Talk therapy, especially cognitive behavioral therapy (CBT), and certain medications are often recommended to treat panic disorder. Still, there are also many home remedies and lifestyle changes you can try.
Maybe you’re here because you just received a panic disorder diagnosis.
While living with panic disorder can be challenging, know that effective treatment is available. You can get better. You’re already taking a step in the right direction.
Which treatment you try will depend on your preference, previous response to treatment, availability of treatment, and whether you have any co-occurring conditions like agoraphobia, depression, or bipolar disorder.
Psychotherapy, also called talk therapy, is often recommended as a first-line treatment for panic disorder.
While cognitive behavioral therapy (CBT) is the best known and most researched therapy for panic disorder, other psychotherapy methods are available too.
CBT for panic disorder
The National Institute for Health and Care Excellence, which provides evidence-based recommendations for health and care in England, recommends CBT as the first-line treatment for panic disorder.
CBT typically consists of 12 sessions at 60 minutes each week.
In CBT, your therapist will teach you about panic disorder, going over the causes of anxiety and how it works. For example, your therapist may speak on the role of the fight, flight, or freeze response in panic symptoms.
Your therapist will also teach you how to differentiate facts from common myths and beliefs, such as thoughts like “I’m losing control!” or “I’m having a heart attack!” that you may experience during a panic attack.
You’ll learn to closely monitor your symptoms and record panic attacks in a journal. This often includes jotting down triggers, symptoms, thoughts, and behaviors.
Your therapist will teach you how to practice relaxation techniques, too, such as progressive muscle relaxation.
Plus, you’ll examine the validity of your thoughts and change unhelpful or catastrophic beliefs, like “I’m too weak to handle this” or “What if that horrible thing does happen?” into more positive thoughts, like:
- “I’ve felt like this before and got through it.”
- “I am strong!”
- “There is no evidence to suggest that anything horrible will happen.”
In addition, your therapist will help you face uncomfortable sensations that normally trigger anxiety and help you learn to cope with them.
For example, you might spin around to trigger dizziness or breathe through a straw to trigger shortness of breath. Since you’ll be aware of the causes of these sensations, the feelings of dizziness or shortness of breath are unlikely to cause anxiety in the moment.
Then you’ll replace thoughts like “I’m going to die” with more helpful, realistic thoughts, such as “It’s just a little dizziness. I can handle it.”
You’ll also gradually face anxiety-provoking situations like driving or going to the grocery store, because not facing them is what feeds your fear.
You’ll reduce your avoidance behaviors as well. These may be anything from needing to be with others to having your cellphone or medication with you.
Lastly, you and your therapist will develop a plan to manage setbacks and prevent relapse.
While it can seem daunting to read about everything you’ll be doing as part of CBT, keep in mind that these exercises and steps will be spread out over several weeks.
Other forms of psychotherapy for panic disorder
CBT may not work for everyone, but other effective options are available.
Panic-focused psychodynamic psychotherapy (PFPP) and panic-focused psychodynamic psychotherapy extended range (PFPP-XR) appear to be effective for panic disorder and other anxiety disorders, though they’re less researched than CBT.
PFPP-XR consists of 24 sessions, two times a week. It’s divided into three phases. The content of these phases varies by person.
In the first phase, you explore the origins of your anxiety and discover the meaning of your symptoms. Having a deeper understanding of your anxiety, and knowing the source, can reduce anxiety and panic attacks.
In the second phase, you further identify the unconscious feelings and underlying conflicts of your anxiety symptoms.
In the third phase, you explore any conflicts or fears around ending therapy.
Other treatments for panic disorder include acceptance and commitment therapy (ACT) and mindfulness-based stress reduction (MBSR). Although more research is needed for MBSR and ACT, the results so far are promising.
One 2011 study of 68 people concluded that MBSR was effective at treating anxiety disorders, including panic disorder, though the researchers admitted that the study had limitations.
