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How are SSRIs Used in the Treatment of Panic Disorder?

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Updated October 22, 2013

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SSRIs are often used in the treatment of panic disorder.

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Question: How are SSRIs Used in the Treatment of Panic Disorder?

You may have heard that antidepressants can help treat panic disorder. One class of antidepressants, selective serotonin reuptake inhibitors (SSRIs), are often prescribed to treat panic disorder, anxiety, and panic attacks. Learn how SSRI's are used for the treatment of panic disorder.

Answer:

Selective Serotonin Reuptake Inhibitors, or simply SSRIs, refer to a specific class of antidepressant medications. When first introduced in the 1980s, SSRIs were used to treat depression. Now established to be effective in treating panic disorder, SSRIs include medications such as Prozac (Fluoxetine), Paxil (Paroxetine), Celexa (Citalopram), Lexapro (Escitalopram), Luvox (Fluvoxamine), and Zoloft (Sertraline).

As the name implies, SSRIs affect serotonin, which is a naturally occurring chemical or neurotransmitter in the brain. Serotonin is associated with the regulation of mood and is considered to be imbalanced in those with anxiety issues. SSRIs focus solely on the levels of serotonin (selective) by preventing its absorption (reuptake) by nerve cells in the brain. By stabilizing levels of serotonin, these medications decrease feelings of anxiety, regulate mood, and improve sleep making them effective in managing depression and anxiety.

Due to long-term effectiveness, limited side-effects, and validated research outcomes, SSRIs are the most commonly prescribed drug for panic disorder. If you are considering medication or are currently prescribed SSRIs, you may be wondering how this medication can help. Listed below are common ways in which SSRIs are used in the treatment of panic disorder.

Symptom reduction

By and large, a person with panic disorder is prescribed SSRIs to assist in decreasing troublesome symptoms. SSRIs have been found to decrease the frequency and intensity of panic attacks. Reducing the severity of attacks helps relieve the fear associated with future attacks, which is one of the most debilitating symptoms of panic disorder. SSRIs can make a huge difference for a person who has become afraid of leaving the home or is having difficulties engaging in other necessary activities.

Skill-building

Participating in therapy and self-help activities is an important part of the recovery process. Self-help strategies include breathing exercises and relaxation skills. A qualified therapist can provide Cognitive Behavioral Therapy (CBT), which involves developing new ways of thinking and behaving in order to cope with panic disorder.

Studies indicate that CBT alone is not as beneficial without SSRIs. CBT is a long-lasting aid in managing symptoms, but medication can assist in rapidly reducing symptoms, allowing for focus on techniques. When symptoms are under control, one may feel ready to practice exposure therapy, the gradual introduction to phobic situations to slowly build up a sense of confidence when faced with fear. For many people with panic disorder, exposure therapy is only possible with the support that SSRIs provide.

Treating co-occurring issues

SSRIs can not only serve to combat the symptoms of panic disorder, but can also alleviate coexisting issues. Other mental health issues, such as depression or different forms of anxiety, are often associated with panic disorder. Indicators of a mood disorder include such symptoms as fatigue, sadness, and diminished interest in previously pleasurable activities.

Substance abuse issues are also related to panic disorder. SSRIs can be safely prescribed in such instances. Unlike sedatives, such as Xanax, Ativan, or Valium, SSRIs are non-addictive. Since dependence is not an issue, SSRIs are prescribed for longer durations of time, increasing the chances of improvement.

As with any medication, there are some risks and side-effects associated with SSRIs. Some more serious side effects potentially include an increased chance of suicidal thoughts and behaviors, allergic reactions, and complications during pregnancy. These potential dangers are rare and should be explored with your doctor. Some of the more common side effects include nausea, headaches, weight changes, and sexual dysfunction. Due to the potential of experiencing drowsiness and dizziness typical of SSRIs, caution should be taken when driving or participating in other activities that require alertness.

Some of the commonly occurring side effects often fade over time. It can be helpful to track any side effects and progress you have experienced while taking an SSRI. Such information can assist your doctor in determining if dosage should be adjusted or medication changed. Typically, your doctor will start you out on a low dosage and increase amount as needed. Determining what dosage is right for you will require some patience. SSRIs can take some time to be effective, sometimes need several weeks to begin to see improvements and up to several months to reach their maximum effect. Even if you believe the medication isn’t working, don’t ever abruptly stop taking SSRIs. To avoid potential complications, discontinue use only under the guidance of your doctor.

Generally, most people with panic disorder will react positively to SSRIs. If you decide to try them as a part of your treatment plan, remember to remain patient, be prepared to discuss progress at each doctor visit, and expect to begin to feel relief from the symptoms of panic disorder.

Sources:

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders,4th ed. Washington, DC: American Psychiatric Association, 1994

Bourne, Edmund J. The Anxiety and Phobia Workbook, 4th ed. Oakland, CA: New Harbinger, 2005.

Dudley, William. Antidepressants. San Diego, CA: Reference Point Press, 2008.

Preston, John D., O'Neal, John H., Talaga, Mary C. Handbook of Clinical Psychopharmacology for Therapist, 6th ed. Oakland, CA: New Harbinger Publications, 2010.

Silverman, Harold M. The Pill Book. 14th ed. New York, NY: Bantam Books, 2010.

Van ApeLdoorn FJ, Van Hout WJ, Mersch PP, Huisman M, Slaap BR, Hale, et al. I s a combined therapy more effective than either CBT or SSRI alone? Results of a multi-center trial on panic disorder with or without agoraphobia." Acta Psychiatr Scand. 2008;117:260–70.

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