To panic is normal and sometimes, even necessary to get things done. However, if you have been experiencing recurrent and frequent episodes of panic called panic attacks, you may be suffering from an anxiety disorder, known as panic disorder.<\/p>\n
A panic attack is a sudden, intense, fearful response to an unknown cause, lasting for a few minutes to hours. It can present with physical signs, such as increased heart rate, sweating and chest pain, often mimicking other health conditions, like cardiovascular disorders<\/strong> and thyroid disorders<\/strong>.<\/p>\n Panic attacks and panic disorder are different and the difference lies in the frequency and severity of the condition. Usually, panic attacks occur once or twice in a lifetime, with no major implications. However, recurrent panic attacks with a fear of another attack is suggestive of a panic disorder. To be specific, if you had at least two panic attacks for no apparent reason, followed by at least one month of constant fear of the next attack, you most likely have a panic disorder.<\/p>\n Panic disorder can be a tormenting condition to live with. However, it is not a fatal condition and is completely treatable. Through medical intervention and psychotherapy, you can lead a good quality life. But, if left untreated, it can lead to development of phobia<\/strong>, such as agoraphobia<\/strong> (fear of places or situations that might evoke panic attack), thus causing severe disruption of social and work-life.<\/p>\n According to the Anxiety and Depression Association of America, panic attack is a sudden onset of discomfort or fear that reaches peak within minutes and has at least four of the following symptoms.[1<\/a>]<\/p>\n However, some individuals may not experience four of these symptoms, but have a full-blown panic attack. This condition is known as \u201climited-symptom panic attack\u201d. Treatment of panic disorder is aimed at reducing the frequency of panic attacks and providing symptomatic relief.<\/p>\n Cognitive Behavioral Therapy (CBT) forms the mainstay of treatment of panic disorder. CBT is a type of psychotherapy (also known as Talk therapy). During a CBT, your therapist may ask you questions regarding your feelings at the time of panic attack. By doing so, therapist targets your negative thoughts and try to amend them. For instance, your therapist may teach you some relaxation breathing technique, which can relieve your symptoms during a panic attack.<\/p>\n Based on the severity of your symptoms, your doctor may also prescribe you certain medications to complement the symptom-relieving effects of psychotherapy. Anti-depressants, including first-generation anti-depressants, second-generation anti-depressants and monoamine oxidase inhibitors form the major drugs used in the treatment of panic disorder. However, benzodiazepines and beta blockers may also be prescribed for symptomatic relief.<\/p>\n These medications are described below.<\/p>\n Anti-depressants are used as first-line medications in the treatment of panic disorder. This group of drug acts on a biological process, known as neurotransmission. It is a fundamental process that carries information from brain to the concerned organ, gland or muscle. This process is facilitated by the release of brain chemicals, known as neurotransmitters.<\/p>\n An interesting fact here is that in order to send a new information, the released brain chemicals have to be taken back by the brain cells. This phenomenon of reabsorption of neurotransmitter is known as \u201cre-uptake\u201d.<\/p>\n Anti-depressants inhibit the re-uptake of specific neurotransmitters, thus prolonging the stay of these neurotransmitters in the blood stream and relieving the symptoms of panic disorder.<\/p>\n The anti-depressants used in the treatment of panic disorder are as follows.<\/p>\n These constitute the newly developed anti-depressants, with lesser side-effects as compared to the first-generation anti-depressants.<\/p>\n A. Selective Serotonin Reuptake Inhibitors (SSRIs)<\/strong><\/p>\n SSRIs have a mood elevating property. They selectively block a transporter on the nerve cell membrane, known as Serotonin Transporter (SERT). This transporter is responsible for re-uptake of a specific neurotransmitter, i.e. serotonin.