What can i take for an anxiety attack

Panic disorder is a mental health condition that causes repeated panic attacks that affect a person’s overall quality of life.

We’ve all experienced moments of panic. Some moments are big, like being lost in a large city or coming face to face with a bear on a hiking trail. Some moments are small, like losing our car keys while trying to race out the door for work. Panic is a natural response to fear and stress in our lives and it happens to all of us at some point or another.

But what happens when we panic without the traditional presence of fear or stress? Often, we hear these called panic attacks, and they can seemingly come out of nowhere. If these attacks happen often, they may be a symptom of panic disorder.

Panic disorder is a type of anxiety disorder that currently affects around 6 million U.S. adults — close to 3% of the country’s population. Women are twice as likely as men to develop panic disorder. And it’s estimated that nearly 5% of U.S. adults will experience panic disorder at some point during their lifetime.

Let’s take a deeper look into what panic disorder is, what symptoms people typically experience, and what treatments are available.

What is panic disorder?

Panic disorder is a type of anxiety disorder where people have repeated panic attacks plus one of the following:

• Persistent worry about having more panic attacks and the effects those attacks could have

• Negative changes in behavior because of the attack — such as avoiding a location where you experienced a panic attack

You can have a panic attack without having or developing panic disorder. A panic attack is a single event. Panic disorder is when these unexpected panic attacks happen multiple times and the concerns of having another one greatly impact your day-to-day activities.

What are the symptoms of a panic attack?

We’ve already discussed the difference between a single panic attack and panic disorder. But just what does a panic attack look like?

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) — the official manual of all mental health conditions and their symptoms — a panic attack includes at least four of the following symptoms:

• A racing or pounding heart

• Sweating

• Trembling or shaking

• Feeling breathless

• Chest pain or discomfort

• Nausea or stomach-area pain

• Feeling dizzy, unsteady, light-headed, or faint

• Feeling chilly or hot

• Numbness or tingling

• Fear of being out of control or dying

• Feelings of being detached from yourself

Panic attacks are different for everyone. People may experience some or all of these symptoms. It’s also possible to experience others not on this list. If you feel you’ve had a panic attack, talk with your healthcare provider and describe everything that happened.

Can panic disorder be cured?

Everyone’s experience with panic disorder is unique. However, there is no known cure for this condition. Thankfully, panic disorder is treatable, and you can control symptoms with medications, behavioral therapies, or a combination of both. 

One study found that close to 65% of people with panic disorder experienced symptom remission (no panic attacks) within 6 months. But, of those who achieved remission, over 20% experienced a return of their symptoms. If your symptoms start again after having been under control for a while, discuss it with your healthcare provider, but know that this is common.

What medications can be used to treat panic disorder?

Medications that are FDA-approved to treat panic disorder fall into three classes: selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and benzodiazepines.

SSRIs

SSRIs are considered a first-choice group of medications for treating panic disorder. These medications work by raising serotonin levels in your brain. Serotonin is one of the neurotransmitters (chemical messengers) that help control your mood.

While experts are still unsure exactly how serotonin is linked to anxiety disorders, SSRIs are effective in lessening symptoms of panic disorder. SSRIs can also be used to treat other mental health conditions, such as depression and other types of anxiety.

Three SSRIs are currently FDA-approved to treat panic disorder:

Healthcare providers sometimes prescribe other SSRIs for panic disorder even though they are not FDA-approved for the condition. This is considered an off-label use, but guidelines suggest other medications in this class are similarly effective for this condition.

SNRIs

SNRIs work in a similar way to SSRIs. The major difference is which neurotransmitters SNRIs affect. In addition to serotonin, SNRIs also increase brain levels of norepinephrine — another chemical messenger connected with anxiety.

The only FDA-approved SNRI for panic disorder is extended-release (ER) venlafaxine(Effexor XR). Venlafaxine comes as an immediate-release tablet, an ER tablet, and an ER capsule. Only the ER capsule — and not the ER tablet — is FDA-approved for panic disorder. Other SNRIs haven’t been well-studied for treating panic disorder.

Benzodiazepines

Benzodiazepines are used to treat several conditions, including generalized anxiety disorder, panic disorder, and seizure conditions. These medications work by calming the central nervous system (CNS) — the brain and spinal cord. The two benzodiazepines FDA-approved to treat panic disorder are alprazolam (Xanax) and clonazepam (Klonopin).