One 2016 study of 152 people observed that both guided and unguided online ACT treatment through a smartphone app helped reduce panic symptoms.
The researchers concluded that getting help through an app may at least partially compensate for being unable to see a therapist.
What if speaking with a therapist is not an option?
If you have health insurance, Medicare, or Medicaid, call your insurance provider to learn more about mental health coverage and to get a list of providers in your network.
If you don’t have insurance or are concerned about the costs of psychotherapy, affordable options are available.
Some therapists and clinics offer sliding scale or free services for people with no insurance or low incomes.
Asking your primary healthcare provider for their recommendations can be a good first step. You can also ask about any therapy apps or local support groups they recommend.
The National Alliance on Mental Illness (NAMI) HelpLine and
Medication is sometimes used to:
- prevent panic attacks
- reduce their frequency and severity
- decrease the associated anticipatory anxiety
Serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs)
When it comes to medication, the first-line treatment for panic disorder is selective serotonin reuptake inhibitors (SSRIs).
The Food and Drug Administration (FDA) has approved the following SSRIs for treating panic disorder:
- fluoxetine (Prozac)
- paroxetine (Paxil)
- sertraline (Zoloft)
Your healthcare provider may prescribe a different SSRI “off label” if the usual SSRIs for panic disorder aren’t working.
Sometimes healthcare providers prescribe serotonin-norepinephrine reuptake inhibitors (SNRIs). One example is venlafaxine (Effexor XR), which has also been FDA-approved for panic disorder.
It typically takes about 4 to 6 weeks to experience improvement with an SSRI or SNRI.
Fast-acting medications
If your symptoms are very acute and you can’t wait 4 to 6 weeks until an SSRI or SNRI becomes effective, your healthcare provider may prescribe an additional medication: a benzodiazepine, such as clonazepam (Klonopin).
Within hours, benzodiazepines can reduce:
- the frequency of panic attacks
- anticipatory anxiety
- avoidance behaviors
Benzodiazepines have a high potential for tolerance and dependency, so your healthcare provider will take into account your substance use history when prescribing them.
Benzodiazepines can also interfere with CBT. They’re best used short term.
Some side effects of benzodiazepines can include:
- drowsiness
- dizziness
- confusion
- impaired coordination
Because of these side effects and their potential for tolerance and dependency, your healthcare provider may decide to prescribe another fast-acting medication, such as:
Unlike benzodiazepines, these medications have a lower risk of tolerance, dependency, and intense discontinuation syndrome.
Talk with your healthcare provider about the pros and cons of fast-acting medications for your panic disorder.
Other drugs for panic disorder
Tricyclic antidepressants (TCAs) may also be effective in treating panic disorder.
Some TCAs your healthcare provider may prescribe include:
- nortriptyline (Pamelor)
- imipramine (Tofranil)
- clomipramine (Anafranil)
However, TCAs can come with side effects that aren’t well tolerated by many people, like:
- dizziness
- dry mouth
- blurred vision
- fatigue
- weakness
- weight gain
- sexual dysfunction
TCAs can also cause heart problems. They shouldn’t be prescribed to people with a history of heart disease.
Monoamine oxidase inhibitors (MAOIs) can be effective for panic disorder too.
Still, similar to TCAs, their side effects aren’t well tolerated for many people.
MAOIs also require dietary restrictions. MAOIs should never be combined with:
- SSRIs
- seizure medication
- pain medication
- St. John’s wort
What can I do to prepare for taking medication for panic disorder?
Overall, before starting any medication, it’s critical to talk with your healthcare provider about possible side effects.
For example, widely used SSRIs and SNRIs can cause:
- nausea
- headaches
- dizziness
- agitation
- excessive sweating
- sexual dysfunction, such as decreased sexual desire and the inability to have an orgasm
Make sure you also talk with your provider about discontinuation syndrome. It can occur with SSRIs and SNRIs, too.
