8 best medications for panic attacks

*Review of the best according to the editorial board. About the selection criteria. This material is subjective, not an advertisement, and is not intended as a guide to purchase. It is necessary to consult with a specialist before purchase.

One of the most unpleasant sudden states that, despite the absolute safety for life and health, can occur in a person is a panic attack. It is a sudden severe anxiety, internal tension, a sudden and overwhelming fear of death, which is accompanied by a “vegetative storm,” such as redness of the face, heart palpitations and other symptoms.

Doctors who diagnose panic attacks have identified more than 13 striking symptoms, and if a person has 4 or more characteristic signs during an attack, a panic attack diagnosis can be made. However, there are also so-called minor forms, when there are only two or three symptoms. Why would you need such a complicated diagnostic methodology, like a questionnaire or a sociological study?? Simply because there are so many symptoms of a panic attack and they are all “vague. For some it is an indescribable horror, for others an unusual physical sensation that is difficult to describe in words, such as “mobilization of the whole body. Sometimes there is no feeling of fear at all, this is the so-called “decapitated panic” or “panic without panic”.

These suddenly occurring episodes are quite often accompanied by a pronounced state of anxiety, and may recur when faced with a similar situation, such as getting stuck in an elevator. In some cases, however, panic disorder can occur in some other situation and under different circumstances.

Quite often, in addition to purely physical symptoms, such as chest pain, dizziness, shortness of breath or palpitations, there are also symptoms that psychiatrists deal with. These are signs such as feelings of absolute unreality, detachment from reality, the illusory nature of all occurring, that is, feelings of derealization and sometimes depersonalization. Depersonalization is a complex feeling: “I am not me”. Quite often the patient during a panic attack is afraid of going insane, and this is a higher level of fear than just the animal fear of death.

Already after the first attack there is quite often a secondary fear, to get into this situation again, or the fear of a panic attack relapse. The consequence is that the patient develops a rigid style of behavior, and it is aimed at avoiding similar situations and subsequent attacks, and at all costsWhat causes a panic attack, and how often it occurs?

Etiology and risk factors

It was found that panic attacks often occur in families with a high level of hereditary anxiety, when there is a history of pronounced neurosis, when a person in his childhood used violence, both physical and sexual.

In general, any stress, from a serious illness, divorce and the death of a loved one to the death of a pet, can play a role trigger, or trigger factor in the formation of a panic attack.

Physiologically and biochemically, it is not entirely clear which central nervous system structures and disturbances in which mediator media are ultimately realized by a panic attack. However, it has been found that there is a disruption in GABAergic transmission as well as changes in serotonin metabolism.

Panic attacks are more common in women, on average, a second more common than in men. Their prevalence in the population is, on average, 2 to 5 percent. The age at which panic attacks occur is between 20 and 40. This is the age of hormonal flourishing and saturation, and it becomes clear why: because the role of hormones – catecholamines, adrenaline – is key in the realization of “vegetative storms”. The debut of a panic attack occurring for the first time in old age, or during menopause in women is extremely rare and may be considered clinical casuistry. What is the typical clinical picture of a panic attack unfolding, and where did this reaction of the body come from in the first place?

The physiological “basis” of a panic attack

A typical panic attack can be characterized as anxiety of the extreme degree, when a person is deaf to the voice of reason and logical arguments, he is under the influence of very strong fears. It is fear of death or loss of consciousness, fear to go mad, and these fears are abundantly seasoned vegetative symptoms, expressed through sympathoadrenal crises. This tachycardia and chest pain, nausea and increased sweating, redness of the face and dizziness, a feeling of fever or even cold chills with shivering and tremors.

The peculiar insidiousness of panic attacks is that it is usually impossible to recognize them in advance and, unlike a migraine attack, there are no precursors to a panic attack. It begins suddenly, just like a grand mal seizure, and is associated with a release of adrenaline. Therefore, the old doctors who equate a panic attack with an autonomic-vascular sympathoadrenal crisis are right.

We can say that in patients with vegetovascular dystonia and sympathoadrenal crises in the presence of fear of death and severe anxiety during the crisis can be quite put the diagnosis of a panic attack. Sympathoadrenal crisis is nothing but an ancient, but untimely and inappropriate in this situation reaction, which is aimed at the full and maximum rapid mobilization of all the body’s defenses. As a result, in nature, man, or any other living creature, realizes this reaction through immediate flight, or attack – any way to defend his own life as quickly as possible.

