Table of ContentsView AllTable of ContentsDefinitionMedicationsWhich Is Best for You?Nondrug OptionsFrequently Asked Questions

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Table of Contents

Definition

Medications

Which Is Best for You?

Nondrug Options

Frequently Asked Questions

Medications can serve as a treatment option for panic attacks, which are unexpected, intense episodes of fear and discomfort often manifesting through physical symptoms.

Several classes of drugs can treatpanic attacks, including:

Each of these medication classes works differently. It’s important to note that the effectiveness of a particular drug may vary from person to person, and it’s best to work with your healthcare provider to find the right treatment plan for your individual needs.

This article discusses the different types of medications used to treat panic attacks.

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Young unhealthy female sit on couch having difficulty breathing pain of heart, touches his chest with hand

What Is a Panic Attack?

Panic attacks often manifest with physical symptoms that mightfeel similar to a heart attack, such as:

Medications to Treat Panic Attacks

Treatment options for panic disorder include:

Different medication classes are effective, including:

SSRIs/SNRIs

SSRIsand SNRIs are commonly prescribed foranxietyanddepression, but they can also be effective in treating panic disorder. In fact, they are the first-line drug treatment for panic disorder.

However, these medications do not provide immediate relief and may take a few weeks to start working.Therefore, they are not suitable for use in acute situations.

SSRIs for Anxiety Disorders

While SSRIs and SNRIs can be effective, they may also cause adverse effects such as headaches, nausea, or difficulty sleeping. These side effects are usually mild, especially if the dose is started low and increased slowly over time.Talk to your healthcare provider about any side effects you may experience.

Examples of SSRIs include:

Examples of SNRIs include:

What Are Selective Serotonin Reuptake Inhibitors (SSRIs)?

Benzodiazepines

Benzodiazepines are antianxiety medications. They can be very effective in rapidly reducing panic attack symptoms.While these drugs provide fast relief for acute symptoms, they don’t address the underlying causes.Benzodiazepines should not be used long-term as there’s a risk of dependence.

In the emergency room setting, benzodiazepines may sometimes be considered to stop an acute attack, for example, if the patient’s agitation or anxiety is particularly severe.

Examples of benzodiazepines are:

Antianxiety Medications

Tricyclic Antidepressants

TCAs are considered second-line options for people whose conditions have failed to respond to one or moreSSRItreatments or those with neuropathic pain. However, tricyclic antidepressants are not as well tolerated as SSRIs and SNRIs due to a higher incidence of adverse effects.

Examples are:

Monoamine Oxidase Inhibitors

MAOIs are FDA-approved for only treatingmajor depressive disorderbut may be used off-label for panic disorder.

Despite their effectiveness, their use is limited due to safety concerns. People who take MAOIs must adhere to a low-tyramine diet. This is because MAOIs prevent the breakdown of tyramine in the body.Although found naturally in the body,tyramineis also produced in foods from the breakdown of the amino acid tyrosine. Some foods high in tyramine include aged cheese, alcohol, and cured and processed meat.

MAOI users must also be aware of potential drug interactions. For example, MAOIs can interact with other antidepressants, so these medications shouldn’t be taken within two weeks of each other.

Examples of MAOIs are:

Beta-Blockers

Beta-blockers can help control some physical symptoms of panic attacks, such as rapid heart rate, sweating, andtremors.For example, a beta-blocker called propranolol is sometimes prescribed to treatsituational anxiety, such as symptoms of stage fright, and post-traumatic stress disorder (PTSD).

However, beta-blockers are generally not recommended for use, nor effective at treating,panic disorder.

Which Medication Is Right for You?

SSRIs, SNRIs, TCAs, and benzodiazepines all have roughly comparable efficacy (being able to produce a desired effect) in treating panic disorder, but SSRIs are typically the preferred option due to their favorable balance of effectiveness and adverse effects for most people. MAOIs also appear effective, but their safety profile limits use.

SSRIs or SNRIs usually are the best choice, though SSRIs have a larger body of evidence and are more likely to be chosen as a first-line therapy.

For those withdepression, SSRIs, SNRIs, and TCAs are preferable to benzodiazepines when using only one drug to treat it (a monotherapy), while TCAs are preferred for those with nerve pain. When rapid symptom control is needed, benzodiazepines may be used with antidepressants, then tapered once the antidepressants take effect.

