What is the treatment for panic disorder (PD) with fear of having a panic attack?

From the Guidelines

The most effective treatment for panic disorder (PD) with fear of having a panic attack is a combination of cognitive-behavioral therapy (CBT) and selective serotonergic reuptake inhibitors (SSRIs), as this approach has been shown to be superior to monotherapy in reducing symptoms and improving quality of life. When considering treatment options, it's essential to prioritize combination treatment, as suggested by the American Academy of Child and Adolescent Psychiatry (AACAP) 1, which recommends offering combination treatment (CBT and an SSRI) to patients with panic disorder. Some key points to consider when treating panic disorder include:

• Using SSRIs, such as sertraline (50-200mg daily) or escitalopram (10-20mg daily), as a first-line medication treatment, as recommended by AACAP 1
• Practicing cognitive-behavioral techniques, such as deep breathing, progressive muscle relaxation, and mindfulness meditation, to help manage symptoms and reduce the "fear of fear" cycle
• Gradually exposing oneself to feared sensations through controlled exercises, such as spinning or hyperventilating, in a safe environment
• Avoiding triggers, such as caffeine, alcohol, and irregular sleep patterns, which can exacerbate symptoms
• Seeking professional help from a therapist specializing in anxiety disorders for personalized guidance and support. It's crucial to note that while benzodiazepines, such as lorazepam (0.5-1mg), may be used for short-term relief during severe episodes, they are not recommended for long-term treatment due to the risk of dependence and withdrawal. By prioritizing combination treatment and incorporating these strategies, individuals with panic disorder can effectively manage their symptoms and improve their quality of life.

From the FDA Drug Label

Alprazolam tablets are also indicated for the treatment of panic disorder, with or without agoraphobia Panic disorder (DSM-IV) is characterized by recurrent unexpected panic attacks, i.e., a discrete period of intense fear or discomfort in which four (or more) of the following symptoms develop abruptly and reach a peak within 10 minutes: Demonstrations of the effectiveness of alprazolam tablets by systematic clinical study are limited to 4 months duration for anxiety disorder and 4 to 10 weeks duration for panic disorder; however, patients with panic disorder have been treated on an open basis for up to 8 months without apparent loss of benefit.

The treatment for panic disorder (PD) with fear of having a panic attack is alprazolam tablets.

• The recommended duration of treatment is up to 4 to 10 weeks.
• Dose: The average dose of alprazolam tablets was 5-6 mg/day in two of the studies, and the doses of alprazolam tablets were fixed at 2 and 6 mg/day in the third study 2.
• Alternatively, fluoxetine can be used to treat panic disorder, with a recommended initial dose of 10 mg/day, increasing to 20 mg/day after 1 week 3.

From the Research

Treatment Options for Panic Disorder (PD)

The treatment for panic disorder (PD) with fear of having a panic attack typically involves a combination of psychological therapy and pharmacotherapy.

• Cognitive behavioral therapy (CBT) is considered the psychotherapy with the highest level of evidence for treating anxiety disorders, including PD 4, 5, 6, 7.
• First-line drugs for treating PD include selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) 4, 8, 7.
• Other treatment options may include pregabalin, tricyclic antidepressants, buspirone, and moclobemide, although benzodiazepines are not recommended for routine use due to their potential for dependence and other adverse effects 4, 8.

Considerations for Treatment

When developing a treatment plan for PD, several factors should be considered, including:

• Efficacy of the treatment
• Potential adverse effects
• Interactions with other medications
• Costs
• Patient preference 4, 7.
• Treatment should be continued for 6 to 12 months after remission to prevent relapse 4, 8.

Effectiveness of Treatment

Research has shown that CBT and pharmacotherapy can be effective in reducing symptoms of PD and improving quality of life.

• Studies have demonstrated that CBT can lead to significant improvements in anxiety, agoraphobia, depression, and fear of fear 5, 6.
• Meta-analyses have found that SSRIs and SNRIs are associated with small to medium effect sizes compared to placebo in treating PD 7.