What Is the Best Medicine for Anxiety and Panic Attacks?

The best medication is the one that works to help alleviate your symptoms.

Anxiety attacks and panic attacks are types of anxiety disorders that are slightly different. Anxiety attacks come on gradually and involve feelings of increased anxiety, while panic attacks 

come on suddenly and involve and intense feelings of fear or an impending sense of doom that lasts for a short time, usually only a few minutes. 

Differences between anxiety attacks and panic attacks include:

• Anxiety attacks often occur gradually, while panic attacks come on suddenly
• Anxiety attacks are an increased level of anxiety, while panic attacks tend to be more intense senses of fear and dread
• People who have anxiety attacks usually feel somewhat anxious already before the attack, while people who have panic attacks feel fine beforehand and the attack seems to come out of the blue
• Anxiety attacks can take time to build up and may last a while, while panic attacks are shorter in duration, usually about 20 to 30 minutes, reaching its most intense about 10 minutes in

Panic disorder is a type of anxiety disorder that is characterized by recurring panic attacks and fears of having panic attacks, however, people who do not have the panic disorder can also have panic attacks. 

Symptoms of an anxiety attack tend to come on gradually. People who have anxiety attacks often have a low level of anxiety as a baseline. 

Symptoms of an anxiety attack include:

• Excessive worry 
• Restlessness
• Feeling on edge
• Fatigue
• Difficulty concentrating
• Irritability
• Muscle tension
• Being easily startled
• Increased heart rate
• Sleep problems

Symptoms of a panic attack come on suddenly and reach their peak within minutes. The attacks may occur unexpectedly or they may have a trigger. 

Symptoms of a panic attack include:

Heart palpitations or fast heartrate

• Sweating
• Trembling or shaking
• Feeling shortness of breath
• Feeling as if one if being smothered or is choking
• Chest pain (some people may fear they are experiencing a heart attack)
• Feelings of impending doom
• Feelings of being out of control or fear of dying
• Nausea
• Dizziness
• Feeling detached from themselves

Generalized anxiety disorder, panic disorder, and panic attacks have many possible causes such as: 

• Genetics
• Environmental factors such as early childhood trauma
• Underlying medical condition 
• Substance-induced, such as from the use of over-the-counter (OTC) medications, herbal medications, and drugs of abuse

Certain conditions can trigger anxiety attacks or panic attacks, such as:

• Stress
• Loss – of a loved one, pet, job 
• Problems with relationships
• Illness
• Heart problems
• Caffeine
• Side effects from medications
• Low oxygen levels from being at high altitudes, having lung diseases such as COPD, or a pulmonary embolism

Anxiety disorders are usually diagnosed with a psychological evaluation. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, provides diagnostic criteria for an anxiety disorder. 

Lab studies to help diagnose or exclude medical conditions that may cause anxiety disorders or panic attacks include:

• Complete blood cell (CBC) count
• Chemistry profile
• Thyroid function tests
• Urinalysis
• Urine drug screen

Tests to rule out central nervous system (CNS) disorders that can cause anxiety or panic attacks to include:

• Electroencephalography (EEG)
• Lumbar puncture
• Brain computed tomography (CT) scan
• Magnetic resonance imaging (MRI) of the brain 
• Neurologic consultation 
• Positron emission tomography (PET) scan

Tests to rule out heart conditions that can cause anxiety or panic attacks to include:

• Electrocardiography (ECG) 
• Treadmill ECG

Treatment for anxiety disorders usually consists of a combination of medication and/or psychotherapy. 

Types of therapy used to treat anxiety disorders include:

• Behavioral therapy and cognitive-behavioral therapy (CBT) 
• Computerized CBT (FearFighter) 
• Psychodynamic therapy 
• Interpersonal psychotherapy 
• Relaxation therapy
• Supportive psychotherapy
• Mindfulness therapy

There is no one specific medication that is best for anxiety and panic disorders. Each person is different and will respond to a particular medication differently. The best medication is the one that works to help alleviate your symptoms. Medications used to treat anxiety and panic attacks include: 

• Antidepressants
  • Selective serotonin reuptake inhibitors (SSRIs) such as paroxetine (Paxil), escitalopram (Lexapro), sertraline (Zoloft), fluoxetine (Prozac), fluvoxamine (Luvox), and citalopram (Celexa)
  • Serotonin and norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine (Effexor and Effexor XR) and duloxetine (Cymbalta)
  • Atypical antidepressants such as nefazodone (Serzone), mirtazapine (Remeron), and trazodone (Desyrel)
  • Tricyclic antidepressants such as imipramine (Tofranil) and clomipramine (Anafranil)
  • Monoamine oxidase inhibitors (MAOIs) such as phenelzine (Nardil), selegiline (Emsam), tranylcypromine (Parnate), and isocarboxazid (Marplan)
• Benzodiazepines, especially in emergency situations, such as lorazepam (Ativan), clonazepam (Klonopin), and alprazolam (Xanax)
• Anti-anxiety drugs such as buspirone (BuSpar)
• Anticonvulsants such as pregabalin (Lyrica), divalproex (Depakote), and gabapentin (Neurontin)
• Antihypertensive drugs such as clonidine (Catapres), propranolol (Inderal, Betachron E-R, InnoPran XL), nadolol (Corgard), and atenolol (Tenormin)

Other treatments used for anxiety and panic disorders include: 

• Cranial electrotherapy stimulator (CES) 

In severe cases, hospitalization may be indicated to treat anxiety and panic disorders, when the following is present: 

• Severe functional impairment (cannot meet own daily needs)
• Suicide or homicide risk
• Deficits in social skills 

Dietary changes that may help treat anxiety and panic disorders include:

• Avoiding caffeine
• Using caution with over-the-counter preparations and herbal remedies because ephedrine and other herbal compounds may cause or worsen anxiety symptoms

Complications of anxiety and panic attacks include:

• Major depression
• Other psychiatric disorders
• Alcohol and drug abuse
• Significant functional impairment and decreased quality of life from avoiding situations that may trigger the anxiety or panic attacks
  • Problems at work
  • Problems at school
  • Financial problems
• Suicide (in severe cases)