Benzodiazepines are commonly used to treat an active panic attack because they begin to work quickly in the body. However, they do carry a risk of physical dependence and are generally less preferred than SSRIs for panic disorder in many cases.

Because of this, benzodiazepines are best used only for a short period of time — ideally no more than 2 to 4 weeks — while other medications are kicking in or only as needed for active panic attacks.

Aside from SSRIs, SNRIs, and benzodiazepines, treatment guidelines suggest that tricyclic antidepressants (TCAs) can also be used to treat panic disorder. These can include medications like imipramine, clomipramine (Anafranil), and nortriptyline (Pamelor). However, TCAs aren’t FDA-approved to treat panic disorder, and they tend to cause more side effects. 

What are the major side effects of panic disorder medications?

Even though these medications work in different ways, they can have some similar side effects. For example, SSRIs, venlafaxine ER, and benzodiazepines can all cause diarrhea, nausea, and drowsiness. However, there are notable differences between them.

SSRIs and venlafaxine ER

SSRIs and venlafaxine ER can take longer to start working than benzodiazepines. These medications must be taken every day and can take 4 to 6 weeks or more to kick in. SSRIs and venlafaxine ER are also known to cause bothersome side effects — such as sweating and sexual dysfunction — that are not typical with benzodiazepines.

SSRIs and venlafaxine ER also both carry a risk of a rare but serious complication called serotonin syndrome. This potentially life-threatening side effect is caused by the presence of too much serotonin in the body. Serotonin syndrome can become an emergency situation and requires medical attention.

Seek immediate help if you experience the following after starting an SSRI or venlafaxine ER:

• Fever

• Stiff or rigid muscles

• Vomiting

• Tremors (uncontrollable shaking)

• Unexplained agitation, confusion, or restlessness

• Excessive sweating

Benzodiazepines

As mentioned earlier, benzodiazepines carry a risk of dependence. This means that if you’ve been taking them regularly, you could experience withdrawal symptoms if you try to lower your dose or stop taking them. This may include symptoms like nausea, shaking, and anxiety.

Withdrawal symptoms are unique for everyone. But for some people, they can feel similar to panic attack symptoms.

If you notice more panic attack symptoms after starting to lower your benzodiazepine dose, let your provider know. They may need to readjust your dose.

Never attempt to stop or change the dose of your benzodiazepine without your healthcare provider’s OK. Your provider can help suggest an appropriate tapering schedule that lowers your risk of withdrawal symptoms.

Are multiple medications needed to control both panic disorder and panic attacks?

This is a tough question to answer, as the answer is different for everyone. While the medications discussed above are all effective for treating panic disorder, sometimes, a single medication may not be enough on its own.

For example, your healthcare provider may prescribe an SSRI or venlafaxine ER for you to take every day to help lower the number of panic attacks and a benzodiazepine to take only during an active panic attack. Your healthcare provider will work with you to develop a treatment plan that works best to treat your specific symptoms.

Are there any natural alternatives to panic disorder medication?

Medications aren’t the only option for treating panic disorder. There are several steps you can take to help calm yourself down and lessen the symptoms of a panic attack while it’s happening.

These techniques include:

• Removing yourself from the stressful situation or environment

• Listen to calming music

• Taking slow, deep breaths

• Counting slowly to 10

• Talking to someone you trust about what’s happening

Cognitive behavior therapy (CBT) is another non-medication option. CBT is a type of talk therapy where people with panic disorder work with a mental health professional to identify triggers, understand symptoms, and develop responses to panic attacks.

CBT is a first-choice option for treating this condition, and studies show CBT can be used by itself for panic disorder or as an add-on treatment to medications. Discuss this option with your healthcare provider if you’re interested.

The bottom line

Life can be stressful. Having a single panic attack related to stress may be a one-time event. But if you have multiple panic attacks or they affect your day-to-day life, it may be time to talk to your healthcare provider. There are several treatment options available to help you if your provider tells you that you have panic disorder.

Everyone experiences panic attacks differently. It is important to explain your symptoms to your healthcare provider so they know what you’re feeling. They can work with you to develop a plan that includes cognitive behavior therapy, medications, or both. 

GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.

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