Medication for Panic Attacks?

January 4, 2008 8:06 PM

Anxiety medication for panic attacks? What should I look out for / expect.

I have panic attacks a few times a month. They used to be really bad as a teenager and young adult, but through meditation(not medication)/relaxation techniques and exercise I've got most of the physical symptoms under control these last 5 years. The problem is that it still mentally wipes me out for a couple days when it happens - unable to focus or deal with work very effectively. My work now doesn't offer much latitude for screwing up deadlines, and of course they always happen at the worse time, when I'm stressed by deadlines or really busy.

I'm looking to hear from people who are or where in similar situations and started taking medication, to learn if it helps or not and what the side effects might be. I'm hoping that I'll just need to take something during the attacks (we'll see after I meet with the doctor - appointment is scheduled already)? I know that psychiatric drugs aren't ideal but I'm at a loss otherwise.

posted by anonymous to health (32 comments total)

A Xanax here from time to time. Make sure you talk to your doctor and find the right dosage. Too little = no help. Too much = like taking a sleeping pill. I don't notice any other side effects, except I absolutely cannot drink any alcohol (goes without saying, but worth repeating) or I get lazy. Its like a lethary, but not sleepy tired.
posted by uaudio at 8:17 PM on January 4

* lethargy
posted by uaudio at 8:17 PM on January 4

If your doctor recommends anything, make sure you do your own research before taking it and completely understand what you're getting yourself into. I was on both Lexapro and Wellbutrin (at separate times) for anxiety. It was a once-a-day thing... not a "ahhh, i'm freaking out, let me pop a pill" type of thing. They kinda helped for a little while... or at least I told myself they did.

I wound up taking myself off of both because the side effects outweighed the benefits. I won't go into them, since they're... ehem... somewhat personal. But stopping the medication was a scary experience. I got terrible bouts of dizziness and nausea many times a day for 2-3 weeks. And from what I've read, I was somewhat lucky. A lot of people have serious trouble when they go on or come off these kinds of medications.

I don't mean to scare you. If you think it's what you need, then try it out. Just understand the risks involved for whatever drug your doctor recommends.

Honestly, the best cure I've found (for me) is regular exercise. It makes me feel better about myself and boosts my confidence. I haven't had anxiety attacks since I started.
posted by csimpkins at 8:26 PM on January 4

I take klonopin. It's a sedative. I was having multiple panic attacks a day. I went to no panic attacks at all.

It really messes with my alertness sometimes, and gives me really vivid (but nice) dreams. No sexual side effects.

I would recommend taking a vacation to start whatever medication you might start--take a week off so if the meds make you loopy you're not loopy at work and no one thinks you're drunk/high.
posted by sondrialiac at 8:31 PM on January 4

Additionally, you should let your shrink know what side effects really scare you--there are a huge variety of ways for you to treat this and you should be comfortable with your treatment plan.
posted by sondrialiac at 9:10 PM on January 4

I had debilitating panic attacks that got especially bad in late 1996; my doctor put me on Xanax, which I took dutifully for a month, but the only thing that changed was that I was desperately tired in the mornings (much moreso than normal) and I felt nauseated most of the time. My doc, who was not a psych and should never have done this, told me "if it's not helping, stop taking it." I'd only been on Xanax for a month but stopping cold turkey engendered a sort of rebound that was like a CONSTANT panic attack for several days with terrible shaking and unsteadiness, really scary.

After that I found a therapist and started the very difficult, not sudden "cure" of cognitive therapy, and THANK GOD I discovered this approach. I still get panic attacks, rarely, and they are NEVER debilitating and never are recurring. I've learned, among other things, that panic attacks are not viruses; they do not "happen" to me. *I* happen to me. Panic attacks are a resource that I could and did invoke, expertly and with no effort, to avoid things that I hated. Cognitive therapy helped me understand this.