It is for the sake of this that blood flow is redistributed extremely quickly, blood begins to rapidly supply the skeletal muscles and the brain, flows away from the skin and internal organs. There is deepening and more frequent breathing, increased supply of oxygen to the blood, and intensified work of the heart. And all this, not finding an outlet in the immediate muscular activity, without a “discharge”, leads to the development of unpleasant symptoms. If all patients who had a sudden panic attack could rush out to run, and run a few dozen meters, this would be the best kind of treatment, since all the physiological responses aimed at muscle activity would be realized in a normal way.

Panic attack or panic disorder?

A panic attack begins suddenly, and usually lasts for a few minutes, and then it ends safely. And here it is very important for the doctor to discern whether the patient has an isolated panic attack, or whether a panic disorder has already formed. What is the difference between these two states? And this is what:

In the case of isolated panic attacks, the patient in the light intervals between them does not form the fear of waiting for the subsequent attack.

So there’s some kind of unpleasantness, was, and is over. He may attribute it to external factors, such as the heat, a quarrel with his boss at work, and this explanation is quite acceptable. Hence, the freedom of the future, and there is no expectation of a new panic attack, the formation of tension and anxiety. This is the most favorable option.

But if a person believes that external factors have nothing to do with it, and the case is a feature of his organism, then (especially in the presence of hypochondria, suggestibility and melancholic temperament) he starts to form fear of waiting for the next attack, and the next step is to form ritualistic behavior.

The person will very firmly avoid a situation in which a past panic attack has occurred. If he has it in a store or mall, he tries not to go to crowded places. If they feel sick on the bus, they avoid using transportation; and if they feel sick in the elevator, they will only walk from now on. By the way, from the avoidance of the repetition situation it is not very far to OCD, that is obsessive-compulsive disorder or obsessive-compulsive syndrome. There is already a super-valuable, obsessive thought of not falling and not repeating, and from it “close at hand” and to the ritual of compulsive actions.

What do patients complain about at the doctor’s office??

It must be remembered that the doctor does not see the panic picture “on the fly”, the patient talks to him after everything has happened, as they say, “clear-headed”. Depending on which system is responsible for the greatest number of complaints, a patient may consult a cardiologist, a neurologist, or even a gastroenterologist. So, if he has a large number of cardiac signs, such as heart and chest pain, fear of death, irregular heartbeat, he is likely to come to a cardiologist.

If he remembers tremors, numbness in the limbs or sudden weakness, some fogginess of consciousness, half-consciousness and dizziness, then such a patient will find himself at the neurologist, because he will suspect first of all something like epilepsy, brain tumor, or suddenly developed “temporary” stroke.

At the same time the arising fear of death, the panic and pronounced anxiety is completely justified by the patient, and people say that it is simply a “normal reaction to a possible severe illness”, a heart attack or a stroke, and everyone would be frightened if they were him.

At the same time doctors-specialists, even if the diagnosis of a panic attack or panic disorder becomes perfectly clear, find it extremely difficult at times to convince the patient that there is no real threat to their life, no tumor, stroke or other hypothetical serious illness, and that all this is elementary panic. These conclusions by the doctor are discouraging, and even insulting to the patient, who is used to considering himself a victim of an unknown, not yet found, but very severe illness.

Patients believe so strongly in their disease that they are able to express their distrust to several doctors at once, and tend to form a more severe addiction for themselves. In some cases this goes as far as pathological psychoproduction with the formation of a delusional disorder, but this requires serious treatment by a psychiatrist.

It goes without saying that the diagnosis of a panic attack must take into account the presence or absence of psychiatric illness, such as schizophrenia, organic mental disorder, and other conditions, including – the use of various psychoactive drugs. Moreover, without a complete psychiatric evaluation it is impossible to gather comprehensive information and prescribe treatment for a patient with severe panic disorder.

Diagnosing panic attacks and panic disorder is quite a tough job, because you have to make sure that all the various symptoms, from shortness of breath, rapid pulse, to dizziness and fainting, are not a sign of any physical illness. And this means that without a full examination, without ECG, Holter monitoring, spirography, sometimes bicycle ergometry. Although it is often clear to an experienced physician at a glance that this is a panic attack, it is necessary to mechanically, routinely, with the help of various tests and instrumental methods of examination clearly prove in the medical history or outpatient records that there are no serious diseases, such as thyrotoxicosis, or attacks of coronary heart disease. Similarly, it is necessary to make sure that the patient has no psychiatric pathology, no post-traumatic stress disorder, no specific phobia such as social and so on. How to treat panic disorder?

