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Panic Disorder: Should I Take Medicine?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Panic Disorder: Should I Take Medicine?

Get the facts

Your options

  • Take medicines for panic disorder.
  • Don't take medicines. Try home treatment and counseling to deal with your symptoms.

Key points to remember

  • Two types of medicines work well for treating panic attacks. Benzodiazepines can help you feel better right away. You can take antidepressants for long-term treatment.
  • Counseling may work just as well as medicines.
  • If you take medicines, follow your doctor's directions with care. You may have side effects such as headaches or trouble sleeping. Some medicines can treat both depression and panic attacks.
  • For some people, taking medicines along with getting counseling works best.
  • Don't feel bad about taking medicines. Panic disorder is a medical problem, not a weakness. The medicines won't change your personality.
FAQs

What is panic disorder?

When you have panic disorder, you have repeated, unexpected panic attacks. And you worry all the time about having another attack.

A panic attack is a sudden feeling of very bad anxiety. It may make you feel short of breath or dizzy or make your heart pound. An attack may last from 5 to 20 minutes or up to a few hours. You feel most anxious about 10 minutes into the attack.

What are the risks of panic disorder?

Panic disorder can lower your quality of life. It can get in the way of your daily life and work. If you have panic disorder, you are more likely to have other problems, including:

What types of medicines are used for panic disorder?

The two types of medicines used most often are antidepressants and benzodiazepines. Some people use both.

  • Antidepressants. These include:
    • Selective serotonin reuptake inhibitors (SSRIs), such as citalopram, paroxetine, or sertraline. These are the most common medicines for panic disorder.
    • Tricyclic antidepressants (TCAs), such as clomipramine or imipramine.
    • Monoamine oxidase inhibitors (MAOIs), such as isocarboxazid or phenelzine.
    • Antidepressants with mixed neurotransmitter effects, such as venlafaxine.
  • Benzodiazepines, such as alprazolam or clonazepam. They are sometimes used for panic disorder. They may be used alone or with an antidepressant.
    • These drugs can help you feel better right away. They may also be used as a part of long-term treatment, either alone or with an antidepressant.
    • They may be especially helpful if you have agoraphobia.
    • They can be taken as needed. But they can cause addiction (dependence). Symptoms often come back when you stop taking them.

What can you expect if you take medicines for panic disorder?

Antidepressants should help you start to feel better within 1 to 3 weeks. But it can take as many as 6 to 8 weeks to see more improvement.

Talk with your doctor if:

  • You don't notice any improvement by 3 weeks.
  • You have concerns or questions about your medicines.

The medicines may cause side effects, but these are usually mild. They may get better after a few weeks.

Benzodiazepines help relieve symptoms right away.

You may have to try more than one medicine to find one that works. Your doctor may have you switch to another medicine if the first one doesn't help.

What can you expect if you DO NOT take medicines for panic disorder?

Some people use counseling, such as cognitive-behavioral therapy, to treat panic disorder. It can help you to:

  • Deal with problems you are having right now.
  • Learn how to deal with future anxiety and panic attacks.

Other treatments include support groups and exercises that help you relax, such as progressive muscle relaxation or meditation.

Why might your doctor recommend taking medicines?

Your doctor might advise you to take medicines if:

  • You have not been able to control your symptoms with other treatment, such as counseling with cognitive-behavioral therapy.
  • You have other problems linked to panic disorder that could benefit from medicine, such as depression or problems with drugs or alcohol.

Compare your options

Compare

What is usually involved?









What are the benefits?









What are the risks and side effects?









Take medicines for panic disorder Take medicines for panic disorder
  • For antidepressants, you take pills or liquids every day or on certain days of the month, for months or years.
  • For benzodiazepines, you take pills or liquids as needed.
  • You may also try counseling along with taking medicine.
  • Medicines for panic disorder work well.
  • Medicine may cause side effects such as:
    • Nausea.
    • Headaches.
    • Nervousness.
    • Tiredness.
    • Trouble sleeping.
  • Benzodiazepines can lead to addiction. (Antidepressants do NOT lead to addiction.)
Don't take medicines Don't take medicines
  • You try counseling, such as cognitive-behavior therapy, to control your symptoms.
  • Counseling works as well as medicine for many people who have panic disorder.
  • You don't have side effects from taking medicine.
  • Your panic disorder may get worse if you have no treatment.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Personal stories about people deciding whether to take medicine to treat panic disorder