<\/p>\n Researchers believe that low serotonin level can lead to a depressed mood. Thus, by inhibiting the re-uptake of serotonin, SSRIs make more serotonin available, hence potentiating its mood enhancing ability.<\/p>\n Available as:<\/strong> Oral preparations<\/p>\n i) Fluoxetine<\/strong> ii) Paroxetine<\/strong> iii) Sertraline<\/strong> However, every patient may respond differently to each SSRI and it may take 4 to 6 weeks to produce beneficial effects.<\/p>\n SSRIs are also used to treat several other conditions, such as social phobia<\/strong>, OCD, bulimia nervosa<\/strong>, PTSD, Premenstrual dysphoric disorder<\/strong> (PMDD), etc.<\/p>\n B. Serotonin and Noradrenaline Reuptake Inhibitors (SNRIs)<\/strong><\/p>\n It also belongs to a second-generation anti-depressant class of drugs. Unlike SSRI, it blocks two types of transporters on the nerve cell membrane, namely SERT (Serotonin Transporter) and NET (Noradrenaline Transporter), thus inhibting the reuptake of both serotonin and noradrenaline. Therefore, SNRIs are also known as dual re-uptake inhibitors or dual-acting anti-depressants. Potentiated action of serotonin and noradrenaline elevates the mood.<\/p>\n Available as:<\/strong> Oral preparations<\/p>\n i) Venlafaxine<\/strong> ii) Duloxetine<\/strong> SNRIs are also used in certain other conditions, such as diabetic neuropathic pain<\/strong>, fibromyalgia<\/strong>, stress urinary incontinence<\/strong> in women, etc.<\/p>\n II. First Generation Anti-depressants<\/strong><\/p>\n These include earlier developed anti-depressants.<\/p>\n A. Tricyclic Anti-depressants (TCAs)<\/strong><\/p>\n Like second-generation anti-depressants, TCAs also inhibit Serotonin transporter (SERT) and Noradrenaline transporter (NET), thus potentiating the mood-elevating action of serotonin and noradrenaline. These also have a direct action on certain other receptors of the nervous system, such as adrenergic, cholinergic and histaminergic receptors. All these effects together alleviate the mood changes seen in panic disorder.<\/p>\n However, first generation anti-depressants lack the selective inhibitory action on neurotransmitters. Also, these are less effective and bear more side-effects as compared to second-generation anti-depressants. Therefore, second-generation anti-depressants are preferred in panic disorder.<\/p>\n Available as:<\/strong> Oral preparations<\/p>\n i) Clomipramine<\/strong> ii) Imipramine<\/strong> iii) Desipramine<\/strong> B. Monoamine Oxidase (MAO) Inhibitors<\/strong><\/p>\n The brain chemicals (i.e. neurotransmitters), namely serotonin, noradrenaline and dopamine are metabolized by an enzyme, known as Monoamine oxidase. MAO inhibitors block the action of this enzyme thus, prevent the degradation of these neurotransmitters. Available as:<\/strong> Oral preparations<\/p>\n i) Isocarboxazid<\/strong> ii) Phenelzine<\/strong> iii) Tranylcypromine<\/strong> Other than the second-generation anti-depressants, there are some other medications that may be prescribed by your doctor to relieve the symptoms of panic attacks. These are mostly anti-anxiety drugs which are an ill-defined group of drugs with mild depressant effect on the central nervous system. These are used on a short-term basis, to relieve the anxiety associated with the disorder, without interfering with the normal physical and mental functions of the body. Various anti-anxiety drugs used in the treatment of panic disorder are as follows.<\/p>\nSymptoms<\/h2>\n
\n
\nPanic attacks may also occur due to some other mental health condition, such as ADHD<\/a>, Generalized anxiety disorder<\/a>, OCD<\/a>, social anxiety disorder, PTSD<\/a>, etc.<\/p>\nTreatment<\/h2>\n
1. Anti-depressants<\/h3>\n
I. Second Generation Anti-depressants<\/h4>\n
\nUS-FDA Status:<\/strong> Approved for panic disorder
\nAvailability:<\/strong> Prescription only
\nGeneric name:<\/strong> fluoxetine
\nBrand name:<\/strong> Prozac capsule
\nSide-effects:<\/strong> Hives, skin rash, restlessness, inability to sit still
\nIndicated in pregnancy:<\/strong> Only if benefit outweighs fetal risk
