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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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“Antidepressants may help body fight HIV and cancer” was the headline in The Independent recently. The newspaper article was on research that suggests that antidepressant drugs may help the immune system to fight off serious infection. The newspaper says the drugs could increase the activity of Natural Killer (NK) cells, a part of the immune system that targets cancerous and infected cells and induces “apoptosis” or “cell suicide”. The Daily Mirror focuses on the possible effect on cancerous cells, with a headline claiming “Big C hope for Prozac”.

Although the current research will be of scientific and medical interest, claims about the efficacy of antidepressants in HIV and cancer should not be made prematurely. This study involved laboratory research on blood samples from a specific group of women with HIV, and its findings cannot be generalised outside of this context. Much further research will be needed in people with HIV to see whether antidepressants could have any role in enhancing immunity.

At the current time, antidepressants should continue to be viewed in their role as treatments of depression, stress and anxiety - not as potential treatments for HIV or anti-cancer drugs.

Where did the story come from?

Dwight L. Evans and colleagues from the University of Pennsylvania School of Medicine carried out the research. The study was supported by a grant from the National Institute of Mental Health. The lead author is a consultant to a number of pharmaceutical companies, including the company that makes citalopram, the antidepressant that was used in the study.

The study was published in the peer-reviewed medical journal: Biological Psychiatry.

What kind of scientific study was this?

In this experimental laboratory study, the researchers investigated what controls the function of natural killer (NK) cells. NK cells are part of the immune system and protect the body from viruses and tumours. In people infected with HIV, the function of these cells progressively declines making them more susceptible to other infections and to the growth of new tumours.

It has been suggested that, possibly due to changes in the immune system, depression is a risk factor for more severe illness and increased risk of mortality in several diseases including HIV. There are three regulating systems in the human body that have been extensively studied for their potential effects on stress and depression; the serotonin, neurokinin and glucocorticoid systems. The researchers aimed to examine what effects the drugs aimed at inhibiting each of these systems would have on immune function.

In order to test this theory, the researchers recruited 51 women infected with HIV (80% black), half with depression and half without. They excluded any women with a chronic illness other than HIV, neurological disorders or history of schizophrenia or psychosis, alcohol or substance abuse, who were pregnant, or had used any antidepressant or anti-anxiety medications within the past month. More than three-quarters of the women (78%) were currently taking anti-retroviral (anti-HIV) therapy. Each woman received a full medical assessment and any diagnoses of depression or mood disorders were made using recognised criteria. During this assessment, a blood sample was taken so the researchers could look at the activity of immune cells in the sample. The samples were taken at the same time, each day in all women, to allow for any fluctuations in immune levels that can occur.

Blood samples were tested to determine the HIV viral load of each woman (the severity of infection with the virus) and to check the levels and function of different white blood cells, including NK cells, that make up the immune system. A specific subset of white blood cells that included NK cells was then purified from this blood sample, and separate samples of it were incubated with one of the drugs that acted on the regulatory systems being tested: an SSRI antidepressant (citalopram) that inhibits serotonin; a substance P inhibitor, CP-96345 (SP binds to a neurokinin receptor); and a glucocorticoid inhibitor, RU486 (mifepristone).

The researchers looked at the effects that these drugs had on the function of the NK cells. The drugs had previously been tested on blood samples from healthy donors to determine the drug concentrations needed to produce maximal NK cell activity without killing the cells.

They used statistical methods to look at the effects that each of the three drugs had on the NK cells of each woman’s blood sample, compared to her sample with none of the drugs present. They also looked at whether the effects on NK cells differed based on whether a woman was depressed, whether she was taking anti-retroviral therapy, or her viral load.

What were the results of the study?

Compared to the blood sample without any of the drugs, citalopram and the SP inhibitor CP-96345 both significantly increased NK cell activity. The two drugs were equally effective. The glucocorticoid inhibitor RU486 had no effect on NK activity.

Overall, there was no difference in the effect of the drugs between those women with depression and those without. The viral load and use of anti-retroviral therapy did not seem to make a difference on the effects that the drugs had on NK activity.

What interpretations did the researchers draw from these results?

The researchers concluded that, in the laboratory, an SSRI and an SP inhibitor both enhance NK activity in blood samples taken from HIV positive women. They say that clinical studies are needed to see whether NK activity can be improved in the patient, and to look at the potential role these drugs could have in delaying HIV progression or improving survival.

What does the NHS Knowledge Service make of this study?

Although the current research will be of scientific and medical interest, claims about the effects of antidepressants in HIV and cancer are premature.

- This study only involved laboratory research on blood samples. To date, there has been no investigation of the drugs’ effects on the immune system, HIV progression, or survival of living patients. These effects may differ from what happens when the drugs are applied directly to the blood sample.

