[Medical Q&A] How to treat panic disorder?

Author: Wang Jinxiang, The Second Affiliated Hospital of Xinxiang Medical College

Reviewer: Guo Yanxiang, deputy chief physician, Shaanxi Province (Xi'an) Mental Health Center

The current treatment for panic disorder is mainly medication and cognitive behavioral therapy.

1. Drug treatment, such as ① Benzodiazepines: such as lorazepam, alprazolam, clonazepam, etc., which are effective in treating panic attacks. ② Serotonin reuptake inhibitors (such as sertraline, paroxetine, fluoxetine, escitalopram, etc.) and serotonin and norepinephrine reuptake inhibitors (such as venlafaxine, duloxetine, etc.) are effective in treating panic disorder, especially when panic disorder is comorbid with depressive disorder, and usually take effect in 2 to 3 weeks. ③ Tricyclic antidepressants: such as clomipramine, which are effective in treating panic disorder, but it is recommended to start with a small dose and not overdose. In clinical practice, benzodiazepines are usually combined with serotonin reuptake inhibitors (or serotonin and norepinephrine reuptake inhibitors). The patient's symptoms will improve faster at first, and benzodiazepines can be gradually discontinued after 5 to 6 weeks. Generally, the consolidation and maintenance treatment period is longer, at least 1 year.

2. Cognitive behavioral therapy: First, let the patient understand panic attacks, the intermittent nature of attacks, and the avoidance process. Second, interoceptive exposure, let the patient expose himself to the situation he fears, so that the patient can pay attention to these feelings, so that he can tolerate and control these feelings and no longer have panic attacks. Third, establish new cognition.

It is important to note that the goal of panic disorder treatment is to reduce or eliminate panic attacks, improve anticipatory anxiety and avoidance behavior, thereby improving quality of life and social function. During treatment, patients should know that panic attacks are the result of physiological and psychological disorders, and their physical symptoms usually do not lead to life-threatening situations. Through scientific treatment, panic attacks can be well controlled.