Panic disorder can be controlled with medicines (such as antidepressants) and professional counseling (such as cognitive-behavioral therapy). Successful treatment reduces the number and frequency of panic attacks, lowers the anxiety you feel because of the fear of future attacks, and improves the quality of your life.

If your panic attacks were caused by a specific trigger, such as a medication reaction, you may not need treatment after the trigger has been removed, which in this case would mean stopping the medicine with the help of your doctor. But sometimes panic attacks caused by outside factors can continue after the trigger has been removed and may develop into panic disorder.

Initial treatment

Initial treatment for panic disorder depends upon how bad your panic attacks are, how much fear or anxiety you feel about having another attack, and whether you have agoraphobia (avoiding situations or places that might trigger an attack) along with panic disorder.

In general, initial treatment includes:

• Professional counseling.
  • Cognitive-behavioral therapy, which focuses on changing certain thinking and behavior patterns, is the most effective type of therapy for panic disorder. For more information on changing how you think, see:

    Anxiety: Using positive thinking.

    Positive thinking: Stopping unwanted thoughts.

    Positive Thinking With Cognitive-Behavioral Therapy.

  • Exposure therapy is a type of cognitive-behavioral therapy that focuses on confronting a feared object or situation. It can be especially helpful in treating agoraphobia or anxiety linked to a particular place or situation.
• Medicines.
  • The most common medicines used to treat panic disorder are selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac), sertraline ( Zoloft), or paroxetine (Paxil). If these medicines are not effective or do not work because of their side effects, other antidepressants may be tried.
  • Antidepressants with mixed neurotransmitter effects, such as venlafaxine ( Effexor) are sometimes used. ⁷
  • Benzodiazepines such as alprazolam (Xanax), diazepam (for example, Valium), lorazepam (Ativan), or clonazepam ( Klonopin) sometimes are prescribed either alone or combined with an antidepressant. Benzodiazepines are most commonly used for rapid, short-term relief of symptoms and may also be used as a part of ongoing treatment either alone or combined with an antidepressant.
  • Other antidepressants used to treat panic disorder include tricyclic antidepressants (TCAs) such as imipramine ( Tofranil), desipramine ( Norpramin), or clomipramine ( Anafranil) and monoamine oxidase inhibitors (MAOIs) such as isocarboxazid ( Marplan), phenelzine (Nardil), or tranylcypromine ( Parnate).

Your symptoms of panic disorder may start to improve within a few weeks after beginning medicines. If improvement is not seen within 6 to 8 weeks, a higher dose or another medicine may be needed. ¹⁰

Should I take medication to treat panic disorder?

Ongoing treatment

Treatment for recurring or ongoing panic disorder usually consists of continuing or changing initial measures, which include professional counseling and medicines.

During initial treatment, a short-term medicine such as a benzodiazepine may be prescribed to help you deal with immediate symptoms. The short-term medicine will likely need to be tapered off and stopped after long-term medicines begin working and your symptoms improve.