Based on numerous research studies, the National Institute of Mental Health (NIMH) has long recommended medication, therapy, or a combination for the treatment of anxiety disorders, including panic disorder.
Medications
Doctors generally begin treatment for panic disorder with antidepressants, antianxiety medications, or a combination.Antidepressants: Antidepressants may be prescribed because there is coexisting depression, but that's not always the case. Although these medications were developed initially for depression, further research has shown that many help with anxiety disorders as well because of the roles the neurotransmitters play in anxiety disorders. Usually, selective serotonin reuptake inhibitors (SSRIs) and other newer antidepressants are tried first, but older antidepressants -- tricyclics and monoamine oxidase inhibitors (MAOIs) -- also may be used with success.
Antianxiety Medications: Antianxiety medications include the benzodiazepines and Buspar (buspirone). Antianxiety medications may be prescribed on their own or along with other medications, such as antidepressants. Some doctors will prescribe a benzodiazepine temporarily with an antidepressant because the benzodiazepine will decrease the anxiety and panic symptoms rapidly while the antidepressant may take several weeks to take effect. Additionally, the benzodiazepine may help with any increased anxiety that may be a side effect of the antidepressant. Other doctors will prescribe these medications for longer periods.
Other Medications: Researchers and doctors have found a few other categories to help in the treatment of panic disorder. These medications may not have been specifically approved by the Food and Drug Administration (FDA) for the treatment of panic disorder, but doctors may prescribe them "off label." Other medications prescribed to treat panic disorder include beta blockers, anticonvulsants, atypical antipsychotics, and antihistimines.
Therapy
The therapy most recommended, such as by the NIMH, in the treatment of panic disorder is cognitive-behavioral therapy or CBT, a form of psychotherapy. A couple of recent studies have shown CBT alone to be as effective in treating panic disorder as a combination of CBT and medication (see Mitte and Furukawa studies in sources below).Other therapies or a combination of therapies also may be tried. These include: psychotherapy; exposure therapy (a form of behavior therapy); virtual reality exposure therapy (VRET); eye movement desensitization and reprocessing therapy (EMDR); rational emotive behavior therapy (REBT); and psychoanalytic therapy.
Self-Help Methods
For various reasons, many people choose to use self-help methods when overcoming panic disorder. Panic disorder should be diagnosed by a health or mental health professional initially to rule out possible physical causes as well as other possible psychiatric conditions, such as depression. Many self-help methods are similar to those that would be learned in a CBT setting, and it may be more effective to learn these methods with a trained CBT therapist who will make sure the methods are practiced properly and may also provide much-needed motivation. A good self-help book, such as Edmund J. Bourne's The Anxiety & Phobia Workbook, may provide effective and thorough instructions for self-help methods, but, again, motivation often is an issue if practicing these exercises on one's own. Self-help methods include relaxation and breathing exercises; cognitive exercises (such as anger management, assertiveness, positive thinking, and more); and lifestyle changes (exercise and nutrition changes).Alternative Medicine & Holistic Healing
Some people choose to use alternative medicine and/or holistic healing when overcoming panic disorder. Again, there should be professional diagnosis of panic disorder before using any methods. Additionally, your doctor and/or therapist should be aware of any methods you are trying on your own, particularly if these methods include herbs, vitamins, and supplements. Ideally, alternative medicine should be practiced with the help of a practitioner trained in these methods. Alternative medicine and holistic healing practices that may help with panic disorder include: acupuncture; aromatherapy; flower essence therapy; hypnosis and hynotherapy; and herbs, vitamins, and supplements. These methods are not FDA-approved and are not well-validated treatments for panic disorder.Sources:
Furukawa, Toshi A, and Natawabe, Norio. "Psychotherapy Plus Antidepressant for Panic Disorder With or Without Agoraphobia." The British Journal of Psychiatry 2006 188:305-312.
Mitte, Kristin. "A Meta-Analysis of the Efficacy of Psycho- and Pharmacotherapy in Panic Disorder With and Without Agoraphobia." Journal of Affective Disorders 2005 88:27-45.
