Medical Treatment

Generally, panic attacks are treated with reassurance and relaxation techniques. By definition, panic attacks last less than an hour, so many times a person already feels much better by the time he or she makes it to the doctor's office. Nevertheless, because the diagnosis is made by excluding more dangerous causes, people may be given medications during their attack.

• If the doctor is suspicious of a cardiac (heart) cause, then the person may be given aspirin and various blood pressure medicines. An IV line may be started and fluids given. Some doctors will prescribe various antianxiety medicines such as diazepam (Valium) or lorazepam (Ativan) during the evaluation.

• Once the diagnosis of panic attack is made, however, the person may be surprised that no medicines are prescribed. Before medications are started, the person requires further evaluation by a mental health professional to check for the presence of other disorders. These may include anxiety disorders, depression, or panic disorder (a different diagnosis than panic attack).
  
  
• If medications are prescribed, several options are available. Selective serotonin reuptake inhibitors (SSRIs) such as sertraline (Zoloft), fluoxetine (Prozac), paroxetine (Paxil), and fluvoxamine (Luvox) are often the first choice. Clinical trials have shown SSRIs reduce the frequency of panic attack up to 75-85%. SSRIs must be taken 3-6 weeks before they are effective in reducing panic attacks and are taken once daily.
  
  
• Other choices of drug treatment include benzodiazepines such as alprazolam (Xanax), clonazepam (Klonopin), lorazepam (Ativan), or diazepam (Valium). They effectively decrease panic attacks by up to 70-75% almost immediately; however, they must be up to 4 times per day. Additional drawbacks include sedation, memory loss, and after several weeks, tolerance to their effects and withdrawal symptoms may occur.
  
  
• Tricyclic antidepressants such as imipramine (Tofranil) and MAO inhibitors such as phenelzine (Nardil) have also been used, but many individuals experience side effects that are difficult to tolerate.