The main aim of treatment for panic disorder is to reduce the number of panic attacks that you have, and to help ease the severity of your symptoms.
The two main types of treatment for panic disorder are:
- psychological therapy
- medication
Depending on your individual circumstances, you may require either one of these treatment types, or a combination of the two. If you are offered psychological therapy, it will probably be in the form of cognitive behavioural therapy (CBT). If this type of treatment does not work, medication may be recommended.
Before you begin any form of treatment, your GP will discuss all of your options with you, outlining the advantages of each type of treatment, while also making you aware of any possible risks or side effects.
Different treatments will suit different people so you may need to try a variety of treatments at first. This is because no single treatment is best for everyone, and the treatment that is recommended for you will depend on your general health and the severity of your condition, as well as your personal preferences.
It is important for you to understand what your treatment will involve. If you do not understand something that your GP has told you, make sure that you ask them to explain it to you in more detail.
Cognitive behavioural therapy
Psychological therapy has proven long-term benefits, and it is the recommended form of treatment for panic disorder. If you have psychological therapy for panic disorder, it will usually be in the form of CBT.
CBT is thought to be one of the most effective forms of treatment for panic disorder. It is a psychological treatment, and will involve you having weekly sessions where you talk to a therapist.
For example, the therapist may talk to you about the way you react when you have a panic attack, and what you think about when you are experiencing an attack.
Once you and your therapist have identified any negative thoughts and beliefs, you can work on replacing them with more realistic and balanced ones. Your therapist can also teach you ways of changing your behaviour, which should make it easier for you to deal with future panic attacks. For example, they may be able to show you breathing techniques that can be used to help keep you calm during the stress of a panic attack.
The National Institute for Health and Clinical Excellence (NICE) recommend a total of seven to 14 hours of CBT, completed within a period of four months. Your treatment will usually involve having a one to two hour session, once a week.
NICE also recommend that in certain situations a shorter programme of CBT may be appropriate. This shorter programme can involve a reduced number of hours of CBT with ‘homework’ being set between sessions so that you can practice what has been achieved after each session.
During your course of CBT, you should visit your GP regularly so that they can assess your progress and see how you are doing.
See the Health A-Z topic about Cognitive behavioural therapy for more information about this form of treatment.
Support groups
Support groups, such as Anxiety UK and Triumph Over Phobia UK, will be able to provide you with useful information and advice about how to effectively manage your panic disorder, and they are also a good way of meeting other people who have similar experiences of the condition.
Panic attacks can sometimes be frightening and isolating, so it can be helpful to know that other people are experiencing the same feelings and emotions as you.
Support groups often involve face-to-face meetings where you can talk about your problems and difficulties with others. Many support groups can also provide support and guidance over the telephone or in writing. Ask your GP about support groups for panic disorder in your local area.
Antidepressants
Antidepressants are often associated with depression, but they can also be used to treat a number of other psychological conditions.
Antidepressants can take between two to four weeks before they become effective. It is therefore important that you continue to take antidepressant medication, even if you feel that it is not working. You should only ever stop taking prescribed medication if your GP specifically advises you to do so.
The types of antidepressants that are recommended to treat panic disorder are:
- selective serotonin reuptake inhibitors (SSRIs)
- tricyclic antidepressants
When starting a new type of medication, it is important that you are regularly assessed by your GP at two, four, six and 12 week intervals. This gives you the opportunity to discuss any issues that you have with your medication, and enables your GP to asses which treatment is most effective and whether you want to consider trying a different type of medication.
Selective serotonin reuptake inhibitors (SSRIs)
Selective serotonin reuptake inhibitors (SSRIs) are a type of antidepressant that work by increasing the level of a chemical in your brain called serotonin.
SSRIs are the most commonly prescribed form of antidepressant for the treatment of panic disorder. They are usually started at a low dose before gradually being increased as your body adjusts to the medicine.
Common side effects of SSRIs include:
- nausea
- headaches
- low sex drive
- blurred vision
- diarrhoea or constipation
- dizziness
- dry mouth
- loss of appetite
- sweating
- feeling agitated
- insomnia (being unable to sleep)
- abdominal pain
When you first start taking SSRIs, your feelings of anxiety and panic may seem to get worse. In the majority of cases, this is only temporary and you will usually find that your symptoms start to return to normal levels within a few days of taking the medicine.