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

I was having lunch with some friends and suddenly began to feel strange—like I couldn't breathe and my heart was pounding. I didn't know what was happening; I thought I was having a heart attack. Although the symptoms began to go away after about 10 minutes, I went to the emergency room, where they did some tests and didn't find anything wrong. A week later, the same thing happened in the middle of the night. I went to see my doctor, and she suggested I may have had a panic attack. Since then, the attacks have been occurring at least once a week, and I have been diagnosed with panic disorder. Although each attack is still a horrible experience, I now know what is happening and that I will get through it. I have been going to therapy for several weeks and am learning how to deal with the symptoms of panic attacks. They are less frequent now and less intense. I think I can get through this without taking any medicine.

Annie, age 32

As an executive, I have to travel a lot for my job. A few months ago, I was boarding a plane for a business trip, and I began to feel very apprehensive. I felt trapped and got off the plane because I was shaking and sweating and my heart was pounding. I wasn't sure exactly what was wrong, but I felt like I was dying. I had a drink at the bar and was still shaky but took a later flight. After that I began to feel nervous if I even thought about flying, and I had several more similar attacks. Then I had an attack on the subway. I felt like everyone was watching me and there was no escape. I didn't even want to go to the office after that because I was afraid I could have an attack at any moment. My doctor says I have panic disorder and agoraphobia. I can hardly function, so I am going to take antidepressants and try exposure therapy. My doctor says a benzodiazepine would make the symptoms go away sooner. But I am worried they will make me too drowsy and they may be too hard for me to quit.

Manuel, age 43

When I divorced my wife, Celia, I began to feel down and very anxious. As a contractor, I have to deal with people every day, and it seemed very hard to do my job when I felt so stressed out and depressed. I had my first panic attack when my dog got lost at a job. I knew he was probably fine and would soon come back, but with the stress of everything else it just seemed like more than I could handle. I felt awful; I was choking and had bad stomach cramps. Since then, I have had attacks like this nearly every day and a lot of the time I feel down in the dumps. I have been diagnosed with panic disorder and depression. I am going to therapy, and it seems to help a little, but I still have panic attacks and often feel like life is not worth living, and I feel anxious about interacting with people at all. At first I didn't want to take any medicine. But after reading about it and talking it over with my doctor, I decided to start taking an antidepressant.

Louis, age 28

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to take medicines for panic disorder

Reasons not to take medicines for panic disorder

I am willing to take medicine for at least several months, or longer if I need to.

I don't want to take medicines if at all possible.

More important
Equally important
More important

My panic disorder is not improving enough with counseling alone.

I want to continue counseling, without medicine, at least for a while.

More important
Equally important
More important

I think my symptoms may be worse than the possible side effects of the medicine.

I think the side effects of the medicine would be worse than my symptoms.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Taking medicines

NOT taking medicines

Leaning toward
Undecided
Leaning toward

What else do you need to make your decision?

Check the facts

1.

Taking medicine is the only way I can treat my panic disorder.

  • TrueSorry, that's not right. Counseling works just as well for many people.
  • FalseYou're right. Counseling works just as well for many people.
  • I'm not sureIt may help to go back and read "Get the Facts." Counseling may work just as well as medicines.
2.

There are two different kinds of medicines that I can take to help my panic disorder.

  • TrueThat's right. Benzodiazepines are taken as needed to help relieve your symptoms. Antidepressants are taken every day for long-term treatment.
  • FalseSorry, that's not right. Benzodiazepines are taken as needed to help relieve your symptoms. Antidepressants are taken every day for long-term treatment.
  • I'm not sureIt may help to go back and read "Get the Facts." Benzodiazepines are taken as needed to help relieve your symptoms. Antidepressants are taken every day for long-term treatment.

Decide what's next

1.

Do you understand the options available to you?

2.

Are you clear about which benefits and side effects matter most to you?

3.

Do you have enough support and advice from others to make a choice?

Certainty

1.

How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure
3.

Use the following space to list questions, concerns, and next steps.

