The main aim of treatment for panic disorder is to reduce the amount of panic attacks that you have, and to help ease the severity of your symptoms.

What are the treatment options for panic disorder?

There are two main forms of treatment for panic disorder - psychological therapy and medication. Depending on your individual circumstances, you may require either one of these types of treatment or a combination of the two.

Before you begin any form of treatment your GP will discuss all of your options with you, outlining the advantages of each form of treatment, while also making you aware of any possible risks or side effects. This is because no single treatment is best for everyone, and which treatment is recommended will depend on your general health and the severity of your condition, as well as your personal preferences.

It is important that you understand what your treatment will involve. If you do not understand something your GP has told you, make sure that you ask them to explain it in more detail.

Cognitive behavioural therapy

Cognitive behavioural therapy (CBT) is thought to be one of the most effective forms of treatment for panic disorder. CBT is a psychological form of treatment, and will involve you having weekly sessions where you talk to a therapist.

For example, they may talk to you about the way you react when you have a panic attack, and what you think about when you are experiencing an attack.

Once you and your therapist have identified negative thoughts and beliefs, you can work on replacing them with more realistic and balanced ones. Your therapist can also teach you ways that you can change your behaviour, which should make it easier for you to deal with future panic attacks. For example, they may be able to show you breathing techniques which can be used to help keep you calm during the stress of a panic attack.

The National Institute for Health and Clinical Excellence (NICE) recommend that you have a total of seven to 14 hours of CBT, which is to be completed within a period of four months. Your treatment will normally involve having a one-to-two-hour session, once a week.

Self-help techniques

There are a number of self-help techniques that you can use to help treat your symptoms yourself. Some of these techniques are listed below.

Creative visualisation

During a panic attack, lots of things can go through your mind. Some people think about disaster, or even death. Instead of letting your imagination focus on these negative thoughts and images, try and establish some positive visualisations.

Think of a place or a situation that makes you feel peaceful, relaxed, or at ease. Once you know what this image is, you can try to focus your attention on visualising this scene. It should help to distract you from the situation, and in turn may help ease your symptoms.

Try not to fight a panic attack

Fighting a panic attack can often make the experience worse. Trying to fight it and then finding that you are unable to can increase your sense of anxiety and panic.

Instead, during a panic attack, reassure yourself by accepting that although it may seem embarrassing and your symptoms may be difficult to deal with, your attack is not life-threatening. Focus on the fact that your attack will have an end, and try your best to let it pass.

Relaxation

If you have panic disorder, you may feel constantly stressed and anxious, often primarily about when your next panic attack may be. Learning to relax can help to relieve some of this stress and tension, and may also help you to deal more effectively with your panic attacks when they happen.

Some people find complementary therapies, such as massage and aromatherapy, help them to relax. Others find activities such as yoga, or pilates, helpful. You can also practice breathing and relaxation techniques, which you can then use during a panic attack to help ease your symptoms.

Exercise

Regular exercise, particularly aerobic exercise, will help you to combat stress and release tension. It can also encourage your brain to release the chemical serotonin, which can help to improve your mood.

You should be aiming to do a minimum of 30 minutes of vigorous exercise, at least five days a week. Vigorous exercise should make you feel out of breath and tired, but not to the point where it is unbearable. Jogging, cycling, and swimming are good examples of moderate exercise.

However, if you have not exercised before, or for a long time, before starting a new exercise programme you should talk to your GP about your current health and fitness level.

Support groups

Support groups will be able to provide you with useful advice about how you can effectively manage your panic disorder, and they are also a good way of meeting other people who have similar experiences of the condition.

Panic attacks can be frightening and isolating, and it can be helpful to know that other people are experiencing the same feelings and emotions.

Support groups often involve face-to-face meetings where you can talk about your difficulties and problems with others. Many support groups can also provide support and guidance over the telephone, or in writing. Ask your GP about local support groups for panic disorder in your area.

Antidepressant medication

Although many people associate antidepressant medicines with depression, they can also be used to treat a number of other psychological conditions. Research has shown that antidepressants can help to prevent panic attacks in more than half of all cases of panic disorder.