Discontinuation syndrome causes withdrawal-like symptoms, such as:
- dizziness
- headache
- irritability
- agitation
- nausea
- diarrhea
Plus, you can feel like you have the flu with symptoms like tiredness, chills, and muscle aches.
This is why you shouldn’t abruptly stop taking your medication without first discussing it with your healthcare provider.
When you’re ready to stop taking your medication, you’ll slowly decrease your dose over time. Even this gradual process can still produce adverse effects.
Discontinuation syndrome can be very challenging, so be sure to ask your provider about this risk and how to prevent or minimize its effects.
Lastly, the decision to take medication, and which medication to take, should be a thoughtful, collaborative process between you and your healthcare provider.
Though psychotherapy and medication are considered first-line treatments for panic disorder, there are several things you can try on your own to help you feel better.
Exercise
Research has found that engaging in aerobic exercise can decrease symptoms of anxiety in people with panic disorder.
Build an exercise routine slowly. You can start with 20-minute sessions of whatever aerobic exercises you enjoy, like dancing, cycling, or walking.
Other types of exercise may also be beneficial. For example, one small
Practice breathing and relaxation techniques
Both breathing and relaxation techniques
Your healthcare provider or therapist may be able to teach you specific techniques.
You can also find many breathing and guided relaxation practices online, such as this audio exercise. There are also many apps you can download.
Some of these techniques may be particularly useful during a panic attack to help you feel grounded.
For example, if you experience a panic attack, try 4-7-8 breathing:
- Inhale on the count of 4.
- Hold your breath for 7 seconds.
- Exhale very slowly on the count of 8.
If holding your breath for this long is challenging, try a shorter duration, such as breathing in for a count of 4, holding your breath for 1 second, and then exhaling for a count of 4.
Read self-help books
There are many excellent books written by anxiety experts that can help you better understand and cope with anxiety and panic.
For instance, you might check out “When Panic Attacks” by David D. Burns, or “Mastery of your Anxiety and Panic: Workbook” by David H. Barlow and Michelle G. Craske.
When searching for books, be sure to check out reader reviews to evaluate how helpful a book may be.
If you’re meeting with a mental health specialist, ask them for recommendations.
Similarly, if you’re part of an online or in-person support group, ask what others have been reading and whether they found certain books particularly helpful.
Focus on self-care
Self-care can include things like:
- getting enough sleep
- taking restorative breaks throughout the day
- limiting anxiety-provoking substances, like caffeine, tobacco, or alcohol
For instance, to get enough sleep, you may want to create a calming bedtime routine and make sure your bedroom is a soothing space.
To take restorative breaks, try listening to a 5-minute guided meditation, stretch your body, or simply breathe deeply for a few minutes.
Be kind to yourself
Panic disorder management isn’t linear. You may feel frustrated at times and despise your anxiety, becoming angry with yourself.
During these moments is when it’s especially important to be kind, patient, and gentle with yourself.
Remind yourself that you’re not alone. Others are going through the exact same thing.
The National Institute for Mental Health reports that about
Remind yourself that you’re OK, even though you feel uncomfortable. Remind yourself that this isn’t permanent, and the symptoms will pass. Remind yourself that you can get through this.
Because you can.
If you’ve decided that it’s time to talk with a healthcare professional about your panic disorder and possible treatment options, it’s important to be your own advocate.
Being your own advocate can be difficult at times. To make it easier — and ensure you get your questions answered — prep before your visit.
Make a list of questions you want to ask, and bring this list with you to the appointment.
Some possible questions for your healthcare provider can include:
- Do you recommend psychotherapy, medication, or both? What are the risks and benefits of each treatment?
- If you recommend medication, when will it likely take effect?
- What are the medication’s potential side effects and ways to minimize them?
- What happens when I want to stop taking the medication?
- If you recommend psychotherapy, what kind of psychotherapy?
- Do you recommend any therapy apps?
- What tips do you have for helping a panic attack in the moment?
Don’t be afraid to bring up anything that concerns you. Remember, your healthcare provider is there to help you. You deserve to speak up and be heard.