psychiatric disorders
Panic Attacks and Panic Disorder
Treatment of Panic Disorders
Antidepressants, benzodiazepines, or both Psychotherapy Some patients recover without treatment, particularly if they continue to be exposed to situations in which attacks have occurred. For others, especially without treatment, panic disorder follows a chronic waxing and waning course. Patients should be informed that treatment usually helps control symptoms. If avoidance behaviors have not developed, reassurance, education about anxiety, and encouragement to continue to return to and remain in places where panic attacks have occurred may be all that is needed. However, with a long-standing disorder that involves frequent attacks and avoidance behaviors, treatment is likely to require pharmacotherapy combined with more intensive psychotherapy. Many medications can prevent or greatly reduce anticipatory anxiety, phobic avoidance, and the number and intensity of panic attacks ( Treatment references ): The different classes— Selective Serotonin Reuptake Inhibitors (SSRIs) (SSRIs), These anxiolytics work more rapidly than antidepressants but are more likely to cause Sedatives and such adverse effects as somnolence, ataxia, and memory problems. For some patients, long-term use of benzodiazepines is successful without significant adverse effects. Antidepressants plus benzodiazepines:These medications are sometimes used in combination initially; the benzodiazepine is slowly tapered after the antidepressant becomes effective (although some patients respond only to the combination treatment). Panic attacks often recur when medications are discontinued. Most psychotherapies that target anxiety disorders, including panic disorder, involve teaching techniques that promote relaxation. These strategies are an important component of therapy since they both reduce the anxiety and allow for the continuation of a psychotherapy that may be anxiety provoking. Relaxation strategies include mindfulness, meditation, hypnosis, exercise, and slow, steady breathing. (CBT) is a general term that refers to talk therapies that focus on dysfunctional thinking (cognition) and/or dysfunctional behaviors. CBT has been shown to be effective for panic disorder ( Treatment references ). Patients may have their own distinct but dysfunctional cycle of thinking that can induce anxiety and/or panic. For example, a person might have a baseline worry about having a heart attack, and they might spend an inordinate amount of time scanning their bodies for signs of a heart attack. If they feel a twinge in their chest, they might then begin a cycle that quickly leads to a panicky, mistaken belief that they are about to die. CBT involves clarifying these cycles and then teaching patients to recognize and control their distorted thinking and false beliefs. They are then better able to modify their behavior so that it is more adaptive. In addition, the treatment encourages them to gradually expose themselves to situations that might be likely to induce the panic, thereby desensitizing their assumed association between the setting and the symptoms. 1.Quagliato LA, Freire RC, Nardi AE: Risks and benefits of medications for panic disorder: A comparison of SSRIs and benzodiazepines.Expert Opin Drug Saf17(3):315-324, 2018. doi: 10.1080/14740338.2018.1429403 2.Papola D, Ostuzzi G, Tedeschi F, et al: Comparative efficacy and acceptability of psychotherapies for panic disorder with or without agoraphobia: Systematic review and network meta-analysis of randomised controlled trials.Br J Psychiatry221(3):507-519, 2022. doi: 10.1192/bjp.2021.148 