I had them bad. Bedridden, fetal position, considering suicide bad. I got over them without meds and so can you.
posted by ethnomethodologist at 9:20 PM on January 4 [2 favorites]

i'm on paxil for anxiety attacks.

i started to experience them two years ago, and they were completely crippling.
before i went on paxil, i went through a hellish two-week period where i thought i was no longer in my body, thought i was losing my mind, etc. i went to see my doctor and lay on the floor in the waiting room because i was so out of it and scared.

paxil has been working for me. aside from having to experiment with when to take it (taking it in the morning seems to cause nausea, taking it at night seems to be better) i haven't had any trouble. i have had an anxiety attack since going on it, but it was less severe and i just doubled up my dosage the next day (as directed by my doctor) and i was okay.
posted by gursky at 9:22 PM on January 4

I believe my ex-boyfriend takes Effexor on a daily basis, and I know he carries Atavan with him at all times for emergencies. He's extremely prone to panic attacks. So much so that he had to be hospitalized for a time before he started taking meds for it. My father has also taken Effexor for anxiety, but he says trying to stop is like trying to kick a bad drug habit and doesn't recommend it.
posted by katillathehun at 9:57 PM on January 4

i've been on paxil and zoloft, at various points; the paxil did that thing it sometimes does to young people taking it and led to a weird stint of self-injury, and the zoloft had little to no effect at all whatsoever. i was given temazepam as a sleep aid/anxiolytic, and it worked, but it also gave me pretty severe fainting spells (i'd be walking across the living room and fall down in a dead faint with no warning, several times a week).

i was on klonopin for a couple months. i slept like a baby, my panic attacks were gone, and so was my impulse control--after i threatened a classmate with a screwdriver (i'm shy to a pathological degree, under normal circumstances) it became pretty clear that things weren't working out, there.

in any case, i'm afraid psychoactive drugs really aren't something you're going to get much useful advice about, from a venue like this. both the benefits and the side effects of each drug vary so much from person to person that no amount of anecdotal evidence is going to give you a clear picture of how things may or may not play out for you. your best bet is to just find a doctor who seems competent, well-versed, and, above all else, willing to listen to you if feel a given course of treatment isn't working out.
posted by wreckingball at 10:05 PM on January 4

Regarding the benzodiazepine sedatives:

Xanax (aprazolam) has a pretty short half-life. This causes rapid fluctuation of mood, which leads to dependence (addiction). Avoid it. Ativan (lorazepam) lasts a little longer, and is marginally better than Xanax.

Klonopin (clonazepam) has a much longer half-life, and works really well for most people. It may be a little too long, though. The seldom-prescribed Restoril (temazepam), whose half-life falls in between that of lorazepam and clonazepam, is probably best. Valium (diazepam) is too long plus has active metabolites; avoid.

In all cases, finding the right dose is essential. This will require some trial and error.

Eponysterical?
posted by neuron at 10:15 PM on January 4

I used cognitive behavioral therapy to cure my panic attacks. I'd have them just for, say, driving to a place I hadn't been before. I tried Paxil, but hated the fact that I could not orgasm while taking it and it made me gain 30 lbs. Instead, I tried CBT. My therapist taught me self-hypnosis, which I was able to do by myself within 30 days. 9 months later, I no longer needed even that; I've had probably two panic attacks in the past 6 years. Honestly, that's the method that had the fewest side effects (none) and the most benefits (I am cured).

Xanax is highly addictive. My dad went to rehab for it and I was told the withdrawal was as bad as heroin; he had to be put in a padded room it got so bad. Seizures, dementia... just be careful with taking something like that regularly, if that is what your doctor ends up going with. Klonopin is definitely a preferred medication, at least to me, having had a choice and seeing a family member go through withdrawal on Xanax.
posted by Unicorn on the cob at 10:29 PM on January 4 [1 favorite]

I've been on Ativan for anxiety/panic attacks. I found it to be hugely helpful as something that I could take when I felt a panic attack/anxiety spell coming in. In fact, I found that I had less panic attacks just knowing that I could control them if/when they happened. I didn't have any bad side effects, though Ativan can make you sleepy. It also stops working if you take it too often.