Treatment

Of course, the best way to treat panic disorder would be non-drug treatment. After all, at the heart of panic attacks lies, albeit perverse and untimely, but still a normal life-saving reaction. Good, for example, psychotherapeutic exposure, individual and group psychotherapy. There are alternative and harsh methods, where the patient is “forced” into this situation over and over again, until his conditionality breaks down and he is freed from the influence of this situation.

We can give an example of perfume. If, for example, a man loved a woman who used a relatively rare perfume, then the accidental encounter with this scent, he can remember everything in a second, and sometimes it is so striking that a person can freeze on the spot under the influence of memories flooded. But if he is constantly given this fragrance over and over again, if his loved ones and coworkers use it, after a while it will cease to affect his memories. This is also the basis of the provocative methods of treating panic attacks.

In some cases it is necessary to support with medication, for example, monotherapy with a particular drug is indicated, but the best combination of psychotherapy and medication must still be recognized. There are many therapeutic strategies that are very effective, but we will not dwell on them. Our task is to describe some of the medications that are used in the treatment of panic disorder.

It should be said right away that we are not going to talk about emergency treatment, that is, the relief of the panic attack itself. This is a separate topic, and in some cases the patient just needs to breathe into a balloon. When an increased amount of carbon dioxide accumulates there, many of the symptoms associated with an excess of oxygen in the blood go away without medication. In some cases, a glass of water and an open window and a few drops of Corvalol are enough, and sometimes an ambulance and an injection of Relanium are needed.

Our task is to talk about medications that are aimed at stabilizing the condition and preventing subsequent attacks and relapses. All are used in courses, in the “light intervals” between panic attacks. This review is made up of the so-called “real” drugs for treating panic attacks, and almost all of these drugs are prescription. Many, such as atypical neuroleptics, can only be prescribed by a psychiatrist. Many are used to treat depression, anxiety, and even some major mental illnesses, such as schizophrenia or bipolar disorder.

This review will not include the traditional Runet OTC dietary supplements, folk therapies, herbal packs, and drugs filled the entire Runet like Corvalol, tincture of peony and other products.

As usual, the INN, or international nonproprietary name, is indicated first, followed by the first released, or original drug if available, and then a list of commercial copies, or generics, which are much less expensive than the original drug. Drug prices are current for winter 2020 for pharmacies of all forms of ownership on the territory of the Russian Federation.

The list of drugs is not intended to advertise or discredit any product, and the names of drugs and the sequence of presentations are dictated exclusively by national guidelines for the treatment of panic attacks and panic attacks, and information about the drugs, indications and contraindications are taken from official instructions.

Overview of drugs for panic attacks

Antidepressants: SSRIs and tricyclics

Antidepressants of various groups are among the main and most effective treatments for long-term panic disorder. But the choice of one or another drug is carried out by a doctor, taking into account additional criteria. For example, it depends on the effects of side effects, the presence of suicidal behavior, concomitant pathology. Some benzodiazepines are able to treat a panic attack well, such as the same diazepam.

But long-term treatment regimens to prevent panic attacks use both tricyclic antidepressants, such as Anafranil and Melipramine, and high-potency benzodiazepines, such as alprazolam, or selective antidepressants, which include selective serotonin reuptake inhibitors – SSRIs. We will start our review of the medicine with them.

Venlafaxine (Velaxin, Velafax, Venlaxor)

Rating:* 4.9

It is a popular antidepressant that comes in two dosages: 75 mg and 150 mg. It stands alone in its chemical structure, but its therapeutic effect is associated with potent inhibition of serotonin reuptake. Prolonged capsules are popular for treating panic disorder. It is administered orally, with meals. It must be swallowed whole, and it is very important to take the daily dose once a day, and preferably at the same time.

It is advisable to start panic disorder treatment with a minimum dosage of 75 mg, once a day. The drug is excellent as monotherapy, and it is desirable to increase the dose after 2 weeks, but not earlier than 4 days after the start of treatment. It is prohibited to take more than 350 mg daily. Produces Velaksin Hungarian pharmaceutical company Egis, and the cost of one pack of 75 mg of 28 tablets, designed for a one-month course of treatment, will be from 960 to 1560 rubles.

