Information About Panic Attacks
There are two classes of anti-panic medicines that are highly
effective. They are:
Group 1 - Benzodiazepines:
Xanax (alprazolam), Klonopin (clonazepam), Ativan (lorazepam),
Tranxene, Serax Valium, Librium, and others
Group 2 - Antidepressant anti-panic medicines:
-
SSRI's (Zoloft, Prozac, Paxil, Celexa, Lexapro, and Luvox)
-
tricyclics (Tofranil, nortriptyline, protriptyline, Elavil,
Sinequan, Surmontil, and others).
The most important difference between Group 1 and Group 2 is
that medicines in Group 1 work much quicker, i.e. stop panic attacks in twenty
minutes to a couple of weeks in worse cases. Group 2 requires 1-8
weeks to be effective. However, Group 1 can be physically addictive. Patients
with substance abuse tendencies have a high risk of abusing these medicines
and/or they may be a gateway substance leading to relapse on their drug of choice.
Group 2 medicines are just as likely to stop all panic attacks
as Group 1 after a lag period. The lag period is 1-3 weeks to the
onset of reducing the severity and frequency of attacks. It takes Group 2, 3-10 weeks to totally stop all panic attacks in
70% of patients.
Since most people need to be on medicine for at least 1 year to significantly
reduce the risk of relapse back into panic attacks soon after stopping the
medicines, Group 2 are preferred for maintenance because of no risk of
physical or psychological dependence and withdrawal. However, Group 2
medicines do need to be tapered somewhat when stopping to avoid some
discontinuation symptoms, i.e. uncomfortable symptoms associated with stopping
Group 2 meds abruptly.
Hence, if substance abuse is no issue, Dr. Darvin Hege starts most patients
with a Group 1 medicine immediately and encourages starting a Group 2 drug as
well. The purpose is to get immediate relief as soon as possible and to prepare
to taper off the Group 1 medicine and rely on the Group 2 medicine alone
after the lag period until Group 2 is fully in effect. This usually takes 1-3 months. In addition to having a faster onset, Xanax in some studies
appears to have a little more early robust relief of panic attacks. The newer XR
form of Xanax (Xanax XR or alprazolam XR) is generally much preferred for
several reasons. It provides much more even blood levels over twenty-four hours
after a single dose. Consequently, it provides more consistent reduction and
protection against onset of new panic attacks and less severe attacks if they
break through. Additionally, there is less sedation, impaired operation of
vehicles, and abuse.
Criteria for Panic Attack - A person experiences a discrete
period of intense fear or discomfort:
A person experiences four (or more) of the following 13
symptoms:
-
Palpitations, pounding heart, or accelerated heart rate
-
Sweating
-
Trembling or shaking
-
Sensations of shortness of breath or smothering
-
Feeling of choking
-
Chest pain or discomfort
-
Nausea or abdominal distress
-
Feeling dizzy, unsteady, lightheaded, or faint
-
Derealization (feelings of unreality) or depersonalization
(being detached from oneself)
-
Fear of losing control or going crazy
-
Fear of dying
-
Paresthesias (numbness or tingling sensations)
-
Chills or hot flushes
Both Group 1 and Group 2 have risks of side effects. Most
patients do not have side effects to a significant extent. Those who do usually
have side effects that are generally very mild and go away within a few days or
weeks.
The most common side effects of Group 1 medicines occur in a
minority of patients. They are drowsiness and/or incoordination, usually
occurring if the initial dose is too high or the dose is increased too fast. The
risk of developing physical and/or psychological dependence to Group 1
medicines is very low unless the person has a history of substance abuse.
Group 2 medicine side effects occur in only a minority of
patients as well. Most common are nausea, dizziness, sedation, insomnia, sexual
side effects, and/or increased appetite and weight gain. Seldom are there side
effects from a succession of multiple medicine trials so that we can't get panic
attacks reduced or stopped in a few days or a week or two.
Most evidence that we have suggests the majority of patients
should stay on their medicines for at least one year after the panic attacks are
stopped. If the medicine is stopped before one year, there is a higher incidence
of relapse more quickly than for those who wait for at least a year. And our
data shows that it is best to stay on the same dose that stopped the panic
attack for the year unless there is an uncomfortable side effect. Most patients
could be successfully and painlessly weaned off Group 1 medicines during this
year and come to rely solely on the robust long-term effectiveness of a Group 2
medicine. Cognitive behavioral therapy (CBT) has proven effective to augment
extinguishment of panic attacks and increases a patient's likelihood of
successfully weaning off all medicines. Dr. Hege has have a network of CBT therapists to
whom he refers patients while focusing on medication management.
There are many non-psychiatrist physicians who are quite skilled
with these medicines. However, Dr. Hege sees ten or more patients each day in different
stages of recovery from panic attacks. Dr. Hege has been practicing since 1978. If
your PCP is uncomfortable treating panic attacks or reaches the limit of their
skills, Dr. Hege has vast experience in evaluating for some other condition that may
be underlying the panic attacks (depression, bipolar disorder, PTSD, ADHD).
Sometimes a complicating condition develops after the onset of panic attacks
such as depression or substance abuse. Addressing the core panic disorder or
other condition with the vast selection of tools with which psychiatrists are
familiar will
likely result in relief and success.
For more informaton about treatment of panic attacks,
call Dr.
Hege today for the expertise and relief you need!
Self-Pay Patients--Mention this website for 10%
off your first visit!
Darvin Hege MD, PC
2150 Peachford Road, Suite P
Atlanta, GA 30338-6521
770-458-0007
Map and Directions To Dr. Darvin Hege
|