If you suffer from panic attacks or have been diagnosed with panic disorder, it is important to work closely with your healthcare provider to determine the most suitable treatment for you. Medication may or may not be included in your treatment plan, depending on your unique circumstances.

When selecting an appropriate medication, your provider will consider a range of factors, including:

Nondrug Ways to Manage Panic Attacks

Cognitive behavioral therapy (CBT)has emerged as an effective treatment for managing panic disorder.It can be used with or without medication. During CBT sessions, a trained clinician helps you identify and analyze patterns of thinking that lead to worry and anxiety. The therapy also includes exposure to stressful situations and physical sensations and teaches relaxation techniques, such as breathing retraining.

It’s important to consider lifestyle factors when trying to manage panic attacks. Some helpful habits include:

Meditation can also be beneficial.

Lastly, your healthcare provider may assess you for comorbid conditions (e.g., thyroid disease) or medications that could be contributing to the problem so they can be treated or those medications discontinued accordingly.

Summary

The treatment options for panic disorder include CBT, medication, or a combination of both. Several classes of drugs that can be used to treat panic attacks, including selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, benzodiazepines, tricyclic antidepressants, monoamine oxidase inhibitors, and beta-blockers.

However, it’s important to note that each drug has its own benefits and side effects, and not all drugs may suit everyone. It is best to work with a healthcare provider to find the right treatment plan.

Frequently Asked QuestionsIf you experience an isolated panic attack, the symptoms will subside soon. To cope with the situation, you can try strategies such as slowing your breathing, finding a quiet room, and seeking support from a loved one. Usually, no particular treatment is required unless you are diagnosed with panic disorder.However, if your agitation or anxiety is severe, benzodiazepines may sometimes be used in the emergency room setting to relieve an acute attack.In the case of panic disorders, studies have shown that self-help, CBT, and SSRIs/SNRIs are equally effective as first-line treatment options.Results from research studies suggest that SSRIs, SNRIs, TCAs, and benzodiazepines all have roughly comparable efficacy in treating panic disorder. However, SSRIs are considered the most suitable treatment option for most patients due to their favorable balance of efficacy and minimal adverse effects.Additionally, SSRIs are preferred as the first-line therapy due to their significant body of evidence supporting their effectiveness.

If you experience an isolated panic attack, the symptoms will subside soon. To cope with the situation, you can try strategies such as slowing your breathing, finding a quiet room, and seeking support from a loved one. Usually, no particular treatment is required unless you are diagnosed with panic disorder.However, if your agitation or anxiety is severe, benzodiazepines may sometimes be used in the emergency room setting to relieve an acute attack.In the case of panic disorders, studies have shown that self-help, CBT, and SSRIs/SNRIs are equally effective as first-line treatment options.

If you experience an isolated panic attack, the symptoms will subside soon. To cope with the situation, you can try strategies such as slowing your breathing, finding a quiet room, and seeking support from a loved one. Usually, no particular treatment is required unless you are diagnosed with panic disorder.

However, if your agitation or anxiety is severe, benzodiazepines may sometimes be used in the emergency room setting to relieve an acute attack.

In the case of panic disorders, studies have shown that self-help, CBT, and SSRIs/SNRIs are equally effective as first-line treatment options.

Results from research studies suggest that SSRIs, SNRIs, TCAs, and benzodiazepines all have roughly comparable efficacy in treating panic disorder. However, SSRIs are considered the most suitable treatment option for most patients due to their favorable balance of efficacy and minimal adverse effects.Additionally, SSRIs are preferred as the first-line therapy due to their significant body of evidence supporting their effectiveness.

Results from research studies suggest that SSRIs, SNRIs, TCAs, and benzodiazepines all have roughly comparable efficacy in treating panic disorder. However, SSRIs are considered the most suitable treatment option for most patients due to their favorable balance of efficacy and minimal adverse effects.

Additionally, SSRIs are preferred as the first-line therapy due to their significant body of evidence supporting their effectiveness.