\nAlcohol content:<\/strong> Absent<\/p>\n
\nUS-FDA Status:<\/strong> Approved for panic disorder
\nAvailability:<\/strong> Prescription only
\nGeneric name:<\/strong> paroxetine hydrochloride
\nBrand name:<\/strong> Paxil tablet
\nSide-effects:<\/strong> Constipation, diarrhea, dizziness, drowsiness, headache, nausea, insomnia
\nIndicated in pregnancy:<\/strong> Contraindicated
\nAlcohol content:<\/strong> Absent<\/p>\n
\nUS-FDA Status:<\/strong> Approved for panic disorder
\nAvailability:<\/strong> Prescription only
\nGeneric name:<\/strong> sertraline hydrochloride
\nBrand name:<\/strong> Zoloft tablet
\nSide-effects:<\/strong> Fatigue, dizziness, diarrhea, drowsiness, insomnia, decreased libido
\nIndicated in pregnancy:<\/strong> Only if benefit outweighs fetal risk
\nAlcohol content:<\/strong> Absent<\/p>\n
\nUS-FDA Status:<\/strong> Approved for panic disorder
\nAvailability:<\/strong> Prescription only
\nGeneric name:<\/strong> venlafaxine
\nBrand name:<\/strong> Effexor
\nSide-effects:<\/strong> Insomnia, constipation, dizziness, nervousness, nausea, dry mouth
\nIndicated in pregnancy:<\/strong> Only if benefit outweighs fetal risk
\nAlcohol content:<\/strong> Absent<\/p>\n
\nUS-FDA Status:<\/strong> Approved for panic disorder
\nAvailability:<\/strong> Prescription only
\nGeneric name:<\/strong> duloxetine hydrochloride
\nBrand name:<\/strong> Cymbalta capsule
\nSide-effects:<\/strong> Constipation, dizziness, fatigue, drowsiness, headache, nausea, insomnia, xerostomia (dry mouth)
\nIndicated in pregnancy:<\/strong> Only if benefit outweighs fetal risk
\nAlcohol content:<\/strong> Absent<\/p>\n
\nUS-FDA Status:<\/strong> Approved for panic disorder
\nAvailability:<\/strong> Prescription only
\nGeneric name:<\/strong> clomipramine hydrochloride
\nBrand name:<\/strong> Anafranil capsule
\nSide-effects:<\/strong> Drowsiness, headache, dizziness, constipation, ejaculatory disorder, nausea, fatigue, insomnia
\nIndicated in pregnancy:<\/strong> Only if benefit outweighs fetal risk
\nAlcohol content:<\/strong> Absent<\/p>\n
\nUS-FDA Status:<\/strong> Approved for panic disorder
\nAvailability:<\/strong> Prescription only
\nGeneric name:<\/strong> imipramine pamoate
\nBrand name:<\/strong> Tofranil tablet
\nSide-effects:<\/strong> Blurred vision, agitation, abdominal pain, clay colored stools, chest pain
\nIndicated in pregnancy:<\/strong> Only if benefit outweighs fetal risk
\nAlcohol content:<\/strong> Absent<\/p>\n
\nUS-FDA Status:<\/strong> Approved for panic disorder
\nAvailability:<\/strong> Prescription only
\nGeneric name:<\/strong> desipramine hydrochloride
\nBrand name:<\/strong> Norpramin tablet
\nSide-effects:<\/strong> Abdominal pain, blurred vision, anxiety, black tarry stools, anxiety, chest pain
\nIndicated in pregnancy:<\/strong> Only if benefit outweighs fetal risk
\nAlcohol content:<\/strong> Absent<\/p>\n
\nPotentiated action of these neurotransmitters elevates the mood and combats the symptoms of panic disorder.<\/p>\n
\nUS-FDA Status:<\/strong> Approved for panic disorder
\nAvailability:<\/strong> Prescription only
\nGeneric name:<\/strong> isocarboxazid
\nBrand name:<\/strong> Marplan tablet
\nSide-effects:<\/strong> Confusion, chills, numbness, cold sweats, dizziness, difficulty urination
\nIndicated in pregnancy:<\/strong> Only if benefit outweighs fetal risk
\nAlcohol content:<\/strong> Absent<\/p>\n
\nUS-FDA Status:<\/strong> Approved for panic disorder
\nAvailability:<\/strong> Prescription only
\nGeneric name:<\/strong> phenelzine
\nBrand name:<\/strong> Nardil tablet
\nSide-effects:<\/strong> Chills, cold sweats, confusion, dizziness, trembling
\nIndicated in pregnancy:<\/strong> Only if benefit outweighs fetal risk
\nAlcohol content:<\/strong> Absent<\/p>\n
\nUS-FDA Status:<\/strong> Approved for panic disorder
\nAvailability:<\/strong> Prescription only
\nGeneric name:<\/strong> tranylcypromine sulfate
\nBrand name:<\/strong> Parnate tablet
\nSide-effects:<\/strong> Anxiety, uncontrolled action, agitation, bleeding gums, black tarry stools
\nIndicated in pregnancy:<\/strong> Only if benefit outweighs fetal risk
\nAlcohol content:<\/strong> Absent<\/p>\n2. Anti-anxiety drugs<\/h3>\n
I. Benzodiazepines (BZDs)<\/h4>\n