What medications are used to treat panic attacks?

From the Guidelines

Physician-prescribed SSRIs or anxiolytics are the recommended medications for panic attacks, with the choice informed by side-effect profiles, interactions, response, patient age, and preference, as stated in the 2023 guideline update 1. When considering medication for panic attacks, it's essential to weigh the benefits and risks of different options.

• Benzodiazepines like alprazolam, lorazepam, and clonazepam can provide quick relief for acute attacks but should be used short-term due to dependency risks.
• Selective serotonin reuptake inhibitors (SSRIs) like sertraline, escitalopram, or paroxetine are preferred for long-term management as they reduce attack frequency and severity, though they take 2-4 weeks to become fully effective. Some studies suggest that beta-blockers like propranolol can be used to manage physical symptoms like rapid heartbeat, especially when combined with cognitive behavior therapy and/or SSRIs 1. However, the most recent and highest quality study, the 2023 guideline update, recommends SSRIs or anxiolytics as the primary treatment option 1. It's also important to consider lifestyle modifications, including regular exercise, adequate sleep, limiting caffeine and alcohol, and practicing relaxation techniques like deep breathing, to complement medication effectiveness. The Japanese Society of Anxiety and Related Disorders/Japanese Society of Neuropsychopharmacology guideline suggests SSRIs and venlafaxine as recommended pharmacotherapies for social anxiety disorder, which may also be applicable to panic attacks 1. Ultimately, the choice of medication should be individualized, taking into account the patient's specific needs and circumstances, as recommended in the 2020 clinical practice guideline for the assessment and treatment of children and adolescents with anxiety disorders 1.

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: Sertraline Hydrochloride Oral Concentrate is indicated for the treatment of panic disorder in adults, with or without agoraphobia, as defined in DSM-IV 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:

Panic Attack Medication:

• Alprazolam tablets are indicated for the treatment of panic disorder, with or without agoraphobia 2
• Sertraline Hydrochloride Oral Concentrate is indicated for the treatment of panic disorder in adults, with or without agoraphobia, as defined in DSM-IV 3 Key Points:
• Alprazolam and sertraline are both used to treat panic disorder
• Panic disorder is characterized by recurrent unexpected panic attacks with intense fear or discomfort and at least 4 specific symptoms 2, 3

From the Research

Medications for Panic Attacks

• The primary medications used to treat panic attacks are selective serotonin reuptake inhibitors (SSRIs) and benzodiazepines 4, 5, 6, 7, 8.
• SSRIs, such as sertraline, have been shown to be effective in reducing the frequency and severity of panic attacks 4, 5, 7.
• Benzodiazepines, on the other hand, have a rapid onset of action but can cause tolerance and dependence 6, 8.

Efficacy of Medications

• Studies have shown that SSRIs are superior to placebo in reducing panic attack frequency and severity 4, 5, 7.
• Benzodiazepines have also been shown to be effective in reducing panic attack frequency and severity, but the evidence is limited by the small number of studies and the risk of bias 6, 8.
• A systematic review of placebo-controlled studies found that SSRIs, including sertraline, paroxetine, citalopram, escitalopram, fluoxetine, and fluvoxamine, are effective in treating panic disorder 7.

Risks and Benefits

• SSRIs are associated with a delay in onset of therapeutic effect and can exacerbate anxiety and panic early in the treatment course 8.
• Benzodiazepines have a rapid onset of action but can cause tolerance and dependence 6, 8.
• The choice of medication should be based on individual patient needs and circumstances, taking into account the potential risks and benefits of each medication 6, 8.

Comparison of Medications

• Few studies have performed head-to-head comparisons of SSRIs and benzodiazepines in the treatment of panic disorder 6, 8.
• A review of the literature found that SSRIs and benzodiazepines have different mechanisms of action and side effect profiles, and that the choice of medication should be individualized 8.
• Further studies are needed to compare the efficacy and safety of SSRIs and benzodiazepines in the treatment of panic disorder 6, 8.