Medicine for panic attacks
Pro Research Analysisby 
Searched over 200M research papers
Effective Medications for Panic Attacks
Introduction to Panic Attacks and Panic Disorder
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, sweating, shaking, dizziness, and breathlessness. Panic disorder, characterized by recurrent panic attacks, affects 1% to 4% of the general population 12. Treatment options for panic disorder include both psychological and pharmacological interventions, with a focus on antidepressants and benzodiazepines 12.
Antidepressants for Panic Disorder
Selective Serotonin Reuptake Inhibitors (SSRIs)
SSRIs are often recommended as the first-line treatment for panic disorder due to their favorable side effect profile compared to other antidepressants 2. Paroxetine and fluoxetine have shown strong evidence of efficacy in reducing panic symptoms 1. SSRIs are generally well-tolerated, although they may take several weeks to achieve their full therapeutic effect 12.
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
Venlafaxine, an SNRI, has also been effective in treating panic disorder, showing significant reductions in panic symptoms and frequency of attacks 1. However, SNRIs are generally ranked lower in efficacy compared to other classes of antidepressants 1.
Tricyclic Antidepressants (TCAs)
TCAs, such as imipramine and clomipramine, have been effective in treating panic disorder, often showing results comparable to benzodiazepines 16. However, they are associated with more side effects, which can limit their use 2.
Monoamine Oxidase Inhibitors (MAOIs)
MAOIs are another class of antidepressants that have shown efficacy in treating panic disorder, but their use is often limited due to dietary restrictions and potential side effects 12.
Other Antidepressants
Reboxetine, a selective norepinephrine reuptake inhibitor, has been found to be effective and well-tolerated in reducing panic attacks and associated symptoms 4. Mirtazapine and bupropion are also considered effective for short-term treatment 5.
Benzodiazepines for Panic Disorder
Benzodiazepines, such as diazepam, alprazolam, and clonazepam, are highly effective in the acute treatment of panic disorder 12. They provide rapid relief of symptoms, often within the first week of treatment, making them particularly useful for immediate symptom management 67. However, their use is limited by the potential for dependence and withdrawal symptoms 23.
Novel and Investigational Treatments
Recent research has explored novel treatments for panic disorder, including low-dose intranasal midazolam, which has shown promise in reducing the frequency of panic attacks with minimal side effects 3. Additionally, investigational drugs targeting the glutamate and orexin systems, as well as CRF1 and angiotensin II receptor antagonists, are being studied for their potential anti-panic properties 810.
Conclusion
Both antidepressants and benzodiazepines are effective in treating panic disorder, with SSRIs and benzodiazepines often being the first choice due to their efficacy and tolerability. Novel treatments and personalized approaches are being explored to improve outcomes for patients who do not respond to traditional therapies. Further high-quality studies are needed to confirm the efficacy and safety of these emerging treatments.
Sources and full results
Most relevant research papers on this topic
Pharmacological treatments in panic disorder in adults: a network meta-analysis.
Antidepressants and benzodiazepines are effective and acceptably treated for panic disorder, with benzodiazepines showing the highest effectiveness and acceptability.
Meta-AnalysisAntidepressants and benzodiazepines for panic disorder in adults.
Antidepressants and benzodiazepines show no significant difference in response rates for panic disorder in adults, with SSRIs being the first-line treatment.
Systematic Review
Very Rigorous JournalThe use of low-dose intranasal midazolam to treat panic disorder: a pilot study.
Low-dose intranasal midazolam shows promise as a novel alternative treatment for panic disorder, preventing incipient attacks and reducing the overall frequency of attacks.
RCTReboxetine, a selective norepinephrine reuptake inhibitor, is an effective and well-tolerated treatment for panic disorder.
Reboxetine is an effective and well-tolerated treatment for panic disorder, with significant reduction in panic attacks and phobic symptoms.
RCT
Highly CitedWhat are evidence-based medications for the treatment of panic attacks?
Antidepressants and benzodiazepines effectively reduce symptoms and attacks in panic disorder, with varying effectiveness depending on the antidepressant and benzodiazepine class.
Meta-AnalysisDrug treatment of panic disorder: the comparative efficacy of imipramine, alprazolam, and trazodone.
Imipramine and alprazolam effectively reduce panic disorder symptoms, while trazodone is less effective and poorly tolerated.
RCTHighly CitedA meta-analysis of treatments for panic disorder with agoraphobia: imipramine, alprazolam, and in vivo exposure.
Alprazolam is effective for panic and anxiety symptoms, while in vivo exposure is effective for phobias in panic disorder with agoraphobia.
Meta-AnalysisNovel investigational therapeutics for panic disorder
Novel anti-panic drugs targeting glutamate and orexin show promising potential, but more research is needed to overcome barriers in clinical development.
Literature ReviewThe pharmacotherapy of panic disorder.
Pharmacotherapy for panic disorder aims to reduce panic attacks, avoidance behavior, and comorbid conditions, while improving overall function and quality of life.
Are there advances in pharmacotherapy for panic disorder? A systematic review of the past five years
Expanding personalized approaches to existing medications and utilizing new technologies can potentially improve pharmacotherapy outcomes for panic disorder.
Systematic Review