10 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.National Institute of Mental Health.Panic disorder: when fear overwhelms.Bandelow B, Zohar J, Hollander E, et al.World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the pharmacological treatment of anxiety, obsessive-compulsive and post-traumatic stress disorders - first revision.World J Biol Psychiatry. 2008;9(4):248-312. doi:10.1080/15622970802465807American Psychiatric Association.Practice guideline for the treatment of patients with panic disorder.2nd ed. Washington, D.C.: American Psychiatric Association; 2009.Andrews G, Bell C, Boyce P, et al.Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of panic disorder, social anxiety disorder and generalised anxiety disorder.Australian & New Zealand Journal of Psychiatry. 2018;52(12):1109-172. doi:10.1177/0004867418799453Chawla N, Anothaisintawee T, Charoenrungrueangchai K, Thaipisuttikul P, McKay GJ, Attia J, Thakkinstian A.Drug treatment for panic disorder with or without agoraphobia: systematic review and network meta-analysis of randomised controlled trials.BMJ. 2022;376:e066084. doi:10.1136/bmj-2021-066084.Santarsieri D, Schwartz TL.Antidepressant efficacy and side-effect burden: a quick guide for clinicians.Drugs Context. 2015;4:212290. doi:10.7573/dic.212290Szeleszczuk Ł, Frączkowski D.Propranolol versus other selected drugs in the treatment of various types of anxiety or stress, with particular reference to stage fright and post-traumatic stress disorder.Int J Mol Sci. 2022;23(17):10099. doi:10.3390/ijms231710099Nardi AE, Lopes FL, Valença AM, Freire RC, Nascimento I, Veras AB, Mezzasalma MA, de-Melo-Neto VL, Soares-Filho GL, King AL, Grivet LO, Rassi A, Versiani M.Double-blind comparison of 30 and 60 mg tranylcypromine daily in patients with panic disorder comorbid with social anxiety disorder.Psychiatry Res.2010 Feb 28;175(3):260-5. doi: 10.1016/j.psychres.2008.06.025.National Headache Foundation.Low tyramine headache diet.Stein MB, Goin MK, Pollack, et al; Work Group on Panic Disorder. American Psychiatric Association.Practice guideline for the treatment of patients with panic disorder, second edition. Published January 9, 2009. Accessed September 28, 2020.

10 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.National Institute of Mental Health.Panic disorder: when fear overwhelms.Bandelow B, Zohar J, Hollander E, et al.World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the pharmacological treatment of anxiety, obsessive-compulsive and post-traumatic stress disorders - first revision.World J Biol Psychiatry. 2008;9(4):248-312. doi:10.1080/15622970802465807American Psychiatric Association.Practice guideline for the treatment of patients with panic disorder.2nd ed. Washington, D.C.: American Psychiatric Association; 2009.Andrews G, Bell C, Boyce P, et al.Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of panic disorder, social anxiety disorder and generalised anxiety disorder.Australian & New Zealand Journal of Psychiatry. 2018;52(12):1109-172. doi:10.1177/0004867418799453Chawla N, Anothaisintawee T, Charoenrungrueangchai K, Thaipisuttikul P, McKay GJ, Attia J, Thakkinstian A.Drug treatment for panic disorder with or without agoraphobia: systematic review and network meta-analysis of randomised controlled trials.BMJ. 2022;376:e066084. doi:10.1136/bmj-2021-066084.Santarsieri D, Schwartz TL.Antidepressant efficacy and side-effect burden: a quick guide for clinicians.Drugs Context. 2015;4:212290. doi:10.7573/dic.212290Szeleszczuk Ł, Frączkowski D.Propranolol versus other selected drugs in the treatment of various types of anxiety or stress, with particular reference to stage fright and post-traumatic stress disorder.Int J Mol Sci. 2022;23(17):10099. doi:10.3390/ijms231710099Nardi AE, Lopes FL, Valença AM, Freire RC, Nascimento I, Veras AB, Mezzasalma MA, de-Melo-Neto VL, Soares-Filho GL, King AL, Grivet LO, Rassi A, Versiani M.Double-blind comparison of 30 and 60 mg tranylcypromine daily in patients with panic disorder comorbid with social anxiety disorder.Psychiatry Res.2010 Feb 28;175(3):260-5. doi: 10.1016/j.psychres.2008.06.025.National Headache Foundation.Low tyramine headache diet.Stein MB, Goin MK, Pollack, et al; Work Group on Panic Disorder. American Psychiatric Association.Practice guideline for the treatment of patients with panic disorder, second edition. Published January 9, 2009. Accessed September 28, 2020.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

