I am a psychiatrist in Austin, Texas specializing in the treatment of adults, including adults with Panic Disorder. One of the most helpful classes of medications for anxiety is the SSRI medications (Celexa, Lexapro, Paxil, Prozac, Zoloft). Once a patient has been on a therapeutic dose of an SSRI medication for a month, many will experience a decrease in their overall level of anxiety along with a reduction in frequency and intensity of panic attacks. However, for some people with Panic Disorder starting a new medication can be difficult. People with Panic Disorder can become so sensitized to their body’s own sensations, that normal sensations such as an increase in heart rate with exercise can trigger a panic attack. For these people, taking a new medication which may potentially have side effects can feel very frightening; sometimes to the extent that taking the first dose can trigger a panic attack. There are a couple of techniques that can help with this. One possibility is to have the patient take the first dose of their SSRI medication along with a dose of a mild sedative medication like Ativan or Klonopin. The Ativan or Klonopin helps to reduce the sensations of anxiety and prevent a panic attack. Another possibility is to start the medication at an extremely low dose and titrate up as the patient feels comfortable. Some SSRI’s such as Lexapro actually come in a liquid formulation so that the dose can be increased as slowly as one drop at a time to the target dose. Often during the first month of medication therapy, a patient may have to rely on taking Ativan or Klonopin to treat panic attacks as they occur but as they stabilize on their SSRI medication, they will have fewer instances where they need to take Ativan or Klonopin for panic attacks. The goal is that the SSRI medication will decrease or eliminate panic attacks and decrease the severity of any panic attacks that do occur, and also decrease anticipatory anxiety about having panic attacks and help the person feel more comfortable to be in situations or places they previously avoided due to fears or having panic attacks.
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Disclaimer: The information in these posts is not guaranteed to be accurate or complete. It is not meant to serve as medical advice, and your reading of it does not establish a physician-patient relationship with Dr. Cynthia Benton. If you have any questions about this information, please contact your doctor.