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.

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:

• Depression.
• Agoraphobia. This is a fear of being in public places.

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

• Antidepressants include:
  • Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil). These are the most common medicines for panic disorder.
  • Tricyclic antidepressants (TCAs), such as imipramine (Tofranil) or clomipramine (Anafranil).
  • Monoamine oxidase inhibitors (MAOIs), such as isocarboxazid (Marplan) or phenelzine (Nardil).
  • Antidepressants with mixed neurotransmitter effects, such as venlafaxine (Effexor).
• Benzodiazepines include alprazolam (Xanax), diazepam (Valium), lorazepam (Ativan), and clonazepam (Klonopin). 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.

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.

If you don't treat panic disorder, it can get worse. This is more likely if you also have another problem that often occurs with it, such as agoraphobia or depression.

If you decide not to take medicines for panic disorder, keep track of how your symptoms affect your life and the lives of those around you. You can always start to take medicine if you feel you can't deal with your symptoms.

Even if you don't take medicine, you can try counseling, such as cognitive-behavioral therapy. 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.

Your doctor might advise you to take medicines if:

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