Panic Disorder Treatment: Medication, Therapy, & How to Cope

What Is Panic Disorder?

Panic disorder is one of 11 different anxiety disorders listed in the DSM 5 and is said to affect about 5% of the population.² People with panic disorder experience repeated and unexpected panic attacks that interfere with their ability to function and can lower their quality of life. Panic attacks are intense and sudden surges of anxiety that usually last about 10 minutes, but tend to be very scary, upsetting, and distressing for people experiencing them.^1,2,6

Symptoms of a panic attack may include:¹

•  Racing heart or heart palpitations
•  Sweating, hot flashes, or chills
•  Feeling shaky or trembling
•  Shortness of breath
• Chest tightness or pain
•  Nausea, abdominal cramps, or GI upset
•  Dizziness, feeling faint or lightheaded
• Feeling detached from reality (derealization or dissociation)
• Feeling detached from oneself (depersonalization)
• Being afraid of losing control or going crazy
• Feeling like you’re dying or having a medical emergency
• Numbness or tingling sensations

The symptoms of panic disorder are often very severe, and tend to worsen when left untreated, panic disorder raises the risk for a number of different mental and physical health problems including heart problems, respiratory and gastrointestinal problems.

How Is Panic Disorder Diagnosed?

Panic disorder can only be diagnosed by a licensed medical or mental health professional. Usually, this happens during an initial intake appointment with a counselor, psychologist, or psychiatrist. In most cases, the diagnosis is made after the clinician asks questions and gathers information about a person’s symptoms and medical and psychiatric history. Sometimes, questionnaires or surveys are also used in this process.¹⁵

What Causes Panic Disorder?

Often, panic disorder begins when a phobia (like agoraphobia or social anxiety) worsens and creates more frequent and intense panic attacks. Having a pre-existing anxiety disorder or a history of panic attacks significantly increases the likelihood of developing panic disorder. Extreme stress, PTSD, and OCD can also cause anxiety and panic attacks that can progress into panic disorder.^1,2,5,6

Some populations are more susceptible to panic disorder and anxiety because of their genetics or family history. Chemical imbalances in certain brain chemicals are also believed to play a significant role in anxiety, and can increase the risk of developing panic disorder. Having an unmanaged chronic health or mental health condition like generalized anxiety, specific phobias, or even asthma can increase the risk of developing panic disorder.^2,4,6

In addition to risk factors that predispose someone to panic disorder, there are also certain behaviors and choices that can lead to panic symptoms. For example, avoiding situations that trigger anxiety, ruminating on worried thoughts, and relying on unhealthy coping mechanisms tend to worsen anxiety in the long run. When someone doesn’t take proactive steps to manage symptoms of anxiety, they are more likely to develop symptoms of panic disorder.^6,7
 

How Is Panic Disorder Treated?

Panic disorder can be a debilitating disorder that makes it difficult for a person to focus, function, socialize, work, or leave their home. With treatment, most people are able to manage or even overcome their symptoms. Some find therapy effective as a standalone treatment for panic disorder, while others require a combination of therapy and medication to manage their symptoms.^3,4,5

Treatment for panic disorder often includes:

Therapy

Therapy is considered a frontline treatment for all anxiety disorders, including panic disorder. Certain types of therapy for anxiety have been studied more extensively than others.

Therapy options for panic disorder may include:^3,4,8,9

• Cognitive behavioral therapy (CBT): CBT for panic disorders is considered the gold standard treatment in this case. Sessions work to improve symptoms by helping clients identify and challenge worried thoughts and reduce avoidance of triggers.
•  Exposure therapy: Exposure therapy is a specific CBT technique that was created to help desensitize people to anxiety triggers and reduce avoidance behaviors. By gradually exposing individuals to anxiety provoking situations, they are able to overcome their fears.
• Applied relaxation for panic disorder: This therapy helps people with panic disorder identify triggers and early anxiety cues, while teaching relaxation techniques like progressive muscle relaxation, mindfulness, and breathing techniques.
•  Panic-focused psychodynamic psychotherapy (PPFP): Psychodynamic therapy is one of the earliest forms of psychotherapy, and focuses on helping people build awareness and resolve inner conflicts believed to cause anxiety. This treatment involves 24 sessions over a 12-14 week period.
• Online self-guided CBT & relaxation programs: Virtual therapy and online self-help programs for panic disorder that utilize CBT and relaxation training may provide a solution to this problem.

Medications

When therapy alone is ineffective or when a person is struggling with intense, debilitating symptoms of anxiety, medication may be recommended. Medication best when administered in combination with therapy, and may be prescribed daily or on an ‘as needed’ (PRN) basis. People with co-occurring disorders like depression or another anxiety disorder may be more likely to benefit from medication, as many find that panic symptoms increase during times when other conditions aren’t well managed.^4,5,6,10

Medications for panic disorder may include:^6,10

•  Antidepressants: Antidepressant medications like SSRIs* have shown to be effective in treating symptoms of anxiety in some individuals with panic disorder. These medications work on some of the same chemicals involved in anxiety, and can also help to treat co-occurring symptoms of depression or mood disorders.
• Beta blockers: Beta blockers are off-label medications typically used to treat high blood pressure, but may also be prescribed to people who struggle with panic attacks. These medications can sometimes be taken as needed (vs daily) and also have lower risk for serious side effects than other anti-anxiety medications.
• Benzodiazepines**: Benzodiazepines are sometimes prescribed short term or as-needed to people with panic disorders. They work by de-activating nervous system responses that cause physical symptoms of anxiety. While these can be very effective in the moment, they also carry a high risk for abuse, addiction, and adverse side effects.