- It is not possible to generalise the findings outside of this specific group, who are mostly black women with HIV. The women had different HIV viral loads, but the majority (60%) had undetectable levels and three-quarters of the 51 women were also taking current anti-retroviral therapy. The sample also didn’t include women with other chronic illnesses or any mental health conditions other than depression.

- The sample size was relatively small and could not reliably detect differing effects of each of the three drugs on NK activity between women with and without depression.

- The possible underlying mechanisms of how the antidepressant drugs could be affecting NK cells, e.g. whether they act directly on them or whether the increased activity is caused via other cell mediators, has not been studied and is unclear.

- It is only a theory that any increased NK activity caused by these drugs might help to fight cancer. The study did not investigate if this is true and the authors make no claims about any roles of these treatments in cancer prevention.

As the authors say, “These findings represent an initial step in identifying serotonin and substance P regulation of immunity in HIV infection.” Much further research will be needed in people with HIV to see whether the drugs could have any role as treatments to enhance immunity.

At the current time, antidepressants should continue to be viewed in their role as treatments of depression, stress and anxiety - not as potential treatments for HIV or anti-cancer drugs.

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Paxil is an antidepressant derived from the drug group SSRIs or selective serotonin reuptake inhibitors. The drug works by affecting chemical levels in the brain which may become unbalanced. Generically known as paroxetine, this antidepressant is sold as Paxil, Pexeva, and Paxil CR.

Paxil treatment for social anxiety disorders and other anxiety-related conditions like obsessive-compulsive disorder, premenstrual dysphoric disorder, and post-traumatic stress disorder has become increasingly recommended in recent years. The drug is may also be used for other conditions as deemed appropriate by your doctor.

Possible Side Effects of Paxil Treatment

Since Paxil works by affecting brain chemicals, it also has psychological and physical side effects. Psychological side effects may include the following:

* mood swings
* panic attacks
* anxiety
* irritability
* agitation
* aggressiveness
* mania
* restlessness
* self-destructive thoughts

Physical effects of taking Paxil may be caused by reactions to its psychological effects or intolerance to the medicine. Side effects may include the following:

* hyperactivity
* nausea
* headache
* sleeping problems

Contraindications

While Paxil is a highly effective medication against social anxiety, doctors still have reservations when prescribing it. There are several conditions which may make a patient ineligible to take Paxil. Some of the drugs contraindications are as follows:

* Pregnancy. Taking Paxil during pregnancy can cause fatal heart defects and lung problems in the newborn baby.

* Taking other drugs. Paxil may react negatively with other drugs that you are taking. Do not take Paxil if using other drugs like pimozide (Orap), thioridazine (Mellaril), or a monoamine oxidase inhibitor (MAOI) such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate).

* Liver and kidney diseases. Since taking medications can further weaken a diseased liver or kidney, patients who are suffering from these conditions may not be allowed to use Paxil.

* Bipolar disorder. People who are suffering from bipolar disorder or manic depression may not be a suitable candidate for Paxil treatment. Since Paxil affects the balance of brain chemicals, it may increase the frequency and intensity of a persons episodes.

It is best to consult a doctor before taking Paxil to ensure that the drug is safe for you to use. Be upfront about past and existing medical conditions which may cause Paxil to work differently on you.

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Bipolar disorder, or manic depression, is a mental illness that manifests itself as mood swings or mood cycling between depressed, manic, or normal moods. There are two types of bipolar disorder. The first type, sometimes called raging bipolar, manifests itself as almost constant mild mania, with periods of sever mania alternating with depression. Mixed episodes where the patient displays both manic and depressive symptoms at the same time can also occur with this type of bipolar disorder.

The second type, sometimes called rapid cycling bipolar, manifests itself as almost constant depression, with alternating periods of mania and severe depression that can often last a few hours or a few days before cycling to the next episode.

Depression symptoms include oversleeping, extreme sadness, feelings of worthlessness or despair, irritability, anger, and withdrawl. Manic symptoms include sleeplessness, increased energy levels, distractibility, racing thoughts, obsessive behaviors, and extreme happiness.

There are many treatment options for bipolar disorder. Most patients with bipolar disorder require a combination of medication and therapy or counseling for successful treatment of symptoms. However, minor cases of bipolar disorder may not require medication, but may require instead cognitive behavioral therapy. There are some cases, such as in patients with a history of drug abuse, where medication may be recommended but is not a viable treatment option. These cases typically also use cognitive behavioral therapy to assist patients in coping with their illness.

Celexa is an anti-depressant, commonly used with bipolar patients. Celexa, or citalopram, is a serotonin reuptake inhibitor, or SSRI. This family of medications has the effect of balancing serotonin levels in the brain, which are thought to be responsible for mood stabilization.

Celexa is most successful as a treatment for unipolar depression and bipolar disorder type two patients. This is because it is an anti-depressant. Serotonin, the chemical in the brain that balances moods and particularly controls strong emotions, often presents imbalances in the form of depression. Celexa corrects these imbalances, giving the patient relief from depression.

Celexa is most successful as a treatment for bipolar disorder type one patients when used in combination with a mood stabilizer. As an anti-depressant, Celexa alone causes bipolar disorder type one patients to swing into a manic episode. Used in combination with a mood stabilizer or anti-psychotic, however, can allow for a balance of moods to take place, ending rapid or raging mood cycling.

Celexa has several possible minor side effects when used for treatment of bipolar disorder. Common side effects include drowsiness, cotton mouth, nausea, and trouble sleeping. Less common side effects include abdominal pain, anxiety, gas, headache, heartburn, increased sweating, pain in muscles or joints, increases or decreases in weight, weakness, and vomiting. If these side effects persist or become unbearable, you should contact your doctor.

Celexa can also have several possible major side effects when used for treatment of bipolar disorder. Common major side effects include a decrease in sexual desire or ability. Less common major side effects include agitation, confusion, blurred vision, fever, increase in urinal frequency, lack of emotion, decreased memory, skin rashes, and trouble breathing. If you experience any of these side effects you should contact your doctor immediately.

Friends, family and patients with bipolar disorder should keep in mind that even when using anti-depressants such as Celexa, suicide, suicide threats, and suicide attempts can still occur. Always be aware of the signs that can lead to suicide so that medical treatment can be found before an attempt is made.

Bipolar disorder should, in all cases, be treated with a combination of Celexa, or other medications, in conjunction with therapy or counseling. Bipolar disorder patients are encouraged to take active part in their treatment plans. Additionally bipolar patients should not attempt to self medicate or treat symptoms with medication alone. If you show symptoms of bipolar disorder, you should contact your doctor about Celexa and other treatment options.

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Contact your local poison control center or emergency room immediately. Symptoms may include agitation; disorientation; drowsiness or deep sleep; fast heartbeat; impaired memory; loss of consciousness; rigid muscles; sluggishness.

Proper storage of Remeron:

Store Remeron at room temperature, between 68 and 77 degrees F (20 and 25 degrees C). Store away from heat, moisture, and light. Do not store in the bathroom. Keep Remeron out of the reach of children and away from pets.

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All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Abnormal dreams; abnormal thinking; constipation; dizziness; drowsiness; dry mouth; flu symptoms; increased appetite; weakness; weight gain.

Seek medical attention right away if any of these SEVERE side effects occur:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); decreased ability to fight infection (fever, chills, sore throat); mental or mood changes; mouth sores; thoughts of hurting yourself; tremors; worsening of depression.

This is not a complete list of all side effects that may occur. If you have questions or need medical advice about side effects, contact your doctor or health care provider.

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* Remeron may cause drowsiness or dizziness. These effects may be worse if you take it with alcohol or certain medicines. Use Remeron with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it.
* Children, teenagers, and young adults who take Remeron may be at increased risk for suicidal thoughts or actions. Watch all patients who take Remeron closely. Contact the doctor at once if new, worsened, or sudden symptoms such as depressed mood; anxious, restless, or irritable behavior; panic attacks; or any unusual change in mood or behavior occur. Contact the doctor right away if any signs of suicidal thoughts or actions occur.
* Lab tests, including liver function, kidney function, and complete blood cell counts, may be performed while you use Remeron . These tests may be used to monitor your condition or check for side effects. Be sure to keep all doctor and lab appointments.
* Remeron should not be used in CHILDREN; safety and effectiveness in children have not been confirmed.
* PREGNANCY and BREAST-FEEDING: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Remeron while you are pregnant. It is not known if Remeron is found in breast milk. If you are or will be breast-feeding while you use Remeron , check with your doctor. Discuss any possible risks to your baby.

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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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Effexor XR® (venlafaxine XR) and a number of other antidepressants are known to cause withdrawal symptoms in people who quickly stop their medicine.

Effexor XR withdrawal symptoms include, but are not limited to:

* Irritability
* Agitation
* Dizziness
* A burning or tingling sensation
* Anxiety
* Confusion
* Headache
* Insomnia
* Tiredness.

In most people, these withdrawal symptoms improve with time, without the need for any treatment.

Limiting Effexor XR Withdrawal

When a person is going to be taken off of Effexor XR, the doctor will wean him or her slowly to minimize the risks of developing Effexor XR withdrawal symptoms. If withdrawal symptoms do occur, the doctor may return the person to his or her original Effexor XR dosage and then wean him or her even more slowly.

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