From the Guidelines
The best treatment for panic disorder is a combination of cognitive-behavioral therapy (CBT) and medication, specifically selective serotonin reuptake inhibitors (SSRIs), as this approach has been shown to be effective in reducing symptoms and improving quality of life. This recommendation is based on the most recent and highest quality study available, which suggests that combination treatment (CBT and an SSRI) could be offered preferentially over monotreatment (therapy or medication alone) to patients with panic disorder 1.
Key Components of Treatment
- CBT helps by teaching patients to recognize and change thought patterns that lead to panic and provides practical techniques to manage symptoms when they occur.
- SSRIs, such as sertraline or escitalopram, are often first-line treatments, though they may take 2-4 weeks to become fully effective.
- For immediate relief during attacks, benzodiazepines such as lorazepam can help, but should be used sparingly due to dependency risks.
- Deep breathing exercises, regular physical exercise, adequate sleep, and avoiding caffeine and alcohol can also significantly reduce panic frequency.
Rationale for Recommendation
The recommendation for combination treatment is based on the findings from the Child-Adolescent Anxiety Multimodal Study (CAMS) and expert consensus, which supports the prioritization of combination treatment over monotreatment 1. While other studies suggest the use of SSRIs and venlafaxine for social anxiety disorder 2, 3, the most recent and highest quality study available specifically addresses the treatment of panic disorder, making it the most relevant and reliable source for guiding treatment decisions.
From the FDA Drug Label
The effectiveness of sertraline in the treatment of panic disorder was demonstrated in three double-blind, placebo-controlled studies (Studies 1-3) of adult outpatients who had a primary diagnosis of panic disorder (DSM-III-R), with or without agoraphobia.
Support for the effectiveness of alprazolam tablets in the treatment of panic disorder came from three short-term, placebo-controlled studies (up to 10 weeks) in patients with diagnoses closely corresponding to DSM-III-R criteria for panic disorder
The best treatment for panic disorder is sertraline or alprazolam, as both have been shown to be effective in reducing panic attack frequency and improving symptoms in clinical studies [4] [5]. However, it's essential to consider the potential risks and benefits of each medication, including the risk of dependence and withdrawal symptoms associated with alprazolam 6.
- Sertraline has been demonstrated to be effective in three double-blind, placebo-controlled studies, with a significant reduction in panic attack frequency and improvement in symptoms.
- Alprazolam has also been shown to be effective in three short-term, placebo-controlled studies, with a significant reduction in panic attack frequency and improvement in symptoms. However, its use is associated with a higher risk of dependence and withdrawal symptoms, particularly at higher doses and with long-term use.
From the Research
Treatment Options for Panic Disorder
The treatment of panic disorder involves a combination of psychotherapy and pharmacotherapy.
- Cognitive-behavioral therapy (CBT) is considered the treatment of choice for panic disorder, as it has been shown to be effective in reducing symptoms and improving quality of life 7, 8, 9.
- Selective serotonin reuptake inhibitors (SSRIs) are considered first-line pharmacologic treatment for panic disorder, as they have been shown to be effective in reducing symptoms and improving quality of life 7, 8, 9, 10.
- Benzodiazepines may be used as an adjunctive treatment for panic disorder, particularly in cases where patients have not responded to SSRIs or CBT 7, 11.
- Combination therapy, which involves the use of both psychotherapy and pharmacotherapy, may be more effective than either treatment alone 11, 8, 9.
Pharmacologic Treatment
Pharmacologic treatment for panic disorder typically involves the use of SSRIs, which have been shown to be effective in reducing symptoms and improving quality of life.
- Other antidepressants, such as serotonin-norepinephrine reuptake inhibitors, may also be effective in treating panic disorder 9, 10.
- Anticonvulsants and antipsychotics may be considered in certain cases, although the evidence base is limited 9.
- Buspirone, beta blockers, and hydroxyzine may be considered third-line agents for the treatment of panic disorder 9.
Psychotherapeutic Treatment
Psychotherapeutic treatment for panic disorder typically involves the use of CBT, which has been shown to be effective in reducing symptoms and improving quality of life.