Treatment of panic disorder often involves both psychotherapy and medication. A therapist who specializes in treating panic disorder is optimal. According to a year-long study of 232 people with panic disorder treated at primary care clinics, sustained cognitive-behavioral therapy (gradual exposure to whatever brings on symptoms of anxiety) plus anti-anxiety medication is more effective than typical care (initial counseling and ongoing medication) for treating this type of anxiety.
Panic disorder may require more long-term drug therapy than other anxiety disorders (such as GAD). Tricyclic antidepressants and MAO inhibitors are sometimes used to treat panic disorder; both are 80 to 90% effective in blocking panic attacks but require six to 12 weeks to take effect. High doses of alprazolam (Xanax), a benzodiazepine, can be effective within a few days. While Xanax may cause fewer side effects than antidepressants, it is usually addictive (like all benzodiazepines).
In addition to benzodiazepines, the SSRIs fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft) as well as the SNRI venlafaxine (Effexor) are FDA approved for treating panic disorder. The tricyclics desipramine (Norpramin), imipramine (Tofranil), and nortriptyline (Aventyl, Pamelor) also may be used, although they do not have FDA approval for treating panic disorder. Beta-blockers, such as propranolol (Inderal) or atenolol (Tenormin), can halt the physical symptoms of panic attacks but do not prevent the fear or panic itself.
Regardless of the specific drug(s) used to treat panic disorder, about 30 to 60% of people with the disorder suffer a relapse of symptoms six to 12 months after they stop taking their medication.