Experiencing a panic attack can be a frightening experience that results in physical symptoms (such as sweating and palpitations) and mental symptoms (such as fear of losing control or dying). A majority of panic attack sufferers are able to find relief with various types of therapy such as cognitive behavioral therapy (CBT) and psychoanalytic therapy.
Therapy can be extremely beneficial for learning how to cope with the symptoms and teaching us the triggers associated with a panic attack. In some cases people can even learn how to stop a panic attack with certain cues or behaviors. In other cases, going to therapy simply doesn’t provide enough relief from panic attacks and medications need to be utilized.
Panic Attack Medication: List of Treatments
There are many pharmaceutical treatments that work extremely well for panic attacks. Most cases of panic attacks or panic disorders are highly treatable with the proper medication. Based on efficacy, the benzodiazepine class is regarded as being most effective. Despite a high degree of efficacy, benzodiazepines used over a long-term are associated with addiction, an incredibly difficult withdrawal, as well as dementia. Therefore in most cases SSRI’s or non-benzodiazepine anxiolytics are preferred as first-line treatments.
Benzodiazepines: This class of drugs has been around since the early 1960s and work by enhancing the function of the GABA neurotransmitter. They promote sedation (relaxation) and hypnotic (sleep inducing) effects. If used infrequently for panic attacks and/or panic disorder, these are considered to be highly effective.
- Ativan (Lorazepam)
- Klonopin (Clonazepam)
- Valium (Diazepam)
- Xanax (Alprazolam)
SSRIs: This class of drugs known as “selective-serotonin reuptake inhibitors” function by preventing the reuptake of the neurotransmitter serotonin. This results in serotonin staying in the synaptic gap for extended durations, which stimulates receptors of the receiving cell. Although it isn’t well known how these drugs work to alleviate anxiety, depression, and panic attacks – they are regarded as being clinically effective.
- Celexa (Citalopram)
- Lexapro (Escitalopram)
- Luvox (Fluvoxamine)
- Paxil (Paroxetine)
- Prozac (Fluoxetine)
- Zoloft (Sertraline)
Alternative anxiolytics: There are a variety of other medications with alternative classifications that are effective for panic attacks. Usually medications like Buspar, Clonidine, and in select cases beta blockers are recommended to help with panic attacks. Only in rare cases of treatment-resistant panic will stimulants be given a try.
- Beta-blockers: For some people beta blockers work very well for addressing panic attacks. Unfortunately it isn’t well known how these drugs work and they are not clinically approved for panic. Therefore these will be reserved for select cases of panic disorder that fail to respond to other medications.
- Propranolol (Inderal)
- Atenolol (Tenormin)
- Buspar (Buspirone): There are debates about the efficacy of Buspar, but for those who find it effective, it is relatively safe. It is less potent than an SSRI and isn’t associated with developing a tolerance or difficult withdrawals compared to other drugs. Most educated doctors will recommend this drug as a first-line treatment.
- Clonidine: Although unapproved for panic disorders, there is evidence that using Clonidine for anxiety can be very effective. The primary usage for this medication is to regulate blood pressure. However, many people have found it effective for panic disorder and it is considered relatively safe by psychiatrists without causing impaired cognition. It has become a preferred drug to prescribe those who want extra relief from their anxiety without going on a benzodiazepine and/or experiencing impaired cognition.
SNRIs: These drugs target both serotonin and norepinephrine by preventing their reuptake. These are not typically considered as effective as SSRI’s due to the fact that they also act on norepinephrine, which can increase anxiety in certain individuals. For some individuals, an SNRI like Effexor may help reduce panic attacks.
- Cymbalta (Duloxetine)
- Effexor (Venlafaxine)
Tricyclic antidepressants: These drugs work differently than SSRI’s and can be effective in cases where the panic disorder is treatment resistant. If a patient fails to respond to an SSRI or SNRI for their panic, a tricyclic antidepressant may be prescribed. Some of these drugs can be highly effective for managing panic attack symptoms.
- Amitriptyline (Elavil)
- Clomipramine (Anafranil)
- Desipramine (Norpramin)
- Doxepin (Sinequan)
- Imipramine (Tofranil)
- Nortriptyline (Pamelor)
MAOIs: The monoamine oxidase inhibitors function by increasing levels of various neurotransmitters including: serotonin, dopamine, and norepinephrine. These drugs function differently than do SSRIs or TCAs. This is a less prescribed class for panic attacks because MAOIs are thought to carry more significant side effects and food interactions compared to newer medications.
