This information is meant to give you a general idea about each of the medications listed below. Only the most general side effects are included. Ask your doctor if you need to take any safety measures. Use each of these medications as directed by your doctor or according to the instructions provided. If you have further questions about usage or side effects, contact your doctor.

Anxiolytics (anti-anxiety medicines) and antidepressants can help ease the symptoms of panic disorder. They are often used along with counseling. Depending on the person, medicine may be used for a short time or for a long period of time, medicine helps relieve symptoms. It should not take the place of counseling (psychotherapy). Psychotherapy can address the root of the problem.

Prescription Medicines

Selective Serotonin Reuptake Inhibitors (SSRIs)

  • Citalopram
  • Fluvoxamine
  • Paroxetine
  • Fluoxetine
  • Sertraline
  • Escitalopram

Benzodiazepines

  • Lorazepam
  • Prazepam
  • Flurazepam
  • Clonazepam
  • Triazolam
  • Chlordiazepoxide
  • Halazepam
  • Temazepam
  • Oxazepam
  • Clorazepate
  • Diazepam
  • Alprazolam

Tricyclic Antidepressants

  • Doxepin
  • Clomipramine
  • Nortriptyline
  • Amitriptyline
  • Imipramine
  • Maprotiline
  • Desipramine
  • Trimipramine
  • Protriptyline

Atypical Antidepressants

  • Trazodone
  • Venlafaxine
  • Nefazodone

Monoamine Oxidase Inhibitors (MAOIs)

  • Isocarboxazid
  • Phenelzine
  • Tranylcypromine

Prescription Medicines

Selective Serotonin Reuptake Inhibitors (SSRIs)

Common names include:

  • Citalopram
  • Fluvoxamine
  • Paroxetine
  • Fluoxetine
  • Sertraline
  • Escitalopram

Selective serotonin reuptake inhibitors (SSRIs) affect the concentration of the neurotransmitter serotonin. Serotonin plays a role in anxiety. Although they are considered antidepressants, SSRIs have been used effectively to treat panic and other anxiety disorders. Improvement is usually seen in 4-6 weeks after beginning treatment. SSRIs are not addictive. Do not take an SSRI if you have taken an MAOI in the last 2-5 weeks.

Possible side effects include:

  • Nausea
  • Diarrhea
  • Insomnia
  • Loss of appetite or weight loss
  • Weight gain
  • Nervousness
  • Dizziness
  • Sexual difficulties (ranging from decreased arousal to erectile dysfunction and/or delayed time to orgasm)
  • Risk of severe mood and behavior changes, including suicidal thoughts in some patients (young adults may be at a higher risk for this side effect)
Benzodiazepines

Common names include:

  • Lorazepam
  • Prazepam
  • Flurazepam
  • Clonazepam
  • Triazolam
  • Chlordiazepoxide
  • Halazepam
  • Temazepam
  • Oxazepam
  • Clorazepate
  • Diazepam
  • Alprazolam

Benzodiazepines ease symptoms of panic disorder by improving the function of gamma aminobutyric acid (GABA). GABA is a neurotransmitter thought to be abnormal in people with anxiety disorders. These drugs produce a sedative effect. They also ease physical symptoms, such as muscle tension. They often cause drowsiness. The advantage of benzodiazepines is that they are fast acting. They are useful for treating acute anxiety, panic, and insomnia. When stopping the medication, you should slowly decrease it over a period of weeks or months under a doctor’s supervision.

These drugs can be habit-forming when used long-term or in excess. This may cause withdrawal symptoms such as “rebound panic,” anxiety, irritability, and insomnia when stopped. If you have had a problem with substance abuse (alcoholism, drug addiction), talk to your doctor about whether or not you should use benzodiazepines.

Do not take benzodiazepines with alcohol or other drugs that cause drowsiness. Do not take if you must drive a vehicle or operate equipment. These drugs should not be taken with certain oral antifungal medicines or by people with certain types of glaucoma.

Possible side effects include:

  • Drowsiness
  • Dizziness, particularly in elderly persons
  • Confusion
  • Reduced coordination
  • Slow reaction time
Tricyclic Antidepressants

Common names include:

  • Doxepin
  • Clomipramine
  • Nortriptyline
  • Amitriptyline
  • Imipramine
  • Maprotiline
  • Desipramine
  • Trimipramine
  • Protriptyline

Tricyclic antidepressants regulate the neurotransmitters serotonin and/or noradrenalin in the brain. Tricyclic antidepressants are not addictive.

