What is the treatment for ongoing panic attack symptoms?

From the Guidelines

The most effective treatment for ongoing panic attack symptoms is a combination of cognitive-behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs), as it has been shown to significantly reduce the frequency and intensity of panic attacks and improve quality of life. For immediate relief during a panic attack, slow, deep breathing exercises (inhaling for 4 counts, holding for 1, exhaling for 4) can help regulate the body's stress response, as suggested by 1. Grounding techniques like the 5-4-3-2-1 method (identifying 5 things you see, 4 things you feel, 3 things you hear, 2 things you smell, and 1 thing you taste) can redirect attention away from panic sensations.

Medications that may be prescribed include benzodiazepines like lorazepam (0.5-2mg) or alprazolam (0.25-1mg) for immediate relief, though these are typically used short-term due to dependency risks, as noted in the example answer. For long-term management, SSRIs such as sertraline (50-200mg daily) or escitalopram (10-20mg daily) are often prescribed, usually requiring 4-6 weeks to reach full effectiveness. CBT, particularly exposure therapy, has strong evidence for treating panic disorder, typically involving 12-16 weekly sessions, as supported by 1.

Regular exercise, adequate sleep, limiting caffeine and alcohol, and practicing mindfulness meditation can also help reduce the frequency and intensity of panic attacks by lowering baseline anxiety levels and improving the body's stress response. Additionally, beta-blockers may be prescribed for symptom relief in certain cases, as mentioned in 1. However, the most recent and highest quality study, 1, emphasizes the importance of CBT and SSRIs in the treatment of panic disorder, making it the preferred treatment approach.

Some key points to consider when treating ongoing panic attack symptoms include:

• The importance of a comprehensive treatment plan that incorporates both pharmacological and psychological interventions
• The need for regular monitoring and adjustment of treatment as needed
• The potential benefits of lifestyle modifications, such as regular exercise and adequate sleep, in reducing symptoms
• The importance of cultural sensitivity and individualized treatment approaches, as highlighted in 1.

Overall, a treatment plan that prioritizes CBT and SSRIs, while also incorporating lifestyle modifications and cultural sensitivity, is likely to be the most effective in reducing the frequency and intensity of panic attacks and improving quality of life.

From the FDA Drug Label

The successful treatment of many panic disorder patients has required the use of alprazolam tablets at doses greater than 4 mg daily. In controlled trials conducted to establish the efficacy of alprazolam tablets in panic disorder, doses in the range of 1 to 10 mg daily were used The mean dosage employed was approximately 5 to 6 mg daily.

Treatment for Ongoing Panic Attack Symptoms:

• The treatment for ongoing panic attack symptoms is the use of alprazolam tablets, with doses ranging from 1 to 10 mg daily.
• The mean dosage employed is approximately 5 to 6 mg daily.
• It is essential to initiate treatment at a low dose to minimize the risk of adverse responses and advance the dose until an acceptable therapeutic response is achieved.
• Dose maintenance and reduction should be done gradually to avoid withdrawal symptoms.
• The necessary duration of treatment for panic disorder patients responding to alprazolam tablets is unknown, and a carefully supervised tapered discontinuation may be attempted after a period of extended freedom from attacks 2.

Alternative Treatment Options:

• Paroxetine (PAXIL) is also indicated for the treatment of panic disorder, with or without agoraphobia, as defined in DSM-IV 3.
• The efficacy of paroxetine was established in three 10- to 12-week trials in panic disorder patients.
• Long-term maintenance of efficacy was demonstrated in a 3-month relapse prevention trial.

From the Research

Treatment Options for Ongoing Panic Attack Symptoms

The treatment of panic disorder, which includes ongoing panic attack symptoms, involves both psychological and pharmacological interventions.

• Pharmacological interventions include:
  • Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), and monoamine oxidase inhibitors (MAOIs) 4, 5
  • Benzodiazepines, which have been shown to be effective in reducing panic symptoms and are often used as a first-line treatment 4, 5
• Psychological interventions include:
  • Cognitive-behavioral therapy (CBT), which has been shown to be effective in reducing panic symptoms and improving overall well-being 5
  • Relaxation techniques, such as progressive muscle relaxation, deep breathing, and guided imagery, which can help reduce stress and promote relaxation 6

Efficacy of Treatment Options

Studies have shown that:

• Most medications, including antidepressants and benzodiazepines, are more effective than placebo in reducing panic symptoms 4
• Benzodiazepines, such as diazepam and alprazolam, are among the most effective medications for reducing panic symptoms 4
• CBT is a highly effective psychological intervention for reducing panic symptoms and improving overall well-being 5
• Relaxation techniques, such as progressive muscle relaxation, deep breathing, and guided imagery, can be effective in reducing stress and promoting relaxation 6

Ranking of Treatment Options

Studies have ranked treatment options based on their efficacy and tolerability, with:

• Benzodiazepines ranking as the most effective medication class for reducing panic symptoms 4
• TCAs ranking as the most effective medication class for achieving remission 4
• CBT ranking as a highly effective psychological intervention for reducing panic symptoms and improving overall well-being 5