Panic disorder: Should I take medicine?

Get the facts
Compare your options
What matters most to you?
Where are you leaning now?
What else do you need to make your decision?

1. Get the Facts

Your options

Take medicines for panic disorder.
Don't take medicines. Try home treatment and counseling to deal with your symptoms.

Key points to remember

Your decision to take medicines may depend on how much your symptoms bother you. Medicine may be a good choice if your panic attacks and anxiety get in the way of your daily life.
Two types of medicines work well for treating panic attacks. Benzodiazepines can help you feel better right away. You can take antidepressants for long-term treatment.
You may not need medicines if you are able to deal with your symptoms. Home treatment and counseling may be enough.
If you take medicines, follow your doctor's directions with care. You may have side effects such as headaches or trouble sleeping. Some medicines can treat both depression and panic attacks.
For many people, taking medicines along with getting counseling works best.¹
Don't feel bad about taking medicines. Panic disorder is a medical problem, not a weakness. The medicines won't change your personality.

FAQs

What is panic disorder?

When you have panic disorder, you have repeated, unexpected panic attacks. And you worry all the time about having another attack.

A panic attack is a sudden feeling of very bad anxiety. It may make you feel short of breath or dizzy or make your heart pound. An attack may last from 5 to 20 minutes or up to a few hours. You feel most anxious about 10 minutes into the attack.

What are the risks of panic disorder?

Panic disorder can lower your quality of life. It can get in the way of your daily life and work. If you have panic disorder, you are more likely to have other problems, including:

Depression.
Agoraphobia. This is a fear of being in public places.

What types of medicines are used for panic disorder?

The two types of medicines used most often are antidepressants and benzodiazepines. Some people use both.

Antidepressants include:
- Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil). These are the most common medicines for panic disorder.
- Tricyclic antidepressants (TCAs).
- Monoamine oxidase inhibitors (MAOIs).
- Antidepressants with mixed neurotransmitter effects, such as venlafaxine (Effexor).
Benzodiazepines include alprazolam (Xanax), diazepam (Valium), lorazepam (Ativan), and clonazepam (Klonopin). They are sometimes used for panic disorder. They may be used alone or with an antidepressant.
- These drugs can help you feel better right away. They may also be used as a part of long-term treatment, either alone or with an antidepressant.
- They may be especially helpful if you have agoraphobia.
- They can be taken as needed. But they can cause addiction (dependence). Symptoms often come back when you stop taking them.

What can you expect if you take medicines for panic disorder?

Antidepressants should help you start to feel better within 1 to 3 weeks. But it can take as many as 6 to 8 weeks to see more improvement.

Talk with your doctor if:

You don't notice any improvement by 3 weeks.
You have concerns or questions about your medicines.

The medicines may cause side effects, but these are usually mild. They may get better after a few weeks.

Benzodiazepines help relieve symptoms right away.

You may have to try more than one medicine to find one that works. Your doctor may have you switch to another medicine if the first one doesn't help.

What can you expect if you DO NOT take medicines for panic disorder?

If you don't treat panic disorder, it can get worse. This is more likely if you also have another problem that often occurs with it, such as agoraphobia or depression.

If you decide not to take medicines for panic disorder, keep track of how your symptoms affect your life and the lives of those around you. You can always start to take medicine if you feel you can't deal with your symptoms.

Even if you don't take medicine, you can try counseling, such as cognitive-behavioral therapy. It can help you to:

Deal with problems you are having right now.
Learn how to deal with future anxiety and panic attacks.

Other treatments include support groups and exercises that help you relax. For more information see:

Stress management: Doing progressive muscle relaxation.

Stress management: Doing meditation.

Why might your doctor recommend taking medicines?

Your doctor might advise you to take medicines if:

You have not been able to control your symptoms with other treatment.
You have other problems linked to panic disorder that could benefit from medicine, such as depression or problems with drugs or alcohol.

2. Compare Options

	Take medicines for panic disorder	Don't take medicines
What is usually involved?	For antidepressants, you take pills or liquids every day or on certain days of the month, for months or years. For benzodiazepines, you take pills or liquids as needed. You may also try counseling along with taking medicine.	You try counseling and home treatment to control your symptoms.
What are the benefits?	Medicines for panic disorder work well.	Counseling and home treatment help many people with panic disorder. You don't have side effects from taking medicine.
What are the risks and side effects?	Medicine may cause side effects such as: Nausea. Headaches. Nervousness. Tiredness. Trouble sleeping. Benzodiazepines can lead to addiction. (Antidepressants do NOT lead to addiction.)	Your panic disorder may get worse.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

For more information, see the topic Panic Attacks and Panic Disorder.