National Institute of Mental Health.Panic disorder: when fear overwhelms.Bandelow B, Zohar J, Hollander E, et al.World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the pharmacological treatment of anxiety, obsessive-compulsive and post-traumatic stress disorders - first revision.World J Biol Psychiatry. 2008;9(4):248-312. doi:10.1080/15622970802465807American Psychiatric Association.Practice guideline for the treatment of patients with panic disorder.2nd ed. Washington, D.C.: American Psychiatric Association; 2009.Andrews G, Bell C, Boyce P, et al.Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of panic disorder, social anxiety disorder and generalised anxiety disorder.Australian & New Zealand Journal of Psychiatry. 2018;52(12):1109-172. doi:10.1177/0004867418799453Chawla N, Anothaisintawee T, Charoenrungrueangchai K, Thaipisuttikul P, McKay GJ, Attia J, Thakkinstian A.Drug treatment for panic disorder with or without agoraphobia: systematic review and network meta-analysis of randomised controlled trials.BMJ. 2022;376:e066084. doi:10.1136/bmj-2021-066084.Santarsieri D, Schwartz TL.Antidepressant efficacy and side-effect burden: a quick guide for clinicians.Drugs Context. 2015;4:212290. doi:10.7573/dic.212290Szeleszczuk Ł, Frączkowski D.Propranolol versus other selected drugs in the treatment of various types of anxiety or stress, with particular reference to stage fright and post-traumatic stress disorder.Int J Mol Sci. 2022;23(17):10099. doi:10.3390/ijms231710099Nardi AE, Lopes FL, Valença AM, Freire RC, Nascimento I, Veras AB, Mezzasalma MA, de-Melo-Neto VL, Soares-Filho GL, King AL, Grivet LO, Rassi A, Versiani M.Double-blind comparison of 30 and 60 mg tranylcypromine daily in patients with panic disorder comorbid with social anxiety disorder.Psychiatry Res.2010 Feb 28;175(3):260-5. doi: 10.1016/j.psychres.2008.06.025.National Headache Foundation.Low tyramine headache diet.Stein MB, Goin MK, Pollack, et al; Work Group on Panic Disorder. American Psychiatric Association.Practice guideline for the treatment of patients with panic disorder, second edition. Published January 9, 2009. Accessed September 28, 2020.

National Institute of Mental Health.Panic disorder: when fear overwhelms.

Bandelow B, Zohar J, Hollander E, et al.World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the pharmacological treatment of anxiety, obsessive-compulsive and post-traumatic stress disorders - first revision.World J Biol Psychiatry. 2008;9(4):248-312. doi:10.1080/15622970802465807

American Psychiatric Association.Practice guideline for the treatment of patients with panic disorder.2nd ed. Washington, D.C.: American Psychiatric Association; 2009.

Andrews G, Bell C, Boyce P, et al.Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of panic disorder, social anxiety disorder and generalised anxiety disorder.Australian & New Zealand Journal of Psychiatry. 2018;52(12):1109-172. doi:10.1177/0004867418799453

Chawla N, Anothaisintawee T, Charoenrungrueangchai K, Thaipisuttikul P, McKay GJ, Attia J, Thakkinstian A.Drug treatment for panic disorder with or without agoraphobia: systematic review and network meta-analysis of randomised controlled trials.BMJ. 2022;376:e066084. doi:10.1136/bmj-2021-066084.

Santarsieri D, Schwartz TL.Antidepressant efficacy and side-effect burden: a quick guide for clinicians.Drugs Context. 2015;4:212290. doi:10.7573/dic.212290

Szeleszczuk Ł, Frączkowski D.Propranolol versus other selected drugs in the treatment of various types of anxiety or stress, with particular reference to stage fright and post-traumatic stress disorder.Int J Mol Sci. 2022;23(17):10099. doi:10.3390/ijms231710099

Nardi AE, Lopes FL, Valença AM, Freire RC, Nascimento I, Veras AB, Mezzasalma MA, de-Melo-Neto VL, Soares-Filho GL, King AL, Grivet LO, Rassi A, Versiani M.Double-blind comparison of 30 and 60 mg tranylcypromine daily in patients with panic disorder comorbid with social anxiety disorder.Psychiatry Res.2010 Feb 28;175(3):260-5. doi: 10.1016/j.psychres.2008.06.025.

National Headache Foundation.Low tyramine headache diet.

Stein MB, Goin MK, Pollack, et al; Work Group on Panic Disorder. American Psychiatric Association.Practice guideline for the treatment of patients with panic disorder, second edition. Published January 9, 2009. Accessed September 28, 2020.

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