Your Summary

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Your decision 

Next steps

Which way you're leaning

How sure you are

Your comments

Your knowledge of the facts 

Key concepts that you understood

Key concepts that may need review

Getting ready to act 

Patient choices

Credits

Credits
Author Healthwise Staff
Primary Medical Reviewer Anne C. Poinier, MD - Internal Medicine
Specialist Medical Reviewer Lisa S. Weinstock, MD - Psychiatry
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Panic Disorder: Should I Take Medicine?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
  1. Get the facts
  2. Compare your options
  3. What matters most to you?
  4. Where are you leaning now?
  5. What else do you need to make your decision?

1. Get the Facts

Your options

  • Take medicines for panic disorder.
  • Don't take medicines. Try home treatment and counseling to deal with your symptoms.

Key points to remember

  • Two types of medicines work well for treating panic attacks. Benzodiazepines can help you feel better right away. You can take antidepressants for long-term treatment.
  • Counseling may work just as well as medicines.
  • If you take medicines, follow your doctor's directions with care. You may have side effects such as headaches or trouble sleeping. Some medicines can treat both depression and panic attacks.
  • For some people, taking medicines along with getting counseling works best.
  • Don't feel bad about taking medicines. Panic disorder is a medical problem, not a weakness. The medicines won't change your personality.
FAQs

What is panic disorder?

When you have panic disorder, you have repeated, unexpected panic attacks. And you worry all the time about having another attack.

A panic attack is a sudden feeling of very bad anxiety. It may make you feel short of breath or dizzy or make your heart pound. An attack may last from 5 to 20 minutes or up to a few hours. You feel most anxious about 10 minutes into the attack.

What are the risks of panic disorder?

Panic disorder can lower your quality of life. It can get in the way of your daily life and work. If you have panic disorder, you are more likely to have other problems, including:

What types of medicines are used for panic disorder?

The two types of medicines used most often are antidepressants and benzodiazepines. Some people use both.

  • Antidepressants. These include:
    • Selective serotonin reuptake inhibitors (SSRIs), such as citalopram, paroxetine, or sertraline. These are the most common medicines for panic disorder.
    • Tricyclic antidepressants (TCAs), such as clomipramine or imipramine.
    • Monoamine oxidase inhibitors (MAOIs), such as isocarboxazid or phenelzine.
    • Antidepressants with mixed neurotransmitter effects, such as venlafaxine.
  • Benzodiazepines, such as alprazolam or clonazepam. They are sometimes used for panic disorder. They may be used alone or with an antidepressant.
    • These drugs can help you feel better right away. They may also be used as a part of long-term treatment, either alone or with an antidepressant.
    • They may be especially helpful if you have agoraphobia.
    • They can be taken as needed. But they can cause addiction (dependence). Symptoms often come back when you stop taking them.

What can you expect if you take medicines for panic disorder?

Antidepressants should help you start to feel better within 1 to 3 weeks. But it can take as many as 6 to 8 weeks to see more improvement.

Talk with your doctor if:

  • You don't notice any improvement by 3 weeks.
  • You have concerns or questions about your medicines.

The medicines may cause side effects, but these are usually mild. They may get better after a few weeks.

Benzodiazepines help relieve symptoms right away.

You may have to try more than one medicine to find one that works. Your doctor may have you switch to another medicine if the first one doesn't help.

What can you expect if you DO NOT take medicines for panic disorder?

Some people use counseling, such as cognitive-behavioral therapy, to treat panic disorder. It can help you to:

  • Deal with problems you are having right now.
  • Learn how to deal with future anxiety and panic attacks.

Other treatments include support groups and exercises that help you relax, such as progressive muscle relaxation or meditation.

Why might your doctor recommend taking medicines?

Your doctor might advise you to take medicines if:

  • You have not been able to control your symptoms with other treatment, such as counseling with cognitive-behavioral therapy.
  • You have other problems linked to panic disorder that could benefit from medicine, such as depression or problems with drugs or alcohol.