Advantages and disadvantages

Velaxin is contraindicated along with taking monoamine oxidase inhibitors (MAOIs), but this is a standard contraindication, with severe liver and kidney dysfunction, in children, and in pregnant and lactating women. Great caution is required in the case of recent myocardial infarction, the presence of cardiovascular disease, high blood pressure, glaucoma. Velaxin has side effects, and most commonly, these include decreased appetite, dry mouth, palpitations, sweating, and ejaculatory disorders in men, anorgasmia. In cases of severe panic disorder, treatment should continue for at least 6 months. In some cases, use of Velaksin and analogues may cause psychomotor agitation, inability to sit or stand still, and, most often, this occurs in the first weeks of treatment.

Duloxetine (Cymbalta)

Rating:* 4.8

Cymbalta is a highly effective drug from the group of not only serotonin reuptake, but also norepinephrine. Its capabilities are wider. It is produced by a European company Eli Lilly, and the drug is not cheap. A pack of 14 tablets of 30 mg will cost from 1700 to 2300 rubles at retail. And a pack of 28 tablets of 60 mg (that is, in a dose twice as large) will cost from 3,300 to 4,300 rubles. This substance, in addition to inhibiting mediator reuptake, also suppresses pain, increases the threshold of pain sensitivity. Duloxetine is therefore used for a variety of pain of central origin, such as diabetic polyneuropathy. In severe resistant panic disorder, 60 mg once daily should be prescribed at the beginning of treatment, and the maximum daily dose is 120 mg per day, in two doses.

Advantages and disadvantages

Duloxetine is contraindicated for a fairly small number of conditions, and this is a definite plus: it is closed-angle glaucoma. In some cases, it can be used during pregnancy and while breastfeeding, and it can also be used with liver and kidney dysfunction, but only with caution. Of the side effects, dizziness, dry mouth and constipation, heart palpitations, weight loss and hot flashes are quite common. Remember, this medication, like other antidepressants for suicidal tendencies, should be prescribed with great caution and should not be used with monoamine oxidase inhibitors (MAOIs). Must limit driving and potentially dangerous activities during treatment, as the patient may develop drowsiness as a side effect. Cymbalta and other drugs are also not recommended for use with alcohol, due to the mutual intensification of effects.

Fluoxetine (Prozac)

Rating:* 4.8

Prozac is the original drug from the same company (Eli Lilly) and is the next drug in the same group of selective serotonin reuptake inhibitors called fluoxetine. Prozac is, of course, a prescription drug, and is the most expensive of all the fluoxetines, as it is the original drug. A pack of 14 20 mg capsules costs from 450 to 530 rubles. Fluoxetine manufactured by OOO Ozon in the same dosage and in the amount of 30 pieces in a package will cost from 73 to 120 rubles. If you take a pack of 20 capsules, it can be found at a price of 33 rubles, you are unlikely to find anywhere else fluoxetine cheaper.

Prozac is a classic antidepressant that does not affect the activity of receptors other than serotonin receptors. After the first administration, the maximum plasma concentration occurs after 8 hours, and the permanent therapeutic concentration of this drug appears 2 weeks after the start of treatment. In addition to panic disorder, the classic indications for use would be various depressions, gluttony nervosa, or bulimia, obsessive compulsive disorder and thoughts, i.e. obsessive-compulsive disorder (OCD), and premenstrual dysphoric syndrome. For the prevention of panic attacks, 20 mg daily, once a day, at the same time is usually enough.

Advantages and disadvantages

Prozac side effects are common with other SSRIs. This is dry mouth, decreased appetite and weight loss, constipation and changes in taste are possible. Possible side effects such as drowsiness, but not excluded and insomnia, characterized by decreased libido and lack of orgasm, and in men – disruption of ejaculation and erections.

Some patients noted yawning, and restless legs syndrome against the background of taking this drug, but these were isolated cases. As with the medications described above, you need to be extremely careful if a patient with panic attacks is suicidal, has suicidal thoughts, and so on. After all, the drug can make a person go “from theory to practice”, which increases the risk of suicide attempts.

Importantly, Fluoxetine and Prozac should not be used with Sonapax, or thioridazine. This drug, as a minor neuroleptic, is also used to treat severe panic disorder, and just along with antidepressants, the treating physician should keep this in mind. Prozac and other fluoxetines have a long half-life, and this must always be taken into account when combining Prozac with other drugs, as well as when replacing. You have to be very careful when combining Fluoxetine with other drugs that affect serotonin, such as triptans to treat migraines or Tramadol to treat pain, this leads to a higher risk of serotonin syndrome.

