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Treatment for panic attacks and panic disorder is very effective. The goal of treatment is to eliminate all of your panic attack symptoms. With effective treatment, most people are eventually able to resume everyday activities. The main treatment options for panic attacks are medications and psychotherapy. Both are equally effective.

Medications

Medications can help reduce symptoms associated with panic attacks, as well as depression if that’s an issue for you. Several types of medication have been shown effective in managing symptoms of panic attacks, including:

* SSRIs. These medications are in the class of antidepressants called selective serotonin reuptake inhibitors. Because these medications are generally safe and have a low risk of causing serious side effects, SSRIs are typically recommended as the first choice in medication options to treat panic attacks. They include citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Prozac Weekly), paroxetine (Paxil, Paxil CR) and sertraline (Zoloft).
* SNRIs. These medications are in the class of antidepressants called serotonin and norepinephrine reuptake inhibitors. They include duloxetine (Cymbalta) and venlafaxine (Effexor, Effexor XR).
* TCAs. These medications are in the class of antidepressants called tricyclic antidepressants. While effective, they pose a risk of serious side effects, including heart and blood sugar problems. They include desipramine (Norpramin), imipramine (Tofranil) and nortriptyline (Pamelor).
* Benzodiazpines. These medications are mild sedatives. They belong to the group of medicines called central nervous system (CNS) depressants. Benzodiazepines may be habit-forming (causing mental or physical dependence), especially when taken for a long time or in high doses. These include alprazolam (Xanax), clonazepam (Klonopin) and lorazepam (Ativan).
* MAOIs. These medications are in the class of antidepressants called monoamine oxidase inhibitors. Because they can cause life-threatening side effects and require strict dietary restrictions, they’re not commonly prescribed. They include phenelzine (Nardil), tranylcypromine (Parnate), isocarboxazid (Marplan) and selegiline (Emsam).

If one medication doesn’t work well for you, your doctor may recommend switching to another or combining certain medications to boost their effectiveness. Keep in mind that it can take several weeks after first starting a medication to notice an improvement in your symptoms. All medications have a risk of side effects, and some may not be recommended in certain situations, such as pregnancy. Be sure to talk to your doctor about the possible side effects and risks.

Psychotherapy

Psychotherapy, also called counseling or talk therapy, can help you understand panic attacks and panic disorder and how to cope with them. The main type of psychotherapy used to treat panic attacks and panic disorder is cognitive behavioral therapy. Some experts recommend that you have therapy with a psychiatrist or psychologist with experience in treating panic disorder.

Cognitive behavioral therapy can help you change thinking (cognitive) patterns that trigger your fears and panic attacks. It can also help you change the way you react (behave) to anxious or fearful situations. During therapy sessions, you learn to recognize things that trigger your panic attacks or make them worse, such as specific thoughts or situations. You also learn ways to cope with the anxiety and physical symptoms associated with panic attacks. These may include breathing and relaxation techniques.

In addition, working carefully with your therapist, you may re-create the symptoms of panic attacks in the safety of his or her office. This is an important step because it can help you learn to control and master the symptoms so that they don’t continue to be a source of intense fear. Doing this can also help you overcome fear of certain situations that you may avoid, such as crowded malls or driving.

Your therapist may suggest weekly meetings when you first start treatment. You may start to see improvements in panic attack symptoms within several weeks, and often symptoms go away within several months.

As your symptoms improve, maintenance therapy with visits once a month can help ensure that your panic attacks remain under control. Eventually you can stop therapy when your symptoms completely go away, which may be a year or so. However, panic attack symptoms do sometimes come back. Seek prompt treatment if they do, and make sure that you’re managing any stressful life situations.

There’s no sure way to prevent panic attacks or panic disorder. However, getting treatment for panic attacks as soon as possible may help stop them from getting worse or becoming more frequent. Sticking with your treatment plan can help prevent relapses or worsening of panic attack symptoms. Practicing relaxation and stress management techniques can be helpful, too.

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* you are allergic to any ingredient in Remeron
* you are taking furazolidone
* you are taking or have taken a monoamine oxidase inhibitor (MAOI) (eg, phenelzine) within the last 14 days

Contact your doctor or health care provider right away if any of these apply to you.

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Generic Name: Venlafaxine (VEN la fax een)
Brand Names: Effexor, Effexor XR

Effexor is an antidepressant in a group of drugs called selective serotonin and norepinephrine reuptake inhibitors (SSNRIs). Effexor affects chemicals in the brain that may become unbalanced and cause depression.

Effexor is used to treat major depressive disorder, anxiety, and panic disorder. Effexor may also be used for purposes other than those listed in this medication guide.

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Your doctor may occasionally change your dose to make sure you get the best results from the medication. Follow the directions on your prescription label.

Take this medication with a full glass of water. Effexor should be taken with food. Swallow the controlled-release capsule (Effexor XR) whole, without crushing or chewing. To make the medication easier to swallow, you may open the capsule and sprinkle the medicine into a small amount of applesauce. Swallow all of the mixture without chewing, and do not save any for later use.

