From the Guidelines
To treat panic disorder episodes, combination treatment with cognitive-behavioral therapy (CBT) and a selective serotonin reuptake inhibitor (SSRI) is the most effective approach, as it has been shown to be more effective than either treatment alone 1.
Treatment Options
The following treatment options are available for panic disorder episodes:
- Cognitive-behavioral therapy (CBT): a highly effective treatment for lasting results, typically requiring 12-16 weekly sessions
- Selective serotonin reuptake inhibitors (SSRIs): effective for long-term management, such as sertraline (50-200mg daily) or escitalopram (10-20mg daily)
- Combination treatment: CBT and an SSRI, which has been shown to be more effective than either treatment alone 1
- Benzodiazepines: such as alprazolam (Xanax, 0.25-0.5mg) or lorazepam (Ativan, 0.5-1mg), which provide rapid relief but should only be used short-term due to addiction potential
Non-Pharmacological Interventions
Non-pharmacological interventions, such as deep breathing exercises, progressive muscle relaxation, and grounding techniques, can also be effective in managing panic disorder episodes.
Considerations
When treating panic disorder episodes, it is essential to consider the individual's specific needs and circumstances, including any medical comorbidities, and to tailor the treatment approach accordingly, as suggested by a study on individualized beta-blocker treatment 1. However, the most recent and highest quality study on the topic of panic disorder treatment recommends combination treatment with CBT and an SSRI 1.
From the FDA Drug Label
Panic Disorder PAXIL is indicated for the treatment of panic disorder, with or without agoraphobia, as defined in DSM-IV. The efficacy of PAXIL was established in three 10- to 12-week trials in panic disorder patients whose diagnoses corresponded to the DSM-IIIR category of panic disorder
The treatment options for panic disorder (PD) episodes include:
- Paroxetine (PAXIL), as indicated in the drug label 2
- Sertraline, which is used for the treatment of panic disorder, although the specific details of its use for panic disorder episodes are not provided in the label 3
- Alprazolam, which is used for the treatment of panic disorder, with studies showing its effectiveness in reducing the number of panic attacks per week 4
From the Research
Treatment Options for Panic Disorder (PD) Episodes
The following treatment options are available for panic disorder (PD) episodes:
- Cognitive-behavioral therapy (CBT): CBT is considered a first-line treatment for panic disorder, offering benefits after short-term intervention, typically consisting of 12-15 sessions 5, 6.
- Pharmacotherapy: Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are first-line pharmacotherapy for panic disorder, with small to medium effect sizes compared to placebo 7.
- Combination treatment: CBT can be used in combination with pharmacotherapy, with research supporting its efficacy as a strategy for medication nonresponders and as a replacement strategy for patients who wish to discontinue pharmacotherapy 5, 6.
- Breathing retraining and muscle relaxation: These techniques can be used as part of a cognitive behavioral treatment package to help manage panic symptoms 8, 9.
- Exposure to interoceptive and agoraphobic stimuli: This technique can be used as part of CBT to help patients overcome their fears and anxieties 8, 9.
Key Considerations
When selecting a treatment, clinicians should consider:
- Patient preference: Patients should be involved in the decision-making process when selecting a treatment 7.
- Current and prior treatments: Clinicians should consider the patient's treatment history when selecting a new treatment 7.
- Medical and psychiatric comorbid illnesses: Clinicians should consider the patient's overall health and any comorbid illnesses when selecting a treatment 7.
- Age, sex, and reproductive planning: Clinicians should consider the patient's demographic characteristics when selecting a treatment 7.
- Cost and access to care: Clinicians should consider the patient's access to care and the cost of treatment when selecting a treatment 7.