Medications for Panic Disorder

Medication is one of the most popular and effective treatment options for panic disorder, panic attacks, and agoraphobia. Your doctor may prescribe medication to help reduce how intense your panic attacks are, decrease your overall feelings of anxiety, and potentially treat any co-occurring conditions, such as depression.

Medications for panic disorder are typically classified in one of two categories: antidepressants and anti-anxiety drugs.

When first introduced in the 1950s, antidepressants were primarily used to treat mood disorders, including depression and bipolar disorder. However, it was later discovered that these medications effectively help reduce anxiety, lessen the symptoms of panic, and decrease the intensity of panic attacks. Antidepressant medications are now commonly used to treat many anxiety disorders, including panic disorder and agoraphobia.

Antidepressants affect the chemical messengers in the brain, known as neurotransmitters. There are thought to be many different types of these chemical messengers that are communicating between brain cells.

Selective Serotonin Reuptake Inhibitors, or simply SSRIs, are a popular class of antidepressants prescribed to decrease symptoms of anxiety and depression. This medication affects serotonin, a naturally occurring neurotransmitter in the brain. SSRIs work by influencing only the serotonin levels (selective) and avoiding serotonin absorption (reuptake) through the nerve cells in the brain. By balancing a person’s serotonin functioning, SSRIs are able to reduce anxiety and improve mood.

Studies have demonstrated the long-term effectiveness of SRRIs. These medications have also been found to cause limited side effects, making them the prescription medication of choice for panic disorder.

Common SSRIs include:

• Prozac (fluoxetine)
• Zoloft (sertraline)
• Paxil (paroxetine)
• Celexa (citalopram)

Tricyclic antidepressants, or TCAs, were more popular in treating both anxiety and mood disorders before SSRIs were introduced. However, TCAs are still an effective treatment option for people with anxiety disorders. Like SSRIs, TCAs work to block the reuptake of the chemical messenger serotonin. Additionally, many TCAs also prevent the reuptake of norepinephrine, another neurotransmitter in the brain that is often associated with the fight-or-flight stress response.

Common TCAs include:

• Amitriptyline (Elavil)
• Amoxapine (Asendin)
• Desipramine (Norpramin)
• Doxepin (Adapin, Sinequan)
• Imipramine (Tofranil)
• Nortriptyline (Pamelor)
• Protriptyline (Vivactil)
• Trimipramine (Surmontil)

Monoamine Oxidase Inhibitors (MAOIs) are one of the earliest developed antidepressants used to effectively treat mood and anxiety disorders. MAOIs work by inhibiting the activity of the enzyme, monoamine oxidase.  This enzyme is involved in breaking down neurotransmitters like norepinephrine, serotonin, and dopamine. Dopamine helps regulate many functions, including movement, physical energy levels, and feelings of motivation.

Despite their effectiveness, MAOIs are prescribed less frequently due to necessary dietary restrictions when taking them and the potential for significant drug interactions that can occur when taking MAOIs with other medications.

Common MAOIs include:

• Phenelzine (Nardil)
• Tranylcypromine (Parnate)
• Isocarboxazid (Marplan)
• Selegiline (Emsam)

Anti-anxiety medications are prescribed for their fast-acting relief of panic symptoms. These medications work to relax the central nervous system, which can lower the intensity of panic attacks and cause a person to feel calmer. Due to their tranquilizing effect and rapid relief, anti-anxiety medications are often prescribed to treat panic disorder.

Benzodiazepines are the most commonly prescribed class of anti-anxiety medication for panic disorder. Known for their sedative effect, these medications can quickly reduce panic attack symptoms and induce a more relaxed state. Benzodiazepines slow down the central nervous system by targeting the gamma-aminobutyric acid (GABA) receptors in the brain, inducing a sense of relaxation. In spite of potential risks and side effects of these medications, benzodiazepines have been found to safely and effectively treat panic disorder.

Common benzodiazepines include:

• Xanax (alprazolam)
• Klonopin (clonazepam)
• Valium (diazepam)
• Ativan (lorazepam)
• Librium (chlordiazepoxide)