What treatments should I be offered for panic disorder?

Some treatments may not be suitable for you, depending on your exact circumstances. If you have questions about specific treatments and options covered, please talk to a member of your healthcare team.

Psychological treatment, medication and self-help have all been shown to be effective in treating panic disorder. Studies of different treatments found that the benefits of psychological treatment lasted the longest.

Different treatments will suit different people, so your healthcare professional should discuss the options with you. Whatever you decide, the chosen treatment should be available promptly.

During treatment you may be asked to complete a questionnaire at intervals to help you and your healthcare professional decide whether your symptoms are getting better.

Psychological treatment

If you decide to have psychological treatment, you should be offered cognitive behavioural therapy (which is sometimes shortened to CBT). CBT helps you to understand how your problems, thoughts, feelings and behaviour affect each other.

You should receive between 7 and 14 hours of treatment in total. This is usually provided as weekly sessions of 1–2 hours each, and the total treatment should be completed within 4 months.

During your CBT you should see your GP or other primary care health professional regularly to assess how you are doing.

Medication

If you are considering taking medication to treat your panic disorder, your healthcare professional should discuss with you:

  • the risks of the different options

  • whether you have tried medication for your panic disorder before and how well it worked for you

  • possible interactions with other medications

  • the potential side effects and what would and would not be tolerable for you.

If you and your healthcare professional decide on medication:

  • You should be offered an antidepressant, which should be a type called a selective serotonin reuptake inhibitor (sometimes shortened to SSRI), licensed[1] for the treatment of panic disorder. If that is not suitable for you, you should be offered imipramine or clomipramine (these belong to a group of medicines known as 'tricyclic antidepressants'). Although imipramine and clomipramine don't have a licence for use in the treatment of panic disorder, they have been shown to be effective[1].

  • You should not be prescribed a type of medication known as an antipsychotic, a sedative antihistamine or a benzodiazepine.

  • When you are prescribed a medication, your healthcare professional should discuss with you how it will work and all of its potential side effects.

  • Whichever medication your healthcare professional prescribes, you should be told that, although antidepressants are not addictive in the way alcohol or cigarettes can be, you might experience unpleasant symptoms (called 'discontinuation symptoms') when you stop taking it, miss a dose or reduce the dose.

  • You should contact your healthcare professional if you experience discontinuation (withdrawal) symptoms that cause you concern.

Each time you start a new type of medication you should see your healthcare professional 2, 4, 6 and 12 weeks after starting the treatment so that you can both decide whether to continue or consider another treatment.

Self-help

There are many things you can do yourself that can be successful in reducing panic attacks. If you and your healthcare professional decide on self-help, you should be offered one or both of the following:

  • access to support groups (sometimes run by people who have experienced panic disorder themselves)

  • advice on exercise, which can improve mood.

During the self-help programme you should see your healthcare professional regularly, usually every 4–8 weeks.

What happens if I don't feel better after psychological treatment, medication or self-help?

If you have tried one type of treatment and it hasn't worked, your healthcare professional should discuss with you whether to try another type of treatment. (For example, if you have tried psychological treatment, your healthcare professional may offer you medication or self-help.)

If you have tried any two treatments (two of psychological treatment, medication or bibliotherapy) and you still have significant symptoms, your healthcare professional should discuss with you whether you wish to have an appointment with a specialist.

Specialist care

In specialist care you may meet with a psychiatrist, a psychiatric nurse, a clinical psychologist, an occupational therapist or a social worker. The specialist may offer psychological treatment and/or medication.

The specialist should ask you:

  • about previous treatments, including whether they worked and whether you completed the treatment as prescribed

  • whether you use substances such as alcohol, caffeine or other drugs and whether you smoke

  • about other diseases and conditions you have

  • how much your symptoms are affecting your day-to-day life

  • how much support you have from family and friends

  • about things in your life that may be affecting your condition.

The specialist should then discuss the options with you and agree a plan for treatment. This may include any of the following:

  • psychological treatment such as CBT (which you may be able to do at home if it is difficult for you to attend the clinic), if it has not been offered already, or a therapy known as structured problem solving

  • treatment of other diseases and conditions that may be affecting your symptoms

  • medications other than those you have already tried

  • referral to highly specialised services.

Questions you could ask your healthcare team

  • Do I have a choice about which treatment I have?

  • What will the treatment involve?

  • Can you give me a leaflet explaining the treatment?

  • What are the advantages, disadvantages and risks of this treatment?

  • How long will it take for my medication to work?

  • When should I start to feel better? What should happen if I don't start to feel better by then?

  • Would it help to make changes to my current treatment?

  • What other treatment options are there?



[1] When a drug is said to be 'licensed' for a specific condition, it means the drug is marketed and can be prescribed for that specific condition. Normally, a drug needs 'marketing authorisation' before it can be marketed or prescribed for a specific condition. The process of giving a medicine its marketing authorization is carried out by the Medicines and Healthcare products Regulatory Agency (MHRA). Further information on this is available from their website (www.mhra.gov.uk).

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