Medicines Used In The Treatment Of Panic Disorder

There are several different types of medications used either singly, or in combination with one another to relieve the symptoms of panic disorder and other anxiety disorders.

SSRI's and Panic Disorder

SSRI stands for Selective Serotonin Reuptake Inhibitor.

This group of medications is being prescribed more and more often, due to the absence of such harsh side effects. Also, this is the newer class of medicines being used for panic disorder.

There are seven SSRI's, Luvox (fluvoxamine), Paxil (paroxetine), Prozac (fluoxetine), Celexa (Citalprolam), Lexapro (escitalopram) Zoloft (sertraline), and Fluvoxamine (used to be Luvox but is no longer manufactured as that) available in the US at this time. Luvox is generally only used for Obsessive Compulsive Disorder though, so I don't go into details about it on this page.

SSRI's, like all anti-depressants, are supposed to elevate your mood by making serotonin more available in your brain, which means that messages in the form of nerve impulses are going to be more readily transferred and dealt with. You will generally see some effect of taking these meds after several weeks, usually 2 to 4. It can take several months of taking this type of medicine before you get the full effect. However, the side effects can be noted within a short time, often within the first few days. For this reason, many doctors prescribed a benzodiazapine (benzo's include xanax and others) type medicine to take until the SSRI kicks in.

General Information

» Prozac - 1988 - Manufactured by Eli Lilly & Co.
» Zoloft - 1991 - Manufactured by Pfizer, approved by FDA for panic disorder, with or without agoraphobia in July of 1997.
» Paxil - 1992 - Manufactured by SmithKline Beecham, approved in may of 1996 for treatment of panic disorder and OCD. Available in 10, 20, 30 & 40mg tablets.
» Effexor - 1993 - Manufactured by Wyeth. Available in 25, 37.5, 50, 75 and 100mg tablets. In capsule form (Effexor XR - 1997) it is available in 37.5, 75 and 150mg sizes.
» Celexa - July 17, 1998 - Manufactured by Forest Labs
» Lexapro - August 14, 2002 - Manufactured by Forest Labs - available in 5, 10, and 20mg tablets, as well as a 5mg oral solution.

What SSRI's Treat

» Anorexia Nervosa
» Anxiety
» Bulimia
» Depression
» Obsessive-Compulsive Disorder
» Panic
» Premenstrual Tension
» Substance Abuse Disorders

Common Side Effects of SSRI's

» Headache
» Excessive Sweating
» Nausea
» Upset Stomach
» Diarrhea
» Sleep disturbances
» Drowsiness
» Tremor
» Weight gain
» Decreased libido

SSRI's are extremely expensive if there are no generic forms available for them. Effexor, Effexor XR, Celexa and Lexapro have no generic form at this time (December 2004.) They work effectively in about 70% of people who take them for panic disorder as instructed by their physician. Because of their expense, and to ensure maximum benefit, doses should be kept to the lowest working level for you. More is not necessarily better - do not alter your dose of any medication without consulting your doctor first.

Standard Dosing For SSRI's

» Lexapro - 5mg/day for one week, then a weekly increase to therapeutic level, 20mgs daily.
» Celexa - 20mg/day for one week, then an increase to 40mg/day, maximum 80mg/day
» Paxil - 10mg/day or 20mg/day to start, max at 50mg/day.
» Prozac - 20mg/day to start, max at 80mg/day
» Zoloft - 25mg/day or 50mg/day to start, max at 200mg

Fact: You are NOT supposed to drink alcohol while taking an SSRI.

Fact: Paxil and Zoloft stay in your system a shorter amount of time than Luvox and Prozac - if you are going to switch to a new medication, it takes longer for what is called "the washout period", which means DELAYS in switching meds. Switching to a MAOI type medicine will be held up for five weeks if you were taking Prozac, 1-2 weeks if you were taking Luvox, Paxil or Zoloft.

Fact: Studies show that pregnant woman can take SSRI's. Talk to your doctor about this.

FYI - Many woman see an increase in sexual functioning, however men seem to see a decrease while taking an SSRI. Sexual dysfunction is one of the effects of taking this type of medicine, and is often seen after several weeks (6) of treatment.

FYI - Effexor and Effexor XR, Serzone, Wellbutrin, Desyrel, as well as the groups of antidepressants known as Tricyclic Antidepressant and MAO Inhibitors all work on serotonin also, but they differ in their effect, which other chemicals they affect, and their actions.

Tricyclic Antidepressants and Panic Disorder

The group of medicines classed as Tricyclic Antidepressants refer to the following medicines:
» Anafranil (clomipramine)
» Asendin (amoxapine)
» Aventyl and Pamelor (nortriptyline)
» Elavil (amitriptyline)
» Norpramin (desipramine)
» Sinequan (doxepin)
» Surmontil (trimipramine)
» Tofranil (imipramine)
» Vivactil (protriptyline)

How They Work
Tricyclic antidepressant compounds work in your brain to inhibit serotonin reuptake as well as norepinephrine. Following is a quote from this site regarding how tricyclics work in your brain.