Personal stories about people deciding whether to take medicine to treat panic disorder

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"I was having lunch with some friends and suddenly began to feel strange—like I couldn't breathe and my heart was pounding. I didn't know what was happening; I thought I was having a heart attack. Although the symptoms began to go away after about 10 minutes, I went to the emergency room, where they did some tests and didn't find anything wrong. A week later, the same thing happened in the middle of the night. I went to see my doctor, and she suggested I may have had a panic attack. Since then, the attacks have been occurring at least once a week, and I have been diagnosed with panic disorder. Although each attack is still a horrible experience, I now know what is happening and that I will get through it. I have been going to therapy for several weeks and am learning how to deal with the symptoms of panic attacks. They are less frequent now and less intense. I think I can get through this without taking any medication. "

— Annie, age 32

"As an executive, I have to travel a lot for my job. A few months ago, I was boarding a plane for a business trip, and I began to feel very apprehensive. I felt trapped and got off the plane because I was shaking and sweating and my heart was pounding. I wasn't sure exactly what was wrong, but I felt like I was dying. I had a drink at the bar and was still shaky but took a later flight. After that I began to feel nervous if I even thought about flying, and I had several more similar attacks. Then I had an attack on the subway. I felt like everyone was watching me and there was no escape. I didn't even want to go to the office after that because I was afraid I could have an attack at any moment. My doctor says I have panic disorder and agoraphobia. I can hardly function, so I am going to take antidepressants and try exposure therapy. My doctor says a benzodiazepine would make the symptoms go away sooner, but I am worried they will make me too drowsy and they may be too hard for me to quit. "

— Manuel, age 43

"When I divorced my wife, Celia, I began to feel down and very anxious. As a contractor, I have to deal with people every day, and it seemed very hard to do my job when I felt so stressed out and depressed. I had my first panic attack when my dog got lost at a job. I knew he was probably fine and would soon come back, but with the stress of everything else it just seemed like more than I could handle. I felt awful; I was choking and had bad stomach cramps. Since then, I have had attacks like this nearly every day and a lot of the time I feel down in the dumps. I have been diagnosed with panic disorder and depression. I am going to therapy, and it seems to help a little, but I still have panic attacks and often feel like life is not worth living, and I feel anxious about interacting with people at all. At first I didn't want to take any medication, but after reading about it and talking it over with my doctor, I decided to start taking an antidepressant. "

— Louis, age 28

3. Your Feelings

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to take medicines for panic disorder

Reasons not to take medicines for panic disorder

I am willing to take medicine for at least several months, or longer if necessary.

I don't want to take medicines if at all possible.

More important

Equally important

More important

My panic disorder is not improving enough with counseling alone.

I want to continue counseling, without medicine, at least for a while.

More important

Equally important

More important

I think my symptoms may be worse than the possible side effects of the medicine.

I think the side effects of the medicine would be worse than my symptoms.

More important

Equally important

More important

My other important reasons:

More important

Equally important

More important

4. Your Decision

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Taking medicines

NOT taking medicines

Leaning toward

Undecided

Leaning toward

5. Quiz Yourself

Check the facts.

1. Taking medicine is the only way I can treat my panic disorder.

True
False
I'm not sure

You're right. Home treatments and counseling work well for some people. You may not need medicines if your symptoms are manageable.

2. There are two different kinds of medicines that I can take to help my panic disorder.

True
False
I'm not sure

That's right. Benzodiazepines are taken as needed to help relieve your symptoms. Antidepressants are taken every day for long-term treatment.

Decide what's next.

1. Do you understand the options available to you?

2. Are you clear about which benefits and side effects matter most to you?

3. Do you have enough support and advice from others to make a choice?

Certainty.

1. How sure do you feel right now about your decision?

Not sure at all

Somewhat sure

Very sure

2. Check what you need to do before you make this decision.

Nothing. I'm ready to take action.
I want to discuss the options with others.
I want to learn more about my options.

3. Use the following space to list questions, concerns, and next steps.

References

Citations

Kumar S, Oakley-Browne M (2007). Panic disorder, search date May 2006. Online version of BMJ Clinical Evidence. Available online: http://www.clinicalevidence.com.