2     High Potency Benzodiazepine Tranquilizers. Some examples are Xanax and Xanax XR (alprazolam), Ativan (lorazepam) and Klonopin (clonazepam). Xanax (alprazolam) is the most thoroughly studied of this group.  Xanax (alprazolam) was already used for a decade to treat Panic Disorder when it was approved for use in Panic Disorder by the FDA in 1990. Klonopin is also approved by the FDA for treating Panic Disorder. Ativan is regarded by most clinicians as being effective but is not approved for this use by the FDA as of this writing.  These medicines are quite effective and usually have few side effects at proper doses. They block panic attacks almost immediately in the first day or two of treatment.Several dosage increases over a period of several weeks are customary.  Ultimately, no further increases are required.
     Public concern about such medicines being dangerously addictive is unduly exaggerated in the case of persons with Panic Disorder.Scientific evidence shows surprisingly low rates of abuse of this and other medicines in persons with Panic Disorder. Physical dependence does develop with such medicines at larger dosages (more than 3-4 mg per day).
     Xanax XR seems to be less tempting to drug abusers according to a small study by Mumford, et al.  Panic disorder patients often seem to prefer it to regular Xanax, according to Dr. Cox, "They say Xanax XR does not work any better than regular Xanax.  They say it does not have any less side effects. But they seem to like it better due to the convenience of not having to take it at midday. Not having to take it but once or twice a day instead of three or four times a day causes some patients to feel, as they put it, “Free from Xanax'."
3     Nardil (phenelzine). This unique medicine, though more effective than any other medicine for this disorder, is rather complicated to use. It may be best to reserve it for cases where simpler medications have failed or cannot be used for some reason. Nardil is a safe medicine when used by an experienced physician in a patient who complies with the necessary diet and medication restrictions. Unsafe elevations of blood pressure for several hours can occur if one does not adhere to these restrictions while taking Nardil.More information about Nardil, a MAOI medication, is linked to Dr. Ivan Goldberg's PsyCom.Net website for depression.
C     Once the panic attacks have been successfully blocked completely for about three months Panic Disorder patients usually get back to normal life without any additional assistance.  However, many do not automatically overcome their tendencies to avoid the situations that they have been evading.  Success in such patients is achieved by organizing a systematic approach of doing the very things that have been avoided.  They begin going into the least difficult of avoided places first.  This exposure to the feared situations is practiced repeatedly until they are reasonably comfortable.  Then they proceed to the next more difficult avoided activity.
     This highly successful approach is a common sense method based on the old adage "If you fall off the horse, get right back on." This cognitive behavior therapy approach may be helpful in resolving such fears. The person discovers that they can indeed perform the avoided activities and the medication prevents the attacks from occurring. Confidence is restored and normal life resumes with security, peace of mind and a sense that one is in control once again.
     Some professionals believe that Panic Disorder can be treated solely with talk therapy such as cognitive behavioral therapy or expensive cassette tapes. This area is controversial. The National Anxiety Foundation urges professionals and patients to employ the combination of both methods (medication and cognitive-behavioral therapy) until convincing research clarifies, once and for all, this controversy.

     The first step should be to have a medical evaluation to determine the proper diagnosis. Your family physician is the good place to start. Tell him or her what has been happening to you and that you wonder if you might have Panic Disorder. Show the doctor this brochure. After the evaluation perhaps the doctor will tell you that you do have Panic Disorder. Then what? You may wish to see a psychiatrist.
     Psychiatrists are physicians (M.D., or less commonly, D.O.). A psychiatrist who is experienced in treating Panic Disorder is perhaps the most qualified single professional to deal with the problem. There is a national shortage of psychiatrists. There may not be one in your area, or your HMO may not allow you to be seen by one of their psychiatrists. In these instances, seeing your regular doctor for medication to stop the attacks and consulting a psychologist, if necessary, for behavior therapy is second best. Psychologists are not physicians (instead of M.D., they may have other abbreviations after their name such as Ph.D. or Ed.D. or Psy.D.). If a psychologist isn't available for behavior therapy, a social worker who is familiar with this therapy might be helpful in conjunction with your family physician.

Remember, Panic Disorder is a serious but highly treatable medical illness. Almost everyone responds well to treatment and can return to normal functioning in weeks or months.

Stephen Cox, MD
President - NAF
Medical Director

Linda Vernon Blair

C. Todd Strecker

Board of Directors:
Father Edward Bradley
Georgann Chenault
Sarah Wood Cox
Keith Hartman MD

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