Treating panic disorder

Panic disorder may require more long-term drug therapy than other anxiety disorders, such as GAD. Treatment of panic disorder often involves both psychotherapy and pharmacologic measures. Referral to a therapist experienced in treating panic disorder is often necessary. Growing evidence supports the effectiveness of cognitive behavioral psychotherapy that involves graded exposure to situations that induce symptoms of anxiety.

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The mainstay of drug treatment had been the tricyclic antidepressants or MAO inhibitors; both are 80 percent to 90 percent effective in blocking panic attacks but require six to 12 weeks to take effect. High doses of alprazolam (Xanax), one of the newer benzodiazepines, can be effective within a few days and cause fewer side effects than the antidepressants. A relapse of symptoms occurs in 30 percent to 60 percent of patients six to 12 months after drugs are discontinued. In addition to these drugs, the SSRIs fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft) have been approved by the FDA for the treatment of panic disorder. The tricyclics desipramine (Norpramin), imipramine (Tofranil), and nortriptyline (Aventyl, Pamelor) are also used, although they do not have FDA approval for this use. Beta blockers, such as propranolol (Inderal) or atenolol (Tenormin), can halt the physical symptoms of panic attacks but do not prevent the fear or panic itself.