Try to take Effexor at the same time each day. It may take 4 weeks or more for your symptoms to improve. For best results, keep using the medication as directed. Do not stop using Effexor without first talking to your doctor. You may have unpleasant side effects if you stop taking this medication suddenly. Store Effexor at room temperature away from moisture and heat.

Wyeth-Ayerst Laboratories, the pharmaceutical division of American Home Products Corporation announced that the U.S. Food and Drug Administration (FDA) has approved a new label change for its antidepressant Effexor® XR (venlafaxine HCl) Extended-Release Capsules for use as a long-term treatment for generalized anxiety disorder (GAD).

Effexor XR is the first and only antidepressant now indicated for short- and long-term benefits for people with GAD.

“Today’s FDA decision marks a significant milestone in the treatment of GAD since, for the first time, physicians and patients have an approved long-term therapy for this disorder,” says L. Patrick Gage, PhD, President, Wyeth-Ayerst Research. “Because symptoms of GAD persist for years, often decades, patients require a treatment like Effexor XR that provides long-term symptom relief from their uncontrollable, exaggerated, and persistent worries, anxiety, and tension. Effexor XR provides a treatment option that can effectively reduce symptoms of GAD to help patients get well and return to a normal life.”

GAD is characterized by persistent (lasting six months or longer), excessive anxiety, worry, and tension about routine life events. With the new approval, Effexor XR is now the first and only antidepressant approved as a long-term therapy for GAD, an anxiety condition that affects nearly 5 percent of people, two thirds of whom are women. GAD is one of the most common anxiety disorders contributing to the nearly US$46 billion spent annually on these conditions.

The FDA reviewed data from two randomized, double-blind, placebo-controlled trials of 595 patients in the United States, which showed that Effexor XR (venlafaxine HCl) provided significant improvements in symptoms of generalized anxiety disorder (GAD) for up to six months, compared with placebo.

These long-term studies found that patients with GAD who were treated with Effexor XR experienced significant reductions in symptoms of anxiety, based on various psychiatric measures including the Hamilton Anxiety Scale (HAM-A), as well as the more specific HAM-A psychic anxiety factor score. Treatment benefits were maintained, and further improvement shown, for up to six months. Additionally, more patients treated with Effexor XR reported symptom improvement — based on the Hospital Anxiety and Depression Scale (HAD) anxiety subscale — as compared with placebo, and more showed a normalization of social impairment.

“Effexor XR is the only antidepressant proven effective as first-line therapy for both short- and long-term treatment of GAD,” says Dr. Gage. “This new data is important from a treatment perspective because, unlike some anti-anxiety medications, the long-term use of Effexor XR has not been associated with potential dependence.”

Effexor XR, a once-daily formulation, received FDA marketing clearance for the treatment of depression in 1997. Unlike the selective serotonin reuptake inhibitors (SSRIs) Prozac, Paxil, Zoloft, and Celexa, which selectively inhibit the reuptake of only the neurotransmitter serotonin, Effexor XR (venlafaxine HCl) inhibits the reuptake of both serotonin and norepinephrine.

In 1999, Effexor XR received approval for the treatment of generalized anxiety disorder (GAD) based on clinical studies supporting symptom improvement for up to eight weeks. This new label change for long-term use in GAD reinforces the efficacy of Effexor XR for up to six months in patients with this disorder.

The most common adverse events reported in Effexor XR placebo-controlled depression trials (incidence >10 percent and >2x that of placebo) were nausea, dizziness, somnolence, abnormal ejaculation, sweating, dry mouth, and nervousness; and in GAD trials were nausea, dry mouth, insomnia, abnormal ejaculation, anorexia, constipation, nervousness, and sweating. Effexor XR is contraindicated in patients taking monoamine oxidase inhibitors (MAOIs).

Treatment with venlafaxine is associated with sustained increases in blood pressure (BP) in some patients. Three percent of Effexor XR patients in depression studies (doses of 75 to 375 mg/day), and 0.4 percent in GAD studies (doses of 75 to 255 mg/day), had sustained BP elevations. The incidence of sustained increases in BP at doses greater than 300 mg/day has not been fully evaluated. Less than 1 percent discontinued treatment because of elevated BP. Experience with immediate release venlafaxine in depression studies showed that sustained hypertension was dose related, increasing from 3 percent to 7 percent at doses of 100 to 300 mg/day, to 13 percent at doses above 300 mg/day. Regular BP monitoring is recommended.

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A panic attack is a sudden episode of intense fear that develops for no apparent reason and that triggers severe physical reactions. Panic attacks can be very frightening. When panic attacks occur, you might think you’re losing control, having a heart attack or even dying.

You may have only one or two panic attacks in your lifetime. But if you have panic attacks frequently, it could mean that you have panic disorder, a type of chronic anxiety disorder.

Panic attacks were once dismissed as nerves or stress, but they’re now recognized as a real medical condition. Although panic attacks can significantly affect your quality of life, treatment — including medications, psychotherapy and relaxation techniques to help prevent or control panic attacks — is very effective.

