What methods can help decrease the chances of a panic attack?

From the Guidelines

To decrease the chances of a panic attack, a combination of regular deep breathing exercises, progressive muscle relaxation, cognitive behavioral therapy (CBT) techniques, and mindfulness meditation is recommended, as these approaches address both the physical stress response and thought patterns that contribute to panic, with the most effective strategy often being a combination of these methods tailored to individual needs. Several effective methods can help decrease the chances of a panic attack.

• Regular deep breathing exercises, practiced for 5-10 minutes daily, can activate your parasympathetic nervous system and reduce anxiety, as supported by the study 1.
• Progressive muscle relaxation, where you systematically tense and release muscle groups throughout your body for about 15 minutes, helps reduce physical tension that can trigger attacks.
• Cognitive behavioral therapy (CBT) techniques, such as identifying and challenging catastrophic thoughts, provide long-term benefits by changing thought patterns, as shown in the study 1.
• Medications like SSRIs (such as sertraline 50-200mg daily or escitalopram 10-20mg daily) can be effective for prevention when taken consistently, while benzodiazepines like lorazepam (0.5-2mg as needed) may help during acute episodes but aren't recommended for long-term use due to dependency risks.
• Regular exercise (30 minutes of moderate activity most days), adequate sleep (7-9 hours nightly), limiting caffeine and alcohol, and maintaining stable blood sugar through regular meals can all reduce vulnerability to panic attacks.
• Mindfulness meditation practiced for even 10 minutes daily helps develop awareness of thoughts without judgment, as recommended in the study 1. These approaches work by addressing both the physical stress response and thought patterns that contribute to panic, with the most effective strategy often being a combination of these methods tailored to individual needs, as suggested by the study 1.

From the FDA Drug Label

The risk of dependence may increase with dose and duration of treatment In all patients, dosage should be reduced gradually when discontinuing therapy or when decreasing the daily dosage. Although there are no systematically collected data to support a specific discontinuation schedule, it is suggested that the daily dosage be decreased by no more than 0.5 mg every 3 days. To lessen the possibility of interdose symptoms, the times of administration should be distributed as evenly as possible throughout the waking hours, that is, on a three or four times per day schedule.

To decrease the chances of a panic attack, medication adherence and gradual dose reduction are crucial. The FDA drug label suggests that to minimize the risk of interdose symptoms, the medication should be taken at evenly distributed times throughout the day. Additionally, when discontinuing therapy or decreasing the daily dosage, it is recommended to reduce the dosage gradually to avoid adverse effects.

• Key considerations:
  • The risk of dependence may increase with dose and duration of treatment.
  • Gradually reduce the dosage when discontinuing therapy or decreasing the daily dosage.
  • Decrease the daily dosage by no more than 0.5 mg every 3 days.
  • Distribute the times of administration evenly throughout the waking hours. 2

From the Research

Methods to Decrease Chances of a Panic Attack

To decrease the chances of a panic attack, several methods can be employed, including:

• Pharmacological treatments:
  • Selective serotonin reuptake inhibitors (SSRIs) are considered the first-line treatment for panic disorder due to their effectiveness and tolerability 3, 4
  • Benzodiazepines can be used for short-term treatment, especially for patients who do not respond to SSRIs or have a history of dependence and tolerance 3, 4
  • Other antidepressants like tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) can be effective but have more side effects 3, 4
• Psychological treatments:
  • Cognitive behavioral therapy (CBT) is considered the psychological treatment of choice for panic disorder 3
• Lifestyle modifications:
  • Regular physical exercise has been shown to reduce panic-related symptoms, global anxiety, and depression symptoms in patients with panic disorder 5, 6
  • Acute aerobic exercise can reduce the frequency and intensity of panic attacks in patients with panic disorder 6

Key Findings

• A network meta-analysis found that most medications, including SSRIs, TCAs, MAOIs, and benzodiazepines, are more effective than placebo in treating panic disorder 7
• The same analysis found that benzodiazepines are associated with a lower dropout rate compared to placebo and are ranked as the most tolerated medications 7
• Regular exercise programs have been shown to reduce panic-related symptoms, global anxiety, and depression symptoms in patients with panic disorder 5
• Acute aerobic exercise can reduce the frequency and intensity of panic attacks in patients with panic disorder 6

Treatment Considerations

• The choice of treatment should be individualized based on the patient's specific needs and circumstances 4, 7
• A combination of pharmacological and psychological treatments may be more effective than either treatment alone 3
• Lifestyle modifications, such as regular physical exercise, can be a useful adjunct to other treatments 5, 6