*This medication has a black box warning, the most serious kind of warning from the FDA for a risk of suicidal thoughts and behaviors in certain people. You should talk with your doctor about these risks before starting this medication.

**These medications carry black box warnings, the most serious kind of warnings from the FDA for abuse or misuse, risk of physical dependence and risk of serious side effects, including death, when combined with an opioid.

Are Treatments for Panic Disorder Effective?

Panic disorder is highly treatable. Studies suggest that those who engage in 12-14 weeks of relaxation training, CBT, or PPFP see significant improvements or complete resolution in panic disorder symptoms. These improvements are often maintained even one year after treatment.⁸

Unlike certain medications which provide only temporary relief from symptoms, these findings suggest therapy can provide lasting benefits.⁹
Therapy focuses on helping people confront their fears, build confidence, and develop better coping skills, as opposed to only targeting the temporary symptoms of anxiety. That’s why certain medications like benzodiazepines are only recommended for short term or occasional use, especially since they have addictive qualities.⁴

While panic disorder is highly treatable, the main barrier in treating this condition is that only 25% of people diagnosed seek treatment. Leaving home and encountering new situations often triggers intense anxiety and panic symptoms, which can lead people to avoid therapy, cancel appointments, or opt out entirely.⁹

10 Tips for Coping With a Panic Disorder

While many individuals with panic disorder require therapy and professional treatment to get better, there are also some ways for them to facilitate progress on their own. Using healthy coping skills, creating support systems, and gradually facing feared situations are all important steps in the process of recovery.

Below are 10 ways to cope with a panic disorder:^7,11

1. Practice self-care: Consistent self-care can help to keep stress and anxiety in check, helping to curb panic attacks. Maintaining a good sleep, exercise, and meditation routine(s) are all essential parts of self-care you should prioritize.
2. Focus on what you can control: When you find yourself ruminating on things beyond your control, refocus on aspects of your life and routine that you can influence, improve, and change for the better. This helps keep your mind from spiraling on worried, unproductive thoughts that feed into your anxiety.
3. Don’t let problems & stressors snowball: Procrastinating tasks, chores, and other stressful obligations might make you feel relieved in the moment, but tends to cause anxiety later on. Prevent small issues and problems from snowballing into bigger ones by addressing them head on.
4. Spend more time in your life: Ruminating on worried thoughts is one of the most common precursors for panic attacks. Pull your attention away from your thoughts and refocus on things happening in the moment to reduce symptoms of panic and anxiety.
5. Relax your body: It’s easier to de-escalate a panic attack when you catch the symptoms early on. When you notice the earliest signs of an attack, try to use relaxation skills to calm down. Progressive muscle relaxation is one skill that many people find helpful, but even some gentle stretches and deep exhales can help.
6. Use CBT reframing: CBT reframing is a skill that can help reduce your anxiety by working to neutralize irrational thoughts (aka cognitive distortions) that feed into your anxiety. For example, try changing your “what if…” thoughts into “even if..” thoughts to think in ways that help you feel prepared, rather than fill you with dread.
7. Use grounding techniques: Grounding is a mindfulness skill that involves using one or more of your five senses to focus on where you are, what you’re doing, and what’s around you. These simple techniques work by getting you to refocus attention away from panic symptoms in your body or mind.
8. “Ride the wave” of your anxiety: One Acceptance and Commitment Therapy (ACT) exercise is to try to visualize panic as a ‘wave’ that’s rising up inside of you. Track the motion of the wave as it rises in intensity, crests, and eventually subsides. This exercise usually takes only a few seconds to do, and can leave you feeling much more calm.
9. Take small steps: Exposure therapy is one of the fastest and most effective ways to overcome panic disorders, and involves gradually exposing yourself to fears. Experts recommend starting with the smaller fears and gradually working your way up to bigger ones. Over time, this can help you build confidence and feel more in control of your anxiety.
10. Switch up your routine: Rigid and controlling tendencies can sometimes provide temporary relief from symptoms, but they can also undermine your confidence and make it harder to adapt to new situations. Try to keep your routines flexible by pushing yourself to try new things, go new places, and venture out of your comfort zone.

Final Thoughts

Panic disorder is a debilitating condition that involves recurrent panic attacks, fears of future attacks, and a pattern of avoiding people, places, and things that might trigger an attack.^1,2,6 Over time, panic disorder symptoms can significantly limit a person’s life. However, this progression can be prevented and even reversed with treatment. Therapies like CBT, exposure therapy, and relaxation training all have proven, lasting benefits.^3,4,6,8