Signs and symptoms

Panic attack symptoms can make your heart pound and cause you to feel short of breath, dizzy, nauseated and flushed. Because panic attack symptoms can resemble life-threatening conditions, it’s important to seek an accurate diagnosis and treatment.

Panic attack symptoms can include:

* Rapid heart rate
* Sweating
* Trembling
* Shortness of breath
* Hyperventilation
* Chills
* Hot flashes
* Nausea
* Abdominal cramping
* Chest pain
* Headache
* Dizziness
* Faintness
* Tightness in your throat
* Trouble swallowing
* A sense of impending death

You may have a few or many of these panic attack symptoms. Panic attacks typically begin suddenly, without warning. Panic attack symptoms usually peak within 10 minutes and last about half an hour. But panic attacks have many variations. They may last hours or, on rare occasions, up to a day. You may feel fatigued and worn out after a panic attack subsides. One of the worst things about panic attacks is the intense fear that you’ll have another panic attack.

If you have frequent panic attacks, you may have a condition called panic disorder. Panic attacks can greatly interfere with your life — and perhaps even endanger you or others.

Panic attacks can strike at almost any time without warning — when you’re driving the school car pool, at the mall, sound asleep or in the middle of a business meeting. And you may fear having a panic attack so much that you avoid situations where they may occur. You may even be unable to leave your home (agoraphobia), because no place feels safe.

Causes

It’s not known what causes panic attacks or panic disorder. Things that may play a role include:

* Genetics
* Stress
* Certain changes in the way parts of your brain function

Some research suggests that your body’s natural fight-or-flight response to danger is involved in panic attacks. For example, if a grizzly bear came after you, your body would react instinctively. Your heart rate and breathing would speed up as your body prepared itself for a life-threatening situation. Many of the same reactions occur in a panic attack. But it’s not known why a panic attack occurs when there’s no obvious danger present.

Treatment

Treatment for panic attacks and panic disorder is very effective. The goal of treatment is to eliminate all of your panic attack symptoms. With effective treatment, most people are eventually able to resume everyday activities. The main treatment options for panic attacks are medications and psychotherapy. Both are equally effective.

Medications

Medications can help reduce symptoms associated with panic attacks, as well as depression if that’s an issue for you. Several types of medication have been shown effective in managing symptoms of panic attacks, including:

* SSRIs. These medications are in the class of antidepressants called selective serotonin reuptake inhibitors. Because these medications are generally safe and have a low risk of causing serious side effects, SSRIs are typically recommended as the first choice in medication options to treat panic attacks. They include citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Prozac Weekly), paroxetine (Paxil, Paxil CR) and sertraline (Zoloft).
* SNRIs. These medications are in the class of antidepressants called serotonin and norepinephrine reuptake inhibitors. They include duloxetine and venlafaxine (Effexor, Effexor XR).
* TCAs. These medications are in the class of antidepressants called tricyclic antidepressants. While effective, they pose a risk of serious side effects, including heart and blood sugar problems.
* Benzodiazpines. These medications are mild sedatives. They belong to the group of medicines called central nervous system (CNS) depressants. Benzodiazepines may be habit-forming (causing mental or physical dependence), especially when taken for a long time or in high doses.
* MAOIs. These medications are in the class of antidepressants called monoamine oxidase inhibitors. Because they can cause life-threatening side effects and require strict dietary restrictions, they’re not commonly prescribed.

If one medication doesn’t work well for you, your doctor may recommend switching to another or combining certain medications to boost their effectiveness. Keep in mind that it can take several weeks after first starting a medication to notice an improvement in your symptoms. All medications have a risk of side effects, and some may not be recommended in certain situations, such as pregnancy. Be sure to talk to your doctor about the possible side effects and risks.

Psychotherapy

Psychotherapy, also called counseling or talk therapy, can help you understand panic attacks and panic disorder and how to cope with them. The main type of psychotherapy used to treat panic attacks and panic disorder is cognitive behavioral therapy. Some experts recommend that you have therapy with a psychiatrist or psychologist with experience in treating panic disorder.

Cognitive behavioral therapy can help you change thinking (cognitive) patterns that trigger your fears and panic attacks. It can also help you change the way you react (behave) to anxious or fearful situations. During therapy sessions, you learn to recognize things that trigger your panic attacks or make them worse, such as specific thoughts or situations. You also learn ways to cope with the anxiety and physical symptoms associated with panic attacks. These may include breathing and relaxation techniques.

In addition, working carefully with your therapist, you may re-create the symptoms of panic attacks in the safety of his or her office. This is an important step because it can help you learn to control and master the symptoms so that they don’t continue to be a source of intense fear. Doing this can also help you overcome fear of certain situations that you may avoid, such as crowded malls or driving.

Your therapist may suggest weekly meetings when you first start treatment. You may start to see improvements in panic attack symptoms within several weeks, and often symptoms go away within several months.

As your symptoms improve, maintenance therapy with visits once a month can help ensure that your panic attacks remain under control. Eventually you can stop therapy when your symptoms completely go away, which may be a year or so. However, panic attack symptoms do sometimes come back. Seek prompt treatment if they do, and make sure that you’re managing any stressful life situations.

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