"Over time, the tricyclics enhance the concentrations in certain regions of the Central Nervous System (CNS) of two neurotransmitter chemicals, norepinephrine and serotonin, whose underactivity has been implicated in depression and other disorders. When these neurotransmitters, known as monoamines, have been secreted, they must then be inactivated by a variety of mechanisms including reuptake into the secreting cells. Tricyclics impede this reuptake process so that the monoamines remain active longer after secretion, presumably affecting the preexisting underactivity which was responsible for the target symptoms. Some tricyclic side effects relate to the fact that these medications have similar effects on other neurotransmitters in the CNS, notably histamine and acetylcholine." ---- Eliot Gelwan M.D.

This class of meds is one of the older antidepressants, with Tofranil (imipramine) being used back in the 50's. There is no worry of addiction with these drugs. It takes from 1 to 3 weeks to get benefit from these meds, and possibly up to 6 weeks. You should be prepared to feel worse, before you feel better - but if you can push through the initial side effects, listed below, you might find that this is the medicine for you.

If, however, you find that you can not stand the side effects, don't just stop taking this medicine without consulting your doctor first. Abruptly stopping treatment will make you feel horrible - headaches, stomach problems, sleeping problems - and can be avoided by a "tapering off" of the dose.

Many people believe that taking an antidepressant will suddenly make the world a better place, give them a sense of elation, purpose, and strength. This isn't quite the way it works though - although a person who has a "lifting of symptoms" of panic disorder may feel a sense of elation, giving them a feeling of newfound strength and will.

What Tricyclics Treat

» ADD with or without hyperactivity
» Agoraphobia without panic attacks
» Bulimia
» Depression
» Migraine headache
» Narcolepsy
» Obsessive-Compulsive Disorder
» Panic Disorder
» Various other chronic pain syndromes

Common Initial Side Effects of Tricyclics

» Anxiety
» Brainfog - inability to concentrate normally
» Feverish feeling
» Increased perspiration
» Restlessness
» Sleep difficulties
» Trembling

The previous listed initial symptoms are usually only temporary, but are probably the reason that most people discontinue taking the medication within the first few days of weeks of treatment. Since it takes a few weeks for the full effect of this medicine, the initial symptoms will usually have gone away or become bearable by the time that the medicine starts working fully.

Common Side Effects of Tricyclics

» Blurred Vision
» Constipation
» Dilation of Pupils
» Dizziness when standing up quickly
» Dry Eyes
» Dry Mouth
» Palpitations
» Rapid Heartbeat
» Sedation
» Sensitivity to Light
» Sexual Dysfunction
» Urinary Hesitancy
» Weight gain

Because of the possibility of cardiovascular effects, tricyclics are not for everyone, and as always you must be sure to completely thorough in discussing your patient history with your doctor. If you have heart problems, this isn't the medicine for you - especially in higher doses.

Along with these common side effects (keep in mind, not everyone gets all of these side effects!) of Tricyclics, a person can expect to feel a lessening in intensity and frequency of their panic symptoms. An added bonus is that you may begin to think more clearly and better, sleep better, have a lessening of disturbing dreams - also a lessening of dreams altogether may be noted. You may feel more energy and begin eating "like your old self" again.

You can not use alcohol or other sedatives such as sleeping pills and tranquilizers while taking tricyclics because their effect will be magnified. Always consult your doctor.

There are some cold medicines and stomach remedies that you shouldn't take with tricyclics, either. Check with your doctor or pharmacist.

You can take vitamins and other over the counter medicines with this type of antidepressant, but it is always good to check with your doctor or pharmacist first.

No food interactions to worry about with this medicine, either.

Benzodiazapines and Panic Disorder

Xanax (alprazolam), Klonopin (clonazepam), Ativan (lorazepam). These medications take effect quickly, usually getting a severe attack under control within an hour or less. Most people do very well on these medications, there aren't really alot of bothersome side effects, and the ones that do exist are easy to put up with. Just not panicking is wonderful, so the side effects aren't a big worry. One worry is that this class of meds can be addictive, but that isn't common for people suffering from panic disorder.

Some patients take these medications on an "as needed" basis, and others take them daily.

Stay tuned to this page, more on Benzo's coming soon!

Monoamine Oxidase Inhibiters (MAOI's) and Panic Disorder

Phenelzine is the most commonly used. There are dietary warnings that go along with this class of medications. A rise in blood pressure can occur if certain drugs, or foods are taken. Carefully follow your physicians instructions.

Chart

Key: GAD = Generalized Anxiety Disorder

OCD = Obsessive Compulsive Disorder

PTSD = Post Traumatic Stress Disorder

SAD = Social Anxiety Disorder

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Disclaimer: This information is for educational purposes only. Speak with your doctor if you have questions about a medication or are experiencing side effects from your medication. This chart is from http://www.adaa.org