I've also been on Zoloft for anxiety/depression. While on it, I had extremely vivid dreams (sometimes disturbing, sometimes not), bruising, and trouble orgasming. When going off of it, I had horrible withdrawal symptoms, the worst of which was nausea. Before Zoloft, I tried Celexa, which made me so tired I literally couldn't get out of bed at times. But these side effects vary not only from drug to drug, but person to person. If you go on a day-to-do drug, you may find you have to try a few before you find one that works.
posted by rosethorn at 11:00 PM on January 4

Ahem. That should be day-to-day drug, not day-to-do.

will learn to use preview button
posted by rosethorn at 11:02 PM on January 4

good news is bad news...there are, as you can see, a plethora of excellent drugs available. but the catch is finding what works for you...your body/brain chemistry, metabolism,and etc. there are, thank Christ, many Rx's available. I have taken, over the past 35 years, any number of things. All help, but with varying degrees of 'bad' side effects. Nothing psychotic, just sleepy-headed and impotence and such. What I keep coming back to is Librium (Chlordiazepoxide). It's an older drug, circa 1950's. But for me side effects are negligible and there is zero dependency 'problems'. And I am an addictive guy.
That said, I long ago had a 700 dollar one week intensive twice daily treatment with an excellent 'shrink'. That (CBT) was as important as the meds, for me. Of course I have OCD, ADHD and am mildly bi-polar, so often the panic/anxiety is sort of a refreshing break.
But do ask yr doc to try Librium, takes it about 40 minutes to get going (unless you open he capsule and pour it on yr tongue, hint/hint which shortens it to 10-15 minutes) and has a rather long half-life. I've used it for over 20 years with great results and very minor problems.
ok. ive shared WAY to much info here, but dammit I feel for hurting souls...
posted by dawson at 11:17 PM on January 4

Librium is clearly dependency producing, as are all benzodiazipene derivatives. Relief is relief and you gotta do what you gotta do, but taking a drug like this should be done only as part of an overall treatment plan. There are not many people who are served well by taking a tranquilizer on a daily basis.
posted by Slarty Bartfast at 12:05 AM on January 5

The effects will definitely vary from drug to drug and person to person. You may need to try a few things before you find a medication that works for you, and doesn't have unwanted side effects. It's important to note that there are two common ways of medicating for panic attacks: for very frequent attacks, you might be put on a daily med, sometimes with the help of a fast-acting med (often a benzodiazepine) for use when dealing with an attack. Many of the medications prescribed for daily use - such as SSRIs - need to be taken daily in order to work. For less frequent panic attacks, you may be given only the fast-acting med, for use when a panic attack is starting.

In my case (panic attacks a little less frequent than yours - maybe once a month or two?), I use Valium (diazepam.) I'm on Lexapro for depression as well, but that does little to affect anxiety one way or the other in me. (This is not uncommon in SSRIs; some SSRIs or SNRIs like Wellbutrin actually have a reputation for increasing anxiety.) Because I take it so infrequently, problems with benzodiazepine addiction aren't a risk. Taking Valium or Xanax or Klonopin daily is a different thing entirely; because of the addiction risk, most responsible psychiatrists will, if possible, try other treatment methods first if you're having panic attacks that need very frequent treatment.

What to expect? With benzos, you'll... calm down. In me, the panic slowly recedes. It's sort of like the tide going out. I tend to feel somewhat tired, though not nearly as badly as I do after a panic attack. If I go to sleep soon after, I'll often find that I sleep fairly heavily and wake up slightly logy (though definitely within my normal range.) Beyond that, I'm fine. If you end up on an SSRI, you might be lucky and hit one with the side effects I've had: none. I was a little dizzy the first few days I was on it. Other than that... I take a pill, and notice nothing. Well, nothing, until I realize I haven't had to struggle to leave my room, etc. quite as much. It's not a magical cure - I still have bad days, of course - and I am lucky in my lack of side effects. But no, it's definitely possible to treat panic attacks without going into withdrawal seizures or threatening classmates with screwdrivers, and yes, it's certainly worth investigating the possibility of medication to help mitigate the panic attacks. Therapy, CBT, meditation (as you've tried) are all worthwhile as well, but medication's pretty damn good at stopping a panic attack in its tracks - and for me, that's invaluable.
posted by ubersturm at 12:33 AM on January 5

I used to be on Xanax and I felt like a zombie. It sucks you of your ability to feel.