- Nardil (Phenelzine)
- Parnate (Tranylcypromine)
Atypical antidepressants: These are antidepressants that have unique functional properties compared to other classes. Within the atypical class of antidepressants, there are only a couple that are considered helpful for addressing anxiety and panic attacks. Both drugs included below are thought to be relatively sedating, hence contributing significantly to reductions in panic.
- Remeron (Mirtazapine)
- Trazodone (Desyrel)
Anticonvulsants: This class of drugs is used primarily to treat epileptic seizures. They are also used in cases of bipolar disorder as mood stabilizers and can help neuropathic pain in certain individuals. They function by reducing excess neuronal activity and are thought to block sodium channels in the brain. It is also thought that this influences the neurotransmission of GABA, which could reduce the excitatory response that leads to panic attacks.
- Depakote (Valporate)
- Gabapentin (Neurontin)
- Lyrica (Pregabalin)
Stimulants: This can help for certain individuals experiencing a rare anxiety and panic triggered by abnormally low arousal. In some cases medications like Adderall for anxiety work extremely well. Whether they will work for your panic attacks will sometimes require an unorthodox psychiatrist and experimentation.
Panic Attack Medication Hierarchy
Many would regard SSRIs as perhaps the safest drugs to treat panic attacks. Although they may be among the safest, their side effects and long-term effects are seldom taken into consideration. For panic disorder with comorbid depression, an antidepressant such as an SSRI may be the best option. However, for addressing panic attacks, a nonbenzodiazepine anxiolytic medication such as Buspar should be a first-line option. For a more in-depth analysis with alternative treatments and non-medicinal options, read the article “How to Deal with Anxiety.”
Alternative (non-benzo) anxiolytics: Although most doctors will prescribe an SSRI as a first-line treatment for panic attacks, in many cases these do not work as well as non-benzo anxiolytics. Drugs that are specifically created to address panic attacks and/or anxiety without as many side effects are preferred. Perhaps the best drug to try first for a panic disorder would be Buspar as it has minimal side effects and withdrawal symptoms. Other examples of non-benzo anxiolytics include: Clonidine and beta blockers – these are less preferred by professionals.
SSRIs: In most cases the SSRI class will be prescribed as a first-line treatment for panic attacks. These drugs are considered effective for long-term management of the attacks. Unfortunately once a tolerance is established, a person will have to keep increasing their dosage to maintain efficacy. Additionally many of these drugs “poop out” or stop working after months or years of use. In many cases people end up going through severe withdrawals with even worse panic than prior to taking the drug. Also, SSRI antidepressant side effects are usually considered problematic and can include: weight gain and sexual dysfunction. With that said, these are preferred over benzodiazepines because they do not cause any long-term memory impairment and are NOT linked to dementia.
Benzodiazepines: Although this is by far the most effective class of medication at treating panic attacks, it is also among the most problematic. Withdrawal from this class of drugs is considered extremely difficult and in some cases, dangerous. Benzodiazepines are associated with rapid development of tolerance, addiction, and over the long-term, development of dementia. Therefore the use of these drugs should be reserved for only those that do not respond to other forms of pharmacological intervention.
Combined approach: Combining medication and therapy is effective for panic attacks and disorders. Since this article is specifically discussing medications, it should be noted that multiple drugs may be prescribed to help someone cope with panic. For example, someone may be taking an SSRI to reduce the occurrence of panic attacks, but they may need to be prescribed another drug such as a benzodiazepine or non-benzodiazepine (e.g. Buspar) for more relief.
Other antidepressants: In many cases a professional may want to try other antidepressants such as the TCAs, MAOIs, or atypical antidepressants prior to using a benzodiazepine. In many cases people will find relief from their panic disorder with a drug in one of these classes. However for those with debilitating panic, a doctor may simply escalate to prescribing a benzodiazepine so that the patient gets some immediate relief.
Off-label options: If you aren’t responding to any form of treatment, there is a very small chance that you could benefit from an off-label treatment. Typically people will get some relief from benzodiazepines, but in the event that they don’t, a psychiatrist may explore alternative treatments. Off-label treatments are usually only reserved for those who have found no relief and have tested an array of antidepressants and anxiolytics. Other examples of off-label treatments include: anticonvulsants, stimulants, and antipsychotics.
What medication works best for your panic attacks?
Understand that not everyone will have the same response to certain treatments. For one person, using an SSRI may work best for keeping panic attacks at bay. For another individual, benzodiazepines may be the only class of medication that provides any relief. Yet for others a combination of medications such as an SSRI plus a benzodiazepine as needed may be necessary. If you have taken a medication to help with your panic attacks, feel free to share your experience in the comments section below.