Sertraline (Zoloft, Asentra, Serenata, Serlift, Stimuloton)

Rating:* 4.8

Another drug in this group is Zoloft, or sertraline. It is a potent serotonin reuptake inhibitor, but has no stimulant, sedative, or any other action. It does not increase adrenergic activity, which is very important because it is the sympathoadrenal crises that underlie panic attacks. Zoloft is indicated not only for panic disorder, but also for social phobia, obsessive compulsive thoughts and states syndrome, depression and post-traumatic stress disorder. It should be emphasized that panic disorder is present in the official instructions as an indication, while all previous medications had depression as the main indication.

Produces the drug Zoloft Italian company Hauptfarma Latina, and 28 tablets of 100 mg will cost from 1100 to 1250 rubles. However, you should start treatment with Zoloft at a dosage of 25 mg per day, which is half a 50-mg tablet. This dosage is doubled after a week, to 50 mg per day. A pack of 28 tablets of 50 mg would be considerably cheaper – 900 rubles on the average.

Advantages and disadvantages

In extreme cases, this drug can be used by pregnant women, but nursing mothers should not use this medication. Its side effects are classic for drugs of this group: dry mouth, tachycardia, palpitations, involuntary muscle contraction, yawning, nighttime teeth grinding, decreased potency and ejaculatory distress in men, anorgasmia. But fortunately, these effects are dose-dependent and usually do not occur at the low dose indicated for treatment of panic disorder. Withdrawal syndrome may occasionally occur, so it is better to discontinue treatment by halving the dose as at the beginning of the course.

Tricyclics: Imipramine (Melipramine)

Rating:* 4.8

Melipramine is a prominent representative of another group of antidepressants, namely tricyclic antidepressants (TCAs). It was tricyclics that first appeared in clinical practice, while the SSRI drugs became known relatively recently. This medication, in addition to reuptake of noradrenaline and serotonin, and facilitating the corresponding impulse transmission, also blocks histamine and acetylcholine receptors. The result is a choline-blocking and sedative effect. This treatment is also intended for long-term therapy and the optimal effect is achieved after an average of 5 weeks of treatment.

In addition to panic disorder, melipramine is indicated for all depression, including anxiety, atypical depression, and bipolar disorder. This is very helpful because it is the anxiety, the anxious anticipation, that underlies the addiction to the psychotraumatic situation that causes a panic attack.

Melipramine is available from a small number of different manufacturers, and currently only tablets manufactured by Egis in Hungary are sold in Russia, with prices ranging from 320 to 420 rubles. For the package. Pack of 50 tablets of 25 mg. There are also pills in the same dosage, at an average cost of 300 rubles. For the same package. How to use melipramine? In panic disorder, the lowest dose should be prescribed, i.e. 25 mg per day.

Advantages and disadvantages

It should be remembered that in panic disorder a transient increase in anxiety is possible at the start of treatment, in which case benzodiazepines such as Relanium or Seduksen may be used to control anxiety. The benzodiazepines are then withdrawn as the effects develop and anxiety decreases. Melipramine should also be withdrawn gradually, and the minimum duration of panic disorder treatment is, on average, 6 months. This medicine should be taken once after a meal before bedtime. Side effects of tricyclics occur quite often, and these include possible increased liver enzyme activity, sinus tachycardia, tremor, dizziness, blurred vision, and impaired accommodation. Due to the cholin-blocking effect, constipation and dry mouth, urinary disorders, patients complain of increased sweating, sometimes – an increase in body weight. Drugs from the first group, SSRIs, most often lowered body weight by reducing appetite, so you should consider the prescription of one or another drug, taking into account the anamnesis.

Benzodiazepines

Alprazolam (Zolomax, Helex)

Rating:* 4.9

Benzodiazepines are medications that are widely used both for maintenance therapy of panic disorder and directly to relieve the panic attack episode itself, for example, by intramuscular or intravenous administration of Seduxen or Relanium. These drugs are also used to suppress anxiety, which can be exacerbated at first by antidepressant treatment. For example, the combination of tricyclic antidepressants with benzodiazepines is widely known. However, for long-term treatment of panic disorders, it is desirable to use so-called long-acting benzodiazepines, or high-potency benzodiazepines, and their representative is alprazolam. We will not discuss short-acting benzodiazepines such as diazepam here.

Alprazolam is available in 1 mg tablets in a pack of 50. It is a typical anxiolytic, or tranquilizer, which has sedative, muscle relaxant, anticonvulsant effects in high doses, as well as sleeping pills. These effects result in a significant reduction in emotional tension. Anxiety, anxiety and fear are reduced or eliminated in the patient. Since the drug has a concomitant hypnotic effect, and shortens the period of falling asleep, it is very well prescribed to persons with panic disorder and various insomniac symptoms, with insomnia. This medication, in addition to panic disorder, is widely used for neurosis, irritability, and somatized depression.