Antidepressants can take between two to four weeks before they become effective. It is therefore very important to continue taking your antidepressant medication, even if you feel it is not working. You should only stop taking prescribed medication if your GP specifically advises you to do so.

Selective serotonin reuptake inhibitors (SSRIs)

Selective serotonin reuptake inhibitors (SSRIs) are a form of antidepressant which work by increasing the level of a chemical in your brain called serotonin.

SSRIs are the most commonly prescribed form of antidepressant for the treatment of panic disorder. They are normally started at a low dose before gradually being increased as your body adjusts to the medicine. Common side effects of SSRIs include:

• nausea,
• low sex drive,
• blurred vision,
• diarrhoea or constipation,
• dizziness,
• dry mouth,
• loss of appetite,
• sweating,
• feeling agitated, and
• insomnia (not being able to sleep).

When you first start taking SSRIs, your feelings of anxiety and panic may seem to get worse. However, in the majority of cases this is only temporary, and you will usually find that your symptoms start to return to normal levels within a few days of taking the medicine. Speak to your GP if you feel that your symptoms have worsened, and are not showing signs of returning to normal levels after a few days.

When you start taking a SSRI, you should see your GP after two, four, six, and 12 weeks in order to check your progress, and to see if you are responding to the medicine. Not everyone responds well to antidepressant medicines, so it is important that your progress is carefully monitored.

If your GP feels it is necessary, you may require regular blood tests or blood pressure checks when taking antidepressant medication. If after 12 weeks of taking the medication you do not show any signs of improvement, your GP may try prescribing an alternative SSRI for you to see if that has any effect.

How long will I have to take an SSRI for?

The length of time that you have to take an SSRI will vary, depending on how well you respond to the treatment.

Even if you feel that your panic disorder has been successfully treated, it is likely that you will need to keep taking the medication for at least six to 12 months. If this is the case, and you stop taking your SSRI medication before this time, the risk of your symptoms recurring once you stop taking the medication may be increased. Some people may have to take SSRIs for longer than six to 12 months.

When you and your GP decide that it is appropriate for you to stop taking your SSRI medication, you will gradually be weaned off it, by slowly reducing your dosage. However, you should never stop taking your medication unless your GP specifically advises you to.

Even when taken for a suitable length of time, approximately half of all people whose symptoms have been treated while taking SSRIs find that their panic attacks return once they stop taking the medication.

For some people this means having to take SSRIs on a long-term basis. For others, a course of cognitive behavioural therapy can help to reduce the risk of your symptoms recurring.

Tricyclic antidepressants

If SSRIs do not help to improve your symptoms, your GP may try prescribing you a different type of antidepressant. Tricyclic antidepressants work in a similar way to SSRIs. They help to regulate the levels of certain chemicals in your brain (noradrenaline and serotonin) which, in turn, helps affect your feelings and mood.

SSRIs are prescribed before tricyclic antidepressants because they have fewer side effects. Common side effects of tricyclic antidepressants include:

• constipation,
• difficulty urinating,
• blurred vision,
• dry mouth,
• weight gain,
• drowsiness,
• sweating, and
• lightheadedness.

The two tricyclic antidepressants that are often prescribed to treat panic disorder are imipramine and clomipramine.

Referral

If medication, CBT, or attending a support group do not improve your panic disorder, you may have to be referred to a mental health specialist.

A mental health specialist will carry out an overall re-assessment of your condition. They will ask you about your previous treatment, and how effective you found it. They may also ask you about things in your life that may be affecting your condition, or how much support you get from family and friends. Your specialist will then be able to devise a treatment plan for you, which will aim to effectively treat your symptoms.

The type of mental health specialist that you are referred to will depend on your individual situation. You may be referred to one or more of the specialists described below.

Psychiatrists

Psychiatrists train as medical doctors, and then choose to specialise in mental health. A psychiatrist is one of the only mental health specialists who is able to prescribe medication.

Clinical psychologists

Clinical psychologists are trained in the scientific study of human behaviour and mental processes. They focus solely on the assessment and treatment of mental health conditions. A clinical psychologist will help you to find ways of effectively managing your anxiety and your panic attacks.