From the Guidelines
To manage panic attacks, cognitive-behavioral therapy (CBT) should be considered as the first-line treatment, particularly for mild to moderate presentations, with selective serotonin reuptake inhibitor (SSRI) medication as an alternative treatment consideration, particularly for more severe presentations or when quality CBT is unavailable. This approach is supported by the most recent and highest quality study [ 1 ], which suggests that CBT may be more effective for long-term management of anxiety disorders, including panic disorder.
When it comes to medication options, SSRIs like sertraline or escitalopram are commonly prescribed for long-term management [ 1 ]. Additionally, serotonin norepinephrine reuptake inhibitors (SNRIs) could be offered to patients with panic disorder [ 1 ]. However, it's essential to note that beta-blockers are not typically recommended as a first-line treatment for panic disorder, but may be prescribed for symptom relief in combination with CBT and/or SSRIs and/or benzodiazepines [ 1 ].
Some key strategies to help prevent panic attacks include:
- Practicing deep breathing exercises when an attack is coming on
- Grounding techniques, such as the 5-4-3-2-1 technique
- Regular exercise (30 minutes daily)
- Adequate sleep (7-9 hours)
- Limiting caffeine and alcohol
For immediate relief, benzodiazepines like lorazepam may be prescribed, but should be used sparingly due to dependency risks. CBT is highly effective for long-term management, typically involving 12-16 weekly sessions, and works by addressing both the physical symptoms and the underlying thought patterns that trigger panic [ 1 ].
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 of Panic Attacks:
- Alprazolam tablets may be used to treat panic disorder at doses ranging from 1 to 10 mg daily.
- The mean dosage employed is approximately 5 to 6 mg daily.
- Dose titration may be necessary to achieve a therapeutic effect, with a maximum daily dose of 10 mg.
- It is essential to gradually reduce the dosage when discontinuing therapy or decreasing the daily dosage to avoid withdrawal symptoms 2.
Alternative Treatment:
- Paroxetine (PAXIL) is also indicated for the treatment of panic disorder, with or without agoraphobia, as defined in DSM-IV 3 3.
- The efficacy of paroxetine in the treatment of panic disorder was demonstrated in three 10- to 12-week multicenter, placebo-controlled studies.
- Paroxetine doses of 10 to 60 mg daily were used in these studies, with a mean dose of approximately 40 mg/day.
From the Research
Treatment Options for Panic Attacks
- Cognitive-behavioral therapy (CBT) is considered a first-line treatment for panic disorder, offering benefits after short-term intervention 4, 5
- CBT focuses on eliminating patterns that underlie and perpetuate the disorder, and helps patients acquire strategies to counter fears of panic attacks 4
- Selective serotonin reuptake inhibitors (SSRIs) are widely used in the treatment of panic disorder, with studies showing they are superior to placebo 6, 7, 8
- SSRIs such as sertraline, paroxetine, citalopram, escitalopram, fluoxetine, and fluvoxamine have been proven to be effective in reducing panic attack frequency and improving symptoms 7, 8
- Benzodiazepines, such as alprazolam, can be used to treat panic disorder, but their long-term use presents problems with dependence 6
Combination Therapies
- Combining CBT with medication, such as SSRIs, may be an effective treatment strategy for panic disorder 4, 5
- Combining SSRIs with exposure therapy may produce the greatest treatment gains, and is a recommended area for future research 8