Question:
Have any alternative or herbal therapies been shown to be effective in
the treatment of panic disorder? What is considered to be the most
effective treatment?
According to the National Institutes of Mental Health, 25% of the
population of the United States (more than 3 million people) will suffer
from some sort of anxiety disorder in their lifetime, with 2% to 4%
experiencing panic. Panic disorder is a disabling anxiety condition that
severely impairs one's individual, social, interpersonal, and vocational
function. Panic disorders occur twice as frequently in women than in men
and typically occur in younger adults. Panic disorder is characterized
by episodes of severe anxiety with recurrent and intense fear often
occurring without apparent warning or precipitating cause, occurring
"out of the blue" and lasting several minutes to hours.
Answer:
Individuals experiencing panic often develop an intense fear of another
future attack (secondary fear of the fear) and may develop phobias and
irrational fears associated with events and situations they believe
trigger attacks. Some examples of triggering events are driving a car,
visiting new places, or shopping in a crowded mall. In addition, sleep
patterns may also be disturbed, with an individual experiencing frequent
awakenings or nighttime terrors.
Panic attacks are rarely indications of underlying medical conditions.
However, a number of conditions such as thyroid or other endocrine
disorders, cardiac arrhythmias, epilepsy, and certain medications may
cause symptoms similar to those seen in panic disorder. A complete
history, physical exam, and laboratory work will rule out any medical
causes.
Anxiety and depression are the most commonly seen psychiatric disorders
in primary care practices. A single panic attack is a clear indication
to a clinician that an individual is most likely suffering from other
psychiatric symptoms. Depression and panic frequently occur
simultaneously in the same individual with an estimated two thirds of
all individuals diagnosed with panic disorder experiencing a major
depressive episode. Individuals with panic disorder often present with
other psychiatric disorders such as obsessive-compulsive disorder,
posttraumatic stress disorder, and social phobia. Suicidal ideation
always needs to be assessed in such individuals and evaluated for
lethality in all individuals presenting with depressive symptoms.
Panic disorder is characterized by chronic and recurring episodes over a
lifetime. Although panic attacks are relatively common and disabling,
they are also treatable. Individuals frequently remain preoccupied with
their physical symptoms even after a practitioner has ruled out any
medical causes or conditions. Many individuals look to alternative
treatments for symptomatic relief such as meditation, yoga, acupuncture,
and herbal remedies. Herbal treatments such as St. John's wort, ginkgo
biloba, primrose oil, and ginseng (among others) have not been
scientifically proven effective in the treatment of panic disorder.
Also, the FDA currently does not regulate herbal treatments. Further
research into such alternative therapies is necessary before
practitioners can safely recommend such forms of treatment. Having said
that, the most effective treatment of panic disorder, according to the
National Institutes of Mental Health, is a combination of medication and
cognitive behavioral therapy.
Currently, 4 classes of medication are commonly used in the treatment of
panic disorder. These medications include SSRIs (selective serotonin
reuptake inhibitors), TCAs (tricyclic antidepressants), benzodiazepines,
and MAOIs (monoamine oxidase inhibitors). Current clinical data indicate
that SSRIs are the most effective medication and should be used as first
line of choice.[2] Specifically, paroxetine hydrochloride and sertraline
hydrochloride are approved by the FDA for use in panic disorder.
Although individual response to these medications varies, the
pharmacologic management of the acute phase of the disorder usually
lasts approximately 12 weeks or until the benefits of medication can be
seen.
Most important, individuals suffering from panic attacks need to be
educated as to the nature and course of the disorder and included in all
phases of treatment planning. Psychoeducation is crucial to the
successful treatment and management of panic disorder.
Cognitive-behavioral therapy has proven most effective in restructuring
thought processes and modifying individual behaviors commonly associated
with panic disorder. Treatment goals need to include the development of
anxiety management skills, cognitive restructuring, relaxation
techniques, and increased coping skills.
In general, the length and effectiveness of overall treatment is
determined by individual personality dynamics, compliance with
medication and individual therapy, course of treatment, and individual
response. Panic disorder is treatable. Concomitant severe psychiatric
and personality disorders, however, need to be referred to a specialist
for further evaluation and treatment.
