Best medication for panic attacks
Pro Research Analysisby 
Searched over 200M research papers
Best Medication for Panic Attacks
Introduction to Panic Attacks and Their Treatment
Panic attacks are sudden episodes of intense fear or anxiety that peak within minutes and can include symptoms such as a racing heart, chest pain, dizziness, and breathlessness. Panic disorder, characterized by recurrent panic attacks, affects 1% to 4% of the population. Treatment options include both psychological and pharmacological interventions, with antidepressants and benzodiazepines being the primary pharmacological treatments 12.
Efficacy of Antidepressants in Treating Panic Attacks
Selective Serotonin Reuptake Inhibitors (SSRIs)
SSRIs, such as fluoxetine, paroxetine, and fluvoxamine, are commonly prescribed for panic disorder due to their favorable side effect profile compared to older antidepressants like tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) 24. Studies have shown that SSRIs are effective in reducing the frequency and severity of panic attacks. For instance, fluvoxamine has been found to significantly reduce the number of panic attacks and improve anxiety and depressive symptoms after six weeks of treatment .
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
Venlafaxine, an SNRI, has also demonstrated efficacy in treating panic disorder. It works by inhibiting the reuptake of both serotonin and norepinephrine, which can help reduce panic symptoms . However, SNRIs are generally considered less effective than SSRIs and TCAs in some studies .
Tricyclic Antidepressants (TCAs) and Monoamine Oxidase Inhibitors (MAOIs)
TCAs and MAOIs are effective but are often associated with more severe side effects, such as orthostatic hypotension and weight gain, making them less favorable as first-line treatments . Despite this, TCAs have been ranked highly in terms of efficacy in some network meta-analyses .
Benzodiazepines: Rapid Relief but with Caution
Benzodiazepines, including alprazolam, diazepam, and clonazepam, are highly effective in the acute treatment of panic attacks. They provide rapid relief from symptoms and are often used when immediate symptom control is necessary 128. Alprazolam and diazepam, in particular, have been shown to reduce the frequency of panic attacks and are associated with lower dropout rates in clinical trials, indicating good tolerability 17.
However, the use of benzodiazepines is limited by the risk of physical dependence and withdrawal symptoms. Therefore, they are generally recommended for short-term use or as an adjunct to other treatments 24.
Novel and Alternative Treatments
Intranasal Midazolam
A pilot study explored the use of low-dose intranasal midazolam as a novel treatment for panic disorder. The study found that midazolam was well-tolerated and effective in preventing incipient panic attacks, suggesting it could be a promising alternative for rapid symptom relief .
Reboxetine
Reboxetine, a selective norepinephrine reuptake inhibitor, has also shown promise in treating panic disorder. It significantly reduced the number of panic attacks and phobic symptoms in clinical trials, although it is less commonly used compared to SSRIs and benzodiazepines .
Conclusion
In summary, SSRIs and benzodiazepines are the most commonly prescribed medications for panic disorder, with SSRIs being preferred for long-term management due to their favorable side effect profile. Benzodiazepines are effective for rapid relief but should be used cautiously due to the risk of dependence. Novel treatments like intranasal midazolam and reboxetine offer additional options but require further research to establish their efficacy and safety. The choice of medication should be individualized based on the patient's specific symptoms, treatment response, and potential side effects.
Sources and full results
Most relevant research papers on this topic