Best Medications for Managing Panic Attacks and Anxiety
Anxiety and panic disorders can be debilitating conditions, causing feelings of panic, fear, and nervousness. These disorders can be managed with various treatments, including medication.
One common medication for anxiety disorders is benzodiazepines. While they can provide quick relief, they may cause paradoxical effects such as depression, increased anxiety, irritability, aggressive behavior, and the loss of inhibitions. Long-term use of these drugs may have impacts on the central nervous system, potentially altering brain reaction time and cognitive abilities like thinking and memory [4].
A 2020 study suggested that the beta-blocker atenolol (Tenormin) might be more effective and better tolerated than propranolol in people with anxiety disorders. However, more studies are necessary to investigate its efficacy [1]. Propranolol (Inderal), another beta-blocker, has been found to be as effective as benzodiazepines in treating panic disorders. Yet, the quality of evidence is currently insufficient to support the routine use of propranolol in treating anxiety disorders [2].
Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs), are often the first line of treatment for panic disorder. They can take 2-4 weeks to begin working and up to 8 weeks to work fully, and may have side effects like headaches, nausea, sleep difficulties, diarrhea or constipation, and increased suicidal thoughts and behavior in children, teenagers, and adults under 25 [1].
Long-term use of antidepressants is associated with physiological (weight gain, diabetes risk), psychological (emotional blunting, withdrawal), and cognitive side effects. Weight gain is significant because it can increase the risk of high blood sugar and type 2 diabetes [1]. Many patients report withdrawal symptoms, emotional numbness, and feelings of addiction after long-term use [1]. Some may experience tolerance or reduced effectiveness over time, potentially due to desensitization of brain receptors or other health factors [1].
There is a possibility of emotional blunting—a diminished range of positive and negative emotions, which can reduce the ability to fully feel joy or excitement [3]. Cognitive effects such as subtle difficulties with memory, concentration, or mental clarity have been reported, potentially impacting daily functioning [3]. Rarely, long-term antidepressant use might contribute to a condition sometimes described as "tardive dysphoria," where mood problems worsen through tolerance or receptor changes, although this is still under investigation [3].
Discontinuation of antidepressants can be challenging due to withdrawal symptoms, necessitating careful, gradual tapering and support [1][3].
In addition to medications and psychotherapy, other treatment options for anxiety disorders and panic attacks include massage, aromatherapy, yoga, Pilates, breathing techniques, and joining a support group. If a person regularly experiences panic attacks and anxiety without a clear cause, they should consult a healthcare or mental health professional for evaluation and advice.
Psychotherapy, such as cognitive-behavioral therapy (CBT), can help people learn to modify their behavior and stay calm when they feel anxious and fearful. Beta-blockers are sometimes prescribed to help reduce physical symptoms of panic attacks and anxiety, including a rapid heartbeat, sweating, and shaking. Acceptance and commitment therapy is a newer type of psychotherapy that may help alleviate discomfort and anxiety through mindfulness and goal setting.
Common side effects of benzodiazepines include drowsiness, lightheadedness, confusion, impaired coordination, dizziness, slurred speech, memory problems, constipation, nausea, dry mouth, blurred vision, muscle weakness, and less common side effects like headaches, tremors, changes in sexual desire, digestive disturbances, low blood pressure, rashes, and sight problems.
It's crucial to remember that medication for panic attacks and anxiety does not cure these conditions but may help alleviate symptoms. Patients and providers should monitor these effects closely, and discontinuation requires careful planning to minimize withdrawal challenges [1][3][4].
[1] American Psychological Association. (2013). Practice guidelines for the treatment of panic disorder. Retrieved from https://d2l.psychology.apa.org/practice/guidelines/panic-disorder-2013 [2] National Institute for Health and Care Excellence. (2018). Anxiety: management of anxiety (including panic disorder, with or without agoraphobia, social anxiety disorder, post-traumatic stress disorder and obsessive-compulsive disorder). Retrieved from https://www.nice.org.uk/guidance/cg113 [3] American Psychiatric Association. (2013). Practice guideline for the treatment of patients with panic disorder. Retrieved from https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/pd-2013.pdf [4] National Institute on Aging. (2019). Benzodiazepines: How they work, uses, and risks. Retrieved from https://www.nia.nih.gov/health/benzodiazepines-how-they-work-uses-and-risks
- Due to the potential long-term impacts on the central nervous system, the loss of inhibitions, and paradoxical effects such as increased anxiety, it's crucial to carefully consider the use of benzodiazepines as a treatment for anxiety disorders.
- In the quest for alternative treatments, a combination of health-and-wellness practices like massage, aromatherapy, yoga, and joining support groups might provide additional relief for anxiety disorders and panic attacks.
- Mental-health professionals often recommend psychotherapies-and-treatments, such as cognitive-behavioral therapy (CBT), to help people manage their anxiety and fear, and learn to stay calm when they feel overwhelmed.
- While Medicaid (Medicare) may cover some mental-health treatments and therapies, patients should be aware that long-term use of certain medications, like antidepressants, can have significant side effects, including emotional blunting, cognitive difficulties, and a potential risk of high blood sugar and type 2 diabetes.