Possible side effects include:

  • Dizziness
  • Dry mouth
  • Constipation
  • Difficulty urinating
  • Weight gain
  • Low blood pressure
  • Sexual difficulties
  • Risk of severe mood and behavior changes, including suicidal thoughts in some patients (young adults may be at a higher risk for this side effect)
Atypical Antidepressants

Common brand names include:

  • Trazodone
  • Venlafaxine
  • Nefazodone

Atypical antidepressants affect the concentration of the neurotransmitter serotonin. They can be effective in treating panic. Improvement is usually seen in 4-6 weeks after beginning treatment.

Possible side effects include:

  • Nausea
  • Nervousness
  • Reduced sex drive
  • Risk of severe mood and behavior changes, including suicidal thoughts in some patients (young adults may be at a higher risk for this side effect)
Monoamine Oxidase Inhibitors (MAOIs)

Common names include:

  • Isocarboxazid
  • Phenelzine
  • Tranylcypromine

Monoamine oxidase inhibitors (MAOIs) are a type of antidepressant. They ease symptoms of panic disorder by preventing the breakdown of serotonin and noradrenaline. They are especially useful for people whose symptoms have not responded to other treatments. Improvement is usually seen in 2-6 weeks after beginning treatment. MAOIs are not addictive.

MAOIs can cause adverse reactions when combined with many other types of drugs, such as:

  • Other types of MAOIs
  • Antidepressants
  • Sympathomimetics
  • Sedatives
  • Narcotics
  • Anesthetics
  • Antihypertensive drugs
  • Diuretics
  • Antihistamines
  • Buspirone
  • Dexfenfluramine
  • Dextromethorphan

Ask your doctor and pharmacist for a complete list of what to avoid.

At minimum, a 2-5 week break is necessary between stopping MAOIs and starting another antidepressant. MAOIs can cause birth defects and should not be taken by pregnant women.

When taking MAOIs, you should not eat foods that have high tyramine content, such as:

  • Cheese
  • Alcohol
  • Pickled, marinated, smoked, cured, or fermented foods
  • Organ meats
  • Nuts and peanut butter
  • Fava beans
  • Onions
  • Avocados
  • Canned figs
  • Chocolate
  • Caffeine
  • Foods containing monosodium glutamate (MSG)

Possible side effects include:

  • Changes in blood pressure, including hypertensive crisis
  • Weight gain
  • Reduced sexual response
  • Insomnia
  • Risk of severe mood and behavior changes, including suicidal thoughts in some patients (young adults may be at a higher risk for this side effect)

Special Considerations

A discussion with a specially trained mental health professional is advised if you do not respond to treatment with medicines. A mental health professional can help explain the diagnosis and determine if another psychiatric disorder is present. He can also suggest psychotherapy and changes in medicines.

If you are taking medicines, follow these general guidelines:

  • Take your medicine as directed. Do not change the amount or the schedule.
  • Do not stop taking them without talking to your doctor.
  • Do not share them.
  • Know what results and side effects to expect. Report them to your doctor.
  • Some drugs can be dangerous when mixed. Talk to a doctor or pharmacist if you are taking more than one drug. This includes over-the-counter medicine and herb or dietary supplements.
  • Plan ahead for refills so you don’t run out.

When to Contact Your Doctor

Contact your doctor if you have any side effects that are troublesome and persistent. Call if you have any questions about your medicine.

Revision Information

  • Antidepressant use in children, adolescents, and adults. US Food and Drug Administration website. Available at: http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/UCM096273. Published May 22, 2009. Accessed November 21, 2012.

  • Panic disorder. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us. Updated April 23, 2012. Accessed November 21, 2012.

  • Panic disorder. National Institute of Mental Health website. Available at: http://www.nimh.nih.gov/health/topics/panic-disorder/index.shtml. Updated November 19, 2012. Accessed November 21, 2012.

  • Ravindran LN, Stein MB. The pharmacologic treatment of anxiety disorders: a review of progress. J Clin Psychiatry. 2010;71(7):839-854.

  • USP DI. 21st ed. Micromedex; 2001.

  • 2/18/2011 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Serretti A, Mandelli L. Antidepressants and body weight: a comprehensive review and meta-analysis. J Clin Psychiatry. 2010;71(10):1259-1272.