2. Compare your options

  Take medicines for panic disorder Don't take medicines
What is usually involved?
  • For antidepressants, you take pills or liquids every day or on certain days of the month, for months or years.
  • For benzodiazepines, you take pills or liquids as needed.
  • You may also try counseling along with taking medicine.
  • You try counseling, such as cognitive-behavior therapy, to control your symptoms.
What are the benefits?
  • Medicines for panic disorder work well.
  • Counseling works as well as medicine for many people who have panic disorder.
  • You don't have side effects from taking medicine.
What are the risks and side effects?
  • Medicine may cause side effects such as:
    • Nausea.
    • Headaches.
    • Nervousness.
    • Tiredness.
    • Trouble sleeping.
  • Benzodiazepines can lead to addiction. (Antidepressants do NOT lead to addiction.)
  • Your panic disorder may get worse if you have no treatment.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Personal stories about people deciding whether to take medicine to treat panic disorder

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"I was having lunch with some friends and suddenly began to feel strange—like I couldn't breathe and my heart was pounding. I didn't know what was happening; I thought I was having a heart attack. Although the symptoms began to go away after about 10 minutes, I went to the emergency room, where they did some tests and didn't find anything wrong. A week later, the same thing happened in the middle of the night. I went to see my doctor, and she suggested I may have had a panic attack. Since then, the attacks have been occurring at least once a week, and I have been diagnosed with panic disorder. Although each attack is still a horrible experience, I now know what is happening and that I will get through it. I have been going to therapy for several weeks and am learning how to deal with the symptoms of panic attacks. They are less frequent now and less intense. I think I can get through this without taking any medicine."

— Annie, age 32

"As an executive, I have to travel a lot for my job. A few months ago, I was boarding a plane for a business trip, and I began to feel very apprehensive. I felt trapped and got off the plane because I was shaking and sweating and my heart was pounding. I wasn't sure exactly what was wrong, but I felt like I was dying. I had a drink at the bar and was still shaky but took a later flight. After that I began to feel nervous if I even thought about flying, and I had several more similar attacks. Then I had an attack on the subway. I felt like everyone was watching me and there was no escape. I didn't even want to go to the office after that because I was afraid I could have an attack at any moment. My doctor says I have panic disorder and agoraphobia. I can hardly function, so I am going to take antidepressants and try exposure therapy. My doctor says a benzodiazepine would make the symptoms go away sooner. But I am worried they will make me too drowsy and they may be too hard for me to quit."

— Manuel, age 43

"When I divorced my wife, Celia, I began to feel down and very anxious. As a contractor, I have to deal with people every day, and it seemed very hard to do my job when I felt so stressed out and depressed. I had my first panic attack when my dog got lost at a job. I knew he was probably fine and would soon come back, but with the stress of everything else it just seemed like more than I could handle. I felt awful; I was choking and had bad stomach cramps. Since then, I have had attacks like this nearly every day and a lot of the time I feel down in the dumps. I have been diagnosed with panic disorder and depression. I am going to therapy, and it seems to help a little, but I still have panic attacks and often feel like life is not worth living, and I feel anxious about interacting with people at all. At first I didn't want to take any medicine. But after reading about it and talking it over with my doctor, I decided to start taking an antidepressant."

— Louis, age 28

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to take medicines for panic disorder

Reasons not to take medicines for panic disorder

I am willing to take medicine for at least several months, or longer if I need to.

I don't want to take medicines if at all possible.

             
More important
Equally important
More important

My panic disorder is not improving enough with counseling alone.

I want to continue counseling, without medicine, at least for a while.

             
More important
Equally important
More important

I think my symptoms may be worse than the possible side effects of the medicine.

I think the side effects of the medicine would be worse than my symptoms.

             
More important
Equally important
More important

My other important reasons:

My other important reasons:

   
             
More important
Equally important
More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Taking medicines

NOT taking medicines

             
Leaning toward
Undecided
Leaning toward

5. What else do you need to make your decision?

Check the facts

1. Taking medicine is the only way I can treat my panic disorder.

  • True
  • False
  • I'm not sure
You're right. Counseling works just as well for many people.

2. There are two different kinds of medicines that I can take to help my panic disorder.

  • True
  • False
  • I'm not sure
That's right. Benzodiazepines are taken as needed to help relieve your symptoms. Antidepressants are taken every day for long-term treatment.

Decide what's next

1. Do you understand the options available to you?

2. Are you clear about which benefits and side effects matter most to you?

3. Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

         
Not sure at all
Somewhat sure
Very sure

2. Check what you need to do before you make this decision.

  • I'm ready to take action.
  • I want to discuss the options with others.
  • I want to learn more about my options.

3. Use the following space to list questions, concerns, and next steps.

 
Credits
By Healthwise Staff
Primary Medical Reviewer Anne C. Poinier, MD - Internal Medicine
Specialist Medical Reviewer Lisa S. Weinstock, MD - Psychiatry

Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.

Current as of: September 7, 2012

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