mental health disorders
Panic Attacks and Panic Disorder
Treatment of Panic Attacks and Panic Disorder
Antidepressants and/or antianxiety medications Psychotherapy, including exposure therapy, cognitive-behavioral therapy, and interpersonal psychotherapy Without formal treatment, some people recover, particularly if they continue to confront situations in which attacks have occurred. For others, symptoms wax and wane for years. However, if people have had frequent attacks and have changed their behavior to avoid future attacks, treatment with medications and/or psychotherapy is usually necessary. People with panic disorder are more receptive to treatment if they understand that the disorder involves both physical and psychological processes and that treatment can usually control the symptoms. Drugs that are used to treat panic disorder include Antidepressants Antianxiety medications such as benzodiazepines Most types of antidepressants—tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), selective serotonin reuptake inhibitors (SSRIs), serotonin modulators, and serotonin-norepinephrinereuptake inhibitors (SNRIs)—are effective (see table). Benzodiazepines work faster than antidepressants but can cause Misuse of Antianxiety Medications and Sedatives and are probably more likely to cause sleepiness, impaired coordination, memory problems, and slowed reaction time. SSRIs or SNRIs are the preferred medications because they are as effective as the other drugs but usually have fewer side effects. For example, they are much less likely to cause sleepiness, and they do not cause drug dependence, although if stopped abruptly most SSRIs and SNRIs can cause uncomfortable withdrawal symptoms (eg, dizziness, fatigue, headache, nausea). Initially, people may be given a benzodiazepine and an antidepressant. When the antidepressant starts working, the dose of benzodiazepine is typically decreased, then stopped. However, for some people, a benzodiazepine is the only effective long-term treatment. Medications may prevent or greatly reduce the number of panic attacks. However, without psychotherapy, medications may not help people worry less about future attacks and stop avoiding situations that cause panic attacks. A medication may have to be taken for a long time because panic attacks often return once it is stopped. Most psychotherapies that target anxiety disorders—including panic disorder—teach techniques that promote relaxation. Relaxation strategies include mindfulness, meditation, hypnosis, exercise, and slow, steady breathing. These strategies are an important component of therapy since they both reduce the anxiety and also allow for the continuation of a psychotherapy that may be anxiety provoking. Cognitive-behavioral therapy(CBT) has been shown to be effective for panic disorder. CBT is a term used to describe various talk therapies that focus on dysfunctional thinking and/or dysfunctional behavior. People 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 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. People may be taught the following: Not to avoid situations that cause panic attacks To recognize when their fears are not likely to result in bad consequences To respond instead with slow, controlled breathing or other techniques that promote relaxation 