Now I'm on Effexor-XR, which is good for stabilizing, though if I forget one I get headaches.
posted by divabat at 6:36 AM on January 5

I had similar crippling panic attacks 5 years ago that were starting to affect my job where oftentimes I just had to call in sick and not get out of bed. I understand your situation!

I tried Cognitive Therapy and Paxil which worked wonders, as well as a regular exercise regime. Paxil had some disturbing side affects, dizziness, nausea, lack of sex drive that made me change to Cipralex 2 months ago.

Ativan, though addictive, will provide instant relief from panick and or anixety and though may not be a long term solution will allow you to get through a particular difficult time and in my case allow you to keep your job until you can get ramped up on the meds or have the therapy start to affect you.

In any case, I would suggest finding a good therapist that has experience in panic dissorder.
posted by jek at 6:58 AM on January 5

Like sondrialiac, I'm on klonopin and it has worked well for me. It has occasionally caused blackouts, though, so I take it sparingly. I've also taken Cymbalta and Zoloft, and the side effects far outweighed any "benefits." (I actually didn't notice any benefit to either.)
posted by desjardins at 7:38 AM on January 5

Make sure you research any meds you're taking. Psychoactive meds are a delicate balance. A very cold, wet washcloth on the face helps a lot. Cold water on the face triggers the mammalian dive reflex, which fights panic attacks. Xanax is very helpful, on an as-needed basis only. Xanax can be put under the tongue for fastest action. IANAHCP(Health Care Professional)
posted by theora55 at 8:57 AM on January 5 [2 favorites]

Reactions to medications can vary widely among different people. If your doctor suggests that you take meds, be prepared to try several until you find something that works, and try not to get discouraged. Keep a log of the meds you've taken, the dosages, and how you reacted to them. You may need to go back and try one again in combination with something else, and it's best not to rely on memory, or even your doctor's memory.

When you get a prescription, research it carefully before you take it, including how you will need to stop taking it. Some of these meds, you need to wean yourself off to not have bad withdrawal effects. You don't want to be anxious about taking the meds if anxiety is what you are trying to avoid, so learning as much as possible might help. Also, even the best doctors sometimes neglect to tell you important information, so you don't want to rely on just what you've been told.

It's possible that you'll only need the meds for a short time, to get you started with therapy. I don't know enough about therapy for panic attacks to be sure of that, but I know often for anxiety meds are only taken at the beginning of treatment.

I've had panic attacks and been on Klonopin and Lexapro (and other meds, but those were for my main disorder which is bipolar). Klonopin worked for me, but I could feel that it was addictive, so I didn't stay on it long. Unlike an earlier poster who had vivid dreams on it, my dreams completely disappeared. Lexapro made me kind of feel like a zombie. But as I said, what doesn't work for me could be your godsend. Good luck.
posted by veronitron at 9:09 AM on January 5

(Thanks theora55, when I've had panic attacks my hands get very cold, and I've found that putting them on my face has helped to end the attack. I never knew why!)
posted by veronitron at 9:12 AM on January 5

I take klonopin for panic attacks and I only take it when I think one is coming on or when I'm in a situation - like last week, driving up and down I-95 from Charleston to Baltimore and back again - that I know is likely to produce one. It works like a charm - half a klonopin and I feel perfectly fine and normal except I don't freak out. The thing I like best about it is that I don't have to take it all the time - I can just take it once in a while.

