with MAOIs is that they can cause dangerously high blood pressure when ingested with certain foods, so that they have to be taken with very strict dietary restrictions. Because of this and other risk factors — such as their severe reactions when taken with some other types of medicines — they are not generally prescribed nowadays.

That being said, they may be prescribed in particular cases where the other antidepressants have proven not to be effective.

Typical medicines are:

  • isocarboxazid (Marplan)
  • phenelzine (Nardil)
  • selegiline (Emsam, Eldepryl, Zelapar)
  • tranylcypromine (Parnate)

Typical side effects are:

  • insomnia
  • diarrhea
  • nervousness
  • low blood pressure
  • weight gain
  • difficulty with urination
  • dizziness
  • lightheadedness
  • aching muscles
  • erectile dysfunction
  • reduced sexual desire
  • insomnia
  • sleepiness
  • altered sense of taste
  • dry mouth

Important Points to Consider About Medication for Panic Attacks

1. Bear in mind is that drugs approved in one country may not be approved in others, and that includes the ones outlined above. So that you should always work closely with your doctor who will prescribe the most appropriate, approved medication for your particular case and country.

2. Never buy drugs over the Internet because you cannot know their source or efficacy. Only take drugs that have been prescribed by your doctor and that you get from an approved pharmacy.

3. Never stop taking your medication unless your doctor has advised you to do so. This is especially true of drugs for panic disorder because of potential withdrawal and dependency issues. Normally, your doctor will gradually decrease your medication and taper off your regimen.

4. If you are pregnant or plan to become pregnant you must tell your doctor before they prescribe any medication. They will carry out a risk / benefit analysis and advise you of the best course of action.

5. All drugs have side effects, some more or less than others. And some people suffer more or less from them than others. So work very closely with your doctor and do not be afraid to ask them about the possible side effects and risks of the drug options available to you.

6. Remember that it can take some weeks from first taking your medication to notice any improvement. Indeed, if there is little or no improvement after, say, 8 weeks then your doctor may prescribe a larger dosage or even a change to a different drug.

7. Unless known beforehand in your particular case, your doctor has no way of knowing how you will react to drugs prescribed for the first time. You may or may not have a reaction to them. If you develop any side effects such as those listed above — which are not complete by any means — or any other symptoms, or even if you feel that something just is not right, then talk to your doctor immediately.

References

3 thoughts on “Panic Attacks Medication

  1. Jake

    Don’t know where you’re getting your info, however a good topic, well written. Thanks for the wonderful information.

     

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