The drug is administered using the minimum effective dosage, and usually the starting dose is 250 to 500 mcg, micrograms. Dosage in micrograms is found among medicines produced in tablets very rarely, and this is just such a case, because the tablets have a very small dosage of 1 mg. Accordingly, 250 micrograms is a “quarter” of a tablet, and a dose of 500 micrograms is half a tablet. The drug should be withdrawn gradually, with a reduction in the dose, and the medication should also be used for a long time, as decided by the doctor. Several companies produce alprazolam. Currently, in Russia the generic alprazolam is available (though not always) at the price of 940 rubles per month. per package, manufactured by the domestic company Organica.

Advantages and disadvantages

The virtue of alprazolam is a good reduction in anxiety and improvement in sleep, while the disadvantage is its contraindications, which include chronic obstructive airway lesions, and fairly severe depression. In addition, it is advisable to use this medication in lower doses, especially if the person is new to medications such as antidepressants or anxiolytics. If prescribed for a long time and in high doses, drug dependence can occur, and if the dose is rapidly reduced or abruptly withdrawn, severe syndrome can occur, up to and including insomnia and abdominal cramps. Remember that alprazolam is incompatible with other tranquilizers, and alcohol should be prohibited during treatment, as well as refraining from driving vehicles and working with machines and mechanisms.

Non-benzodiazepine anxiolytics

Hydroxyzine (Atarax)

Rating:* 4.8

There is also a whole group of anxiolytics that are not benzodiazepines, and its most famous representative is considered hydroxyzine, which is known under the commercial name Atarax.

What these drugs are used for? They initiate an anti-anxiety effect, and are prescribed the very first in the complex treatment of panic disorder. The fact is that standard antidepressants from the group of selective serotonin reuptake inhibitors, or tricyclic antidepressants, can develop an excellent anti-anxiety effect, but it occurs slowly, as mentioned above, on average, in a month and a half after starting to take. In order to cover the patient in the first weeks after the prescription of antidepressants, Atarax and its “counterparts” in this group are used to quickly affect anxiety.

Let us consider the effects of non-benzodiazepine anxiolytics using Atarax as an example. Hydroxyzine has a very broad spectrum of action because it affects choline and histamine receptors. As a result, it causes sedation and an anti-emetic effect. Atarax is a very fast remedy, after taking the tablet, its effects are noticeable already after half an hour. In addition, in addition to its anti-anxiety effect, it can improve memory and attention, that is, cognitive abilities. Therefore, it is very good in the treatment of allergic manifestations, as it helps to relieve itching in patients with urticaria and eczema. In individuals with anxiety, it improves sleep quality and lengthens sleep duration. Atarax should be used in doses ranging from 25 to 100 mg per day, with the standard dosage being an average of 50 mg per day, which is divided into three doses. It is 12.5 in the morning and at lunchtime and 25 mg in the evening. This is why Atarax is available in such a dosage – 25 mg, and a pack of twenty-five tablets costs from 230 to 290 rubles, manufactured by the Belgian company UCB Pharma.

Advantages and disadvantages

The advantages of Atarax may be considered the low price, the ability to relieve itching, and improve sleep, but if there is no itching and no bad sleep, it still has an excessive sedative effect and cholin-blocking action, which causes dry mouth and difficulty in urination. It is also quite inconvenient that it is necessary to take this medicine three times a day, at that half a tablet in the morning and half a tablet in the afternoon, i.e. it is necessary to break a tablet. However, it should be remembered that the side effects are not very pronounced, and quickly go away, a few days after starting treatment, and these are just constipation, urinary retention and dry mouth. Long-term side effects persist in the elderly. Atarax is contraindicated in pregnancy, breastfeeding, and hereditary galactose intolerance.

Atypical antipsychotics

Risperidone (Speridan, Rispolet, Risset, Torendo)

Rating:* 4.8

And what to do in that case if panic attacks became frequent, panic disorder – severe, and antidepressants taken separately do not help, as well as in combination with anxiolytics, benzodiazepines, or drugs of nonbenzodiazepine series? Then the “heavy artillery” comes in, which refers to neuroleptics, which are also called atypical antipsychotic drugs

These are risperidone (Rispolet), and its “colleagues” olanzapine (Zyprexa, Egolanza), and aripiprazole (Zylaxera, Amdoal, Ariprizole). Neuroleptics are prescribed only by psychiