Best medicine for anxiety and panic attacks

Medication is one of the most popular and effective treatment options for panic disorder, panic attacks, and agoraphobia. Your doctor may prescribe medication to reduce the intensity of panic attacks, decrease overall feelings of anxiety, and potentially treat co-occurring conditions, such as depression.

Medications for panic disorder are typically from one of two categories: antidepressants and anti-anxiety drugs.

This article discusses how medications are used to treat panic disorder and which medications are most often prescribed. It also covers some of the other treatment options that may be effective for panic symptoms.

Panic Disorder Treatment

Treatment for panic disorder may involve medication in addition to psychotherapy. In some cases, more than one medication may be prescribed to help manage symptoms of panic and anxiety.

For example, an antidepressant may be prescribed to help reduce the frequency of panic symptoms, while benzodiazepines may be used on an as-needed basis to help reduce the severity of panic attacks.

Psychotherapy can also be effective for treating panic disorder. Types of psychotherapy that may be helpful include cognitive behavioral therapy (CBT), exposure therapy, and panic-focused psychodynamic psychotherapy (PFPP).

How Long Do Panic Attacks Last?

Antidepressant Medications for Panic Disorder

When first introduced in the 1950s, antidepressants were primarily used to treat mood disorders. However, it was later discovered that these medications effectively help reduce anxiety, lessen the symptoms of panic, and decrease the intensity and frequency of panic attacks.

Antidepressant medications are now commonly used to treat many anxiety disorders, including panic disorder and agoraphobia.

Antidepressants affect the chemical messengers in the brain, known as neurotransmitters. There are thought to be many different types of these chemical messengers that communicate between brain cells.

Classes of Antidepressants for Treating Panic Disorder

Selective Serotonin Reuptake Inhibitors (SSRIs)

Selective serotonin reuptake inhibitors (SSRIs) are a popular class of antidepressants prescribed to decrease symptoms of anxiety and depression. Serotonin is a naturally occurring neurotransmitter in the brain.

These medications work by influencing only serotonin ("selective") and by preventing serotonin absorption ("reuptake") by the nerve cells in the brain. By balancing serotonin functioning, SSRIs are able to reduce anxiety and improve mood.

Common SSRIs include:

• Celexa (citalopram)
• Paxil (paroxetine)
• Prozac (fluoxetine)
• Zoloft (sertraline)

Studies have demonstrated the long-term effectiveness of SSRIs. These medications have also been found to cause limited side effects, making them the prescription medication of choice for panic disorder.

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

Serotonin-norepinephrine reuptake inhibitors (SNRIs) also block the reuptake of serotonin and norepinephrine. Norepinephrine is a neurotransmitter that plays a role in concentration and alertness. 

Common SNRIs include:

• Cymbalta (duloxetine)
• Effexor XR (venlafaxine)

Research has found that SNRIs are effective for treating anxiety disorders, particularly social anxiety disorder. Side effects can occur while taking SNRIs and may include fatigue, insomnia, changes in appetite, and changes in sexual function.

Tricyclic Antidepressants (TCAs)

Tricyclic antidepressants (TCAs) have become less popular in treating anxiety and mood disorders since SSRIs were introduced. However, TCAs can still be an effective treatment option for people with anxiety disorders.

Like SSRIs, TCAs work to block the reuptake of the chemical messenger serotonin. Additionally, many TCAs also prevent the reuptake of norepinephrine, another neurotransmitter in the brain that is often associated with the fight-or-flight stress response.

Common TCAs include:

• Adapin, Sinequan (doxepin)
• Asendin (amoxapine)
• Elavil (amitriptyline)
• Norpramin (desipramine)
• Pamelor (nortriptyline)
• Surmontil (trimipramine)
• Tofranil (imipramine)
• Vivactil (protriptyline)

Monoamine Oxidase Inhibitors (MAOIs)

Monoamine oxidase inhibitors (MAOIs) are one of the earliest developed antidepressants used to effectively treat mood and anxiety disorders. MAOIs work by inhibiting the activity of the enzyme monoamine oxidase. 

This enzyme is involved in breaking down neurotransmitters like norepinephrine, serotonin, and dopamine. Dopamine helps regulate many functions, including movement, physical energy levels, and feelings of motivation.

Common MAOIs include:

• Emsam (selegiline)
• Nardil (phenelzine)
• Marplan (isocarboxazid)
• Parnate (tranylcypromine)

Despite their effectiveness, MAOIs are prescribed less frequently due to necessary dietary restrictions when taking them and the potential for significant drug interactions that can occur when taking MAOIs with other medications.

Anti-Anxiety Medications

Anti-anxiety medications are prescribed for their fast-acting relief of panic symptoms. These medications work to relax the central nervous system, which can lower the intensity of panic attacks and cause a person to feel calmer.

Due to their tranquilizing effect and rapid relief, anti-anxiety medications are often prescribed to treat panic disorder.

Benzodiazepines

Benzodiazepines are the most commonly prescribed class of anti-anxiety medication for panic disorder. Known for their sedative effect, these medications can quickly reduce panic attack symptoms and induce a more relaxed state.

Benzodiazepines slow down the central nervous system by targeting the gamma-aminobutyric acid (GABA) receptors in the brain, inducing a sense of relaxation. In spite of the potential risks and side effects of these medications, benzodiazepines have been found to safely and effectively treat panic disorder.

Common benzodiazepines include:

• Ativan (lorazepam)
• Klonopin (clonazepam)
• Librium (chlordiazepoxide)
• Valium (diazepam)
• Xanax (alprazolam)

Benzodiazepines can be habit-forming, so they are typically prescribed for short-term relief of anxiety symptoms.

Recap

Benzodiazepines are a type of anti-anxiety medication that can offer rapid relief from symptoms of anxiety and panic. They are effective but can produce physical dependence.

A Word From Verywell

Medication can be helpful in the treatment of panic disorder and panic attacks, particularly when utilized in combination with psychotherapy. If you are experiencing symptoms of anxiety or panic, talk to your healthcare provider about which medications may be right for you.

If you or a loved one are struggling with anxiety, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.

For more mental health resources, see our National Helpline Database.

Frequently Asked Questions

• How do I handle a panic attack without medication?

  Psychotherapy can be very helpful for treating panic attacks. During a panic attack, deep breathing can help you manage hyperventilation, a symptom that can play a role in increasing feelings of fear. Other strategies such as grounding techniques, mindfulness, and progressive muscle relaxation can also be helpful for preventing and relieving feelings of panic.

  Learn More: Why Panic Attacks Cause Shortness of Breath

• How do I ask my doctor for panic attack medication?

  The best way to ask is to be direct. Tell your doctor that you are experiencing panic attacks and need medication to help manage these symptoms. Your doctor should then ask more about your symptoms, suggest medications that can help, and talk to you about the potential side effects.

• What kind of non-habit-forming panic attack medication is there?

  Non-habit-forming medications that can help with panic attacks and anxiety include SSRIs, SNRIs, and beta-blockers. Others that may be helpful include Buspar and Vistaril. 

• How long does panic attack medication take to work?

  Benzodiazepines are fast-acting and work to relieve anxiety symptoms right away. This is why they are a good option for short-term relief of panic attacks. Antidepressants often begin offering some relief within one to three weeks, but it may take several weeks to begin feeling the full effects of the medication.

  What medicine helps with panic attacks fast?

  The two benzodiazepines FDA-approved to treat panic disorder are alprazolam (Xanax) and clonazepam (Klonopin). Benzodiazepines are commonly used to treat an active panic attack because they begin to work quickly in the body.

  What is the best medicine prescribed for anxiety?

  SSRIs and SNRIs are often the first-line treatment for anxiety. Common SSRI brands are Celexa, Lexapro, Luvox, Paxil, and Zoloft. Common SNRI brands are Pristiq, Cymbalta, and Effexor XR.

  Does anxiety medication stop panic attacks?

  Medications can help alleviate the symptoms of panic attacks and reduce the risk of a future attack. Examples include antidepressants, benzodiazepines, and beta blockers. All medications can cause side effects, and a person must discuss these with a doctor before taking a drug.

  What are the top 3 anxiety medications?

  The most prominent of anti-anxiety drugs for the purpose of immediate relief are those known as benzodiazepines; among them are alprazolam (Xanax), clonazepam (Klonopin), chlordiazepoxide (Librium), diazepam (Valium), and lorazepam (Ativan).