From the Guidelines
Benzodiazepines, such as lorazepam or alprazolam, are the most effective medications for as-needed use during panic attacks, due to their rapid onset of action and efficacy in reducing symptoms 1. When considering medication for panic attacks, it's essential to weigh the benefits and risks of each option. Benzodiazepines, including lorazepam (Ativan) 0.5-2mg, alprazolam (Xanax) 0.25-1mg, or clonazepam (Klonopin) 0.5-2mg, are commonly prescribed for their quick action, usually within 15-30 minutes, by enhancing the effect of GABA, a calming neurotransmitter in the brain. Some key points to consider when using benzodiazepines for panic attacks include:
- Take the medication at the earliest sign of panic and find a quiet place to rest while it takes effect
- Be aware that benzodiazepines can cause drowsiness, impaired coordination, and should not be combined with alcohol
- They also carry risks of dependence and tolerance with regular use, so they're best used sparingly Alternative non-benzodiazepine options, such as hydroxyzine (Vistaril) 25-50mg or propranolol (Inderal) 10-40mg, may have fewer dependency concerns and can be considered, especially when combined with cognitive behavioral strategies and breathing techniques 1. It's crucial to consult with a healthcare provider before starting any medication to determine the most appropriate option for your specific situation, taking into account individual medical comorbidities and potential interactions with other medications.
From the FDA Drug Label
Additional advice for panic disorder patients: The use of alprazolam tablets at doses greater than 4 mg/day, often necessary to treat panic disorder, is accompanied by risks that you need to carefully consider
- Alprazolam can be used as needed for panic attacks, but it is essential to carefully consider the risks, especially when using doses greater than 4 mg/day.
- The medication has the potential to cause severe emotional and physical dependence in some patients, making it difficult to terminate treatment.
- It is crucial to follow the guidance of a physician to ensure safe and effective use of alprazolam for panic disorder 2.
From the Research
Medications for Panic Attacks
Medications can be used as needed to manage panic attacks. The following are some of the medications that have been studied for their effectiveness in treating panic disorder:
- Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) 3, 4, 5, 6
- Benzodiazepines, such as alprazolam, clonazepam, and diazepam 3, 4, 5, 7
Antidepressants
Antidepressants are commonly used to treat panic disorder. They can take several weeks to start working, but they can be effective in reducing the frequency and severity of panic attacks. Some examples of antidepressants that have been studied for their effectiveness in treating panic disorder include:
Benzodiazepines
Benzodiazepines can be used to treat panic disorder, especially in the short-term. They can be effective in reducing the frequency and severity of panic attacks, but they can also be addictive and have withdrawal symptoms when stopped. Some examples of benzodiazepines that have been studied for their effectiveness in treating panic disorder include:
Comparison of Medications
Studies have compared the effectiveness of different medications for treating panic disorder. For example, one study found that benzodiazepines were more effective than antidepressants in reducing the frequency and severity of panic attacks, but they also had more side effects 3. Another study found that SSRIs were effective in treating panic disorder, but they took longer to start working than benzodiazepines 4. A network meta-analysis found that diazepam, alprazolam, and clonazepam were the most effective medications for treating panic disorder, and that benzodiazepines were associated with a lower dropout rate compared to placebo 5.