However, you should speak to your GP if you feel that your symptoms have got worse and that they are not showing signs of returning to normal levels after a few days.
After you start to take a SSRI, you should visit your GP after two, four, six, and 12 weeks so that they can check on your progress and see whether you are responding to the medicine. Not everyone responds well to antidepressant medicines, so it is important that your progress is carefully monitored.
If your GP feels it is necessary, you may require regular blood tests, or blood pressure checks, when taking antidepressant medication. If after 12 weeks of taking the medication you do not show any signs of improvement, your GP may prescribe an alternative SSRI for you to see if it has any effect.
The length of time that you will have to take a SSRI for will vary depending on how well you respond to the treatment. Even if you feel that your panic disorder has been successfully treated, it is likely that you will need to keep taking the medication for at least six to 12 months.
If you stop taking your SSRI medication before this time, the risk of your symptoms recurring once you stop taking the medication may be increased. Some people may have to take SSRIs for longer than six to 12 months.
When you and your GP decide that it is appropriate for you to stop taking SSRIs, you will gradually be weaned off them by slowly reducing your dosage. As with antidepressants, you should never stop taking your medication unless your GP specifically advises you to.
Stopping your medication straight away without being weaned off, or without seeking advice from your GP, may result in withdrawal symptoms such as:
- dizziness
- numbness and tingling
- nausea and vomiting
- headache
- anxiety
- sleep disturbances
- sweating
These symptoms can also occur if you miss a dose of medication, or if your dose is reduced. The symptoms are usually mild, but they can be severe if the medication is stopped suddenly.
For some people, this means having to take SSRIs on a long-term basis. For others, a course of cognitive behavioural therapy can help to reduce the risk of their symptoms recurring.
Contact you GP if your side effects become troublesome and do not ease.
Tricyclic antidepressants
If SSRIs do not help to improve your symptoms after a 12 week course, or if they are not suitable, your GP may try prescribing a different type of antidepressant.
Tricyclic antidepressants work in a similar way to SSRIs. They regulate the levels of certain chemicals in your brain (noradrenaline and serotonin), which has a positive affect on your feelings and mood.
The two tricyclic antidepressants that are often prescribed to treat panic disorder are:
- imipramine
- clomipramine
Tricyclic antidepressants are not addictive.
SSRIs are usually prescribed before tricyclic antidepressants because they have fewer side effects. However, common side effects of tricyclic antidepressants include:
- constipation
- difficulty urinating
- blurred vision
- dry mouth
- weight gain or weight loss
- drowsiness
- sweating
- lightheadedness
- skin rash
The side effects should ease after seven to ten days as your body begins to get used to the medication. However, contact you GP if they become troublesome and do not ease.
Referral
If CBT, medication, or attending a support group do not help to improve your symptoms of panic disorder, you may have to be referred to a mental health specialist.
A mental health specialist will carry out an overall reassessment of your condition. They will ask you about your previous treatment and how effective you found it. They may also ask you about things in your life that may be affecting your condition, or how much support you get from family and friends.
The specialist will be able to devise a treatment plan for you, which will aim to effectively treat your symptoms.
The type of mental health specialist that you will be referred to will depend on your individual situation. For example, you may be referred to:
- a psychiatrist – a trained medical doctor who specialises in mental health; a psychiatrist is one of the only mental health specialists who is able to prescribe medication.
- clinical psychologists – are trained in the scientific study of human behaviour and mental processes, and focus solely on the assessment and treatment of mental health conditions; a clinical psychologist will help you to find ways of effectively managing your anxiety and your panic attacks.
Glossary
- Benzodiazepine
- Benzodiazepines are a group of medicines used to help sleep, reduce anxiety and as a muscle relaxant. For example, temazepam.
- Psychotherapy
- Psychotherapy is the treatment of mental and emotional health conditions, using talking and listening.
- Anxiety
- Anxiety is an unpleasant feeling when you feel worried, uneasy or distressed about something that may or may not be about to happen.
- Antidepressants
- Antidepressant medicine is used to treat depression. For example fluoxetine, paroxetine.
- Doses
- Dose is a measured quantity of a medicine to be taken at any one time, such as a specified amount of medication.
- Depression
- Depression is when you have feelings of extreme sadness, despair or inadequacy that last for a long time.
