Panic Disorders

Prevention

There is no way to prevent panic disorder. However, if you have been diagnosed with panic disorder, you may be able to prevent panic attacks by cutting down on caffeine, alcohol or other substances that might be triggering your symptoms. Your doctor can help you figure this out. Once a diagnosis is made, treatment often eliminates panic attacks or makes them less intense.

Treatment

If you have panic attacks, there are several treatment options. Your doctor may try one or more of the following:

• Benzodiazepines - These medications include clonazepam (Klonopin), lorazepam (Ativan), diazepam (Valium) and alprazolam (Xanax). They are very safe, and often bring quick relief from the intense fear and anxiety that accompany panic attacks. They may be used particularly during the first weeks of treatment while you are waiting for other medications, such as antidepressants, to start working. In some people, the medication may become less effective because the body becomes accustomed to it. This is called tolerance. There is some risk of dependency and addiction with these drugs, but concerns about this are probably over-emphasized. If you have panic disorder, the advantages of relief often outweigh the risk of addiction. If you need to stop taking these drugs, it needs to be done gradually under a doctor's direction, because withdrawal reactions can occur.

• Antidepressants - These are the main treatment for panic attacks, especially when panic attacks keep occurring or when the person also has depression. The antidepressants most used to treat panic attacks are the popular selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil) and citalopram (Celexa). Tricyclic antidepressants, such as nortriptyline (Aventyl, Pamelor) and imipramine (Tofranil), are a good choice as is the newer antidepressant, venlafaxine (Effexor). Another class of antidepressants, called monoamine oxidase inhibitors, are a bit more difficult to take, because they require you to be on a special diet -- but they have been effective when other medications have not. All antidepressants take several weeks to start working so a benzodiazepine often is prescribed to give relief during that time.

• Cognitive therapy - This nondrug therapy involves teaching the patient that a panic attack will stop and is not life threatening, and to learn the triggers of attacks and how to manage them.

• Behavior therapies - These treatments include in vivo exposure, a form of behavior therapy that gradually exposes the patient to fear-provoking situations; respiratory training, a technique that focuses on breath control as a way of fighting panic; and applied relaxation, a method that teaches the patient to control his or her anxiety level by using muscle control and imagination.

For many patients, the most effective approach is a combination of one or more medications, plus some form of cognitive or behavior therapy.