I got the clonopin, though, by going to therapy for two years, being diagnosed with depression and anxiety and spending about 6 months on lexapro, or, actually, several years on and off. Lexapro helps but after about 6 months it starts to mess up my memory and I begin to really miss orgasms. Therapy really helps. And I don't get the kind of cripplingly awful panic attacks I used to anymore. Also, just as an fyi, I took wellbutrin for one horrific month and it gave me almost continuous panic attacks, so, while YMMV, I would stay the hell away from that one.
posted by mygothlaundry at 9:36 AM on January 5

I had a friend who was on Xanax and had no negative effects. I think she was on a small dosage and only took when an attack was coming on. There was no dependency or anything and sometimes she went months without taking it.
posted by UMDirector at 10:11 AM on January 5

As others have said, it's mostly a matter of avoiding dependence and managing side effects. Look out for paradoxical effects...I discovered that Xanax actually *gives* me panic attacks. Sigh.
posted by jocelmeow at 12:02 PM on January 5

Oh, and the most irritating side effect of all--people who will tell you they had the exact same problem and they handled it without meds! And you should too! Because meds are evil/the sign of a weak mind/masking the true problem! etc.

It's really annoying and completely unhelpful for someone in your situation. Feel free to ignore such "advice" completely.
posted by sondrialiac at 1:05 PM on January 5

sondrialiac, I can only speak for myself, and I would never say that meds are "evil" or any of those other things. I would say that in my case, CBT worked and meds did not. That might be annoying, but it is not unhelpful to mention a course of treatment that worked.

I see the imposition of a medical model to mental "illness" as far more unhelpful than merely suggesting that there are alternatives to drugs. Panic Disorder can be treated with meds, just as shyness or insomnia can. That doesn't make it a "disease" following the defining aspects of the medical model, and it doesn't mean that is HAS to be treated with drugs.
posted by ethnomethodologist at 1:22 PM on January 5

If I sounded bitter, it's because I know a some people (specifically people who have bipolar) who tend to attract advice that they should just take vitamins and meds are evil--and it just encourages a harmful train of thought in people who really do need their medications and who are prone to self-harm. Not saying this is the OP's situation.

My main issue with your comment is that you really have no way of knowing if the OP can get over it without meds--and shouldn't say so like it's a fact, when it's not.
posted by sondrialiac at 3:29 PM on January 6

I'm taking beta blockers for panic attacks. They have been quite effective at preventing the panic attacks themselves because they help with the physical symptoms (racing heartbeat, sweating etc.) but they don't have any impact on my mental state. In your case I can't imagine that it would be much help dealing with the exhaustion you feel after the panic attacks but it may prevent the panic attacks themselves, particually if you are aware of certain situations where they are likely to occur.
posted by Laura_J at 4:03 PM on January 6

Here's a more helpful link.
posted by Laura_J at 4:08 PM on January 6

My boyfriend is bipolar and has Generalized Anxiety Disorder. Among other things, he's prescribed 2mg of Xanax and Klonopin each a day, but only takes them as needed to avoid dependency issues. His tolerance is pretty high but the benzos do somewhat sap his motivation to do anything.

Before getting those he was taking Neurontin/gabapentin, which had fewer side effects but his tolerance went up a lot. Started with 300mg a day and was up to 1200mg a day when his doc prescribed the x/k. There was a bit of a stink about off-label gabapentin prescribing but it's worth asking about. Or would be, if you see a doctor again.
posted by herbaliser at 11:23 AM on January 7

In my personal experience: I was first given Amitrypteline and really hated it, begged off after 2 weeks. I am now on maintenance/once daily low doses of sertraline (generic Zoloft) and Wellbutrin XL and an occasional 1 mg lorazepam as needed. (I was taking the last one daily for about 2 months but found it to be too habit forming so I've mostly weaned off from it.) My anxiety was getting rather debilitating, so the RXs have been incredibly helpful. Since starting the meds I've had lots of life changes and I think they helped me stay on the beam throughout. Also, I had been in both recovery and therapy for 5 years before this, which I still continue to do. The combination of meds and therapy seems to work for me. I also try to get regular vigorous exercise and force myself out of the house when I feel the crazies coming. My therapist is trying something called EMDR which I think is a bit kooky but seems to be working well so far.
posted by wowbobwow at 11:55 AM on January 8