Panic Disorder Treatment Overview

When to see a healthcare provider

If you have experienced symptoms of panic disorder and you have not been able to reduce them on your own, reach out to a mental health provider. A psychiatrist can help with medication management and a mental health professional can offer talk therapy.

If your panic disorder symptoms are causing you to avoid daily activities like leaving the house, going to work, or shopping at the grocery store, you should also see a mental health provider.

If you have become so overly concerned that something is wrong with your physical health that you have asked for a lot of medical tests, you should see a mental health provider.

Getting diagnosed

A psychiatrist or mental health professional will typically diagnose you based on your reported symptoms. They may use a standardized questionnaire like the Panic Disorder Severity Scale. They will also ask about your overall health and any medications you’re taking.

What to expect from your visit

If you are meeting with a psychiatrist or healthcare provider, they will likely talk to you about your symptoms, what triggers them, how often you have them, and your overall mental health. They will discuss treatment options, including medications and talk therapy. Medications may include ones that you take daily to help manage anxiety (and depression, if you have it) and medications you take only when you are having symptoms (for example, benzodiazepines).

What medication is best for panic disorder

SSRIs or selective serotonin reuptake inhibitors can be taken daily to help reduce anxiety and the frequency of panic attacks.

• Celexa (citalopram)
• Lexapro (escitalopram)
• Paxil (paroxetine)
• Prozac (fluoxetine)
• Zoloft (sertraline)

Benzodiazepines may be prescribed to take during a panic attack

• Ativan (lorazepam)
• Klonopin (clonazepam)
• Librium (chlordiazepoxide)
• Valium (diazepam)
• Xanax (alprazolam)

Talk therapy for panic disorder

A psychologist or social worker will work with you to find strategies that help prevent your panic attacks. They will discuss the mind-body connection, which gets short circuited during a panic disorder. And help you build tools to manage future episodes. They may also encourage exposure exercises that help you get more comfortable with the physiological sensations in your body that are causing cycles of fear.

Cognitive behavioral therapy for panic disorder

CBT therapists help you with a range of strategies including:

• Identifying negative thoughts or beliefs that may be triggering panic attacks (I am going to die, I have no control, etc.)
• Challenging these negative thoughts or beliefs and replacing them with healthier thoughts
• Building skills to manage panic symptoms like deep breathing and meditation
• Desensitization, where the therapist gradually introduces the things that trigger your panic in a safe space, and helps you manage your distress using the skills you’ve learned.

Psychodynamic therapy for panic disorder

• This therapy is based on the theory that we are shaped by our early childhood experiences, which create unconscious conflicts that can cause emotional symptoms. Your therapist will work with you to understand your early childhood experiences and how they are affecting you.

Types of providers that treat panic disorder

• A primary care provider can sometimes prescribe medications and may refer you to a mental health professional.
• A psychiatrist can help diagnose you and prescribe medications.
• A psychologist or social worker can offer talk therapy.

How to manage panic at home

It’s important to talk to a mental health provider, like a psychologist or social worker, to help you learn strategies to reduce your chance of having a panic attack. They can also give you strategies for reducing symptoms during a panic attack. Many of these strategies you can practice at home.

What to do during a panic attack

• Focus on deep breathing exercises, which can help reduce symptoms within 5–30 minutes.
  • Lengthening your exhale activates the “rest and digest” response and sends signals of safety to the rest of the body. In contrast, when you are afraid, breathing becomes shallow, which triggers the fight or flight response and creates panic.
  • Belly breathing, which is expanding your belly on your inhale and contracting on the exhale, can activate the rest and digest response.
  • Alternate nostril breathing is when you close off one of your nostrils with your thumb while breathing through the other nostril, and then close off the alternate nostril with your index finger while breathing through the opposite nostril. This slows down breathing and encourages deep inhales and exhales.
• Grounding techniques help you stay present in your surroundings, which can prevent panic from getting worse. Scan your environment for objects around the room and describe them to yourself in detail; for example, shape, color, size or texture. Grounding techniques can reduce symptoms within 5–30 minutes.
• Positive self-talk or affirmations such as “I am safe,” “I have control over my body,” can help you challenge catastrophic thinking.

Wellness and prevention

• Exercise like walking, jogging, or lifting weights can help manage long-term symptoms of panic disorder.
• Reduce or completely eliminate caffeinated beverages, which can increase anxiety and trigger heart palpitations.
• Try to practice relaxation exercises daily, like daily deep breathing, meditation, or yoga.
• Try to do self-care that helps you relax (a bath, reading a book, petting your dog, a hug from a loved one, journaling).
• Quit smoking if you smoke.
• Try to go to sleep at around the same time every night and wake up at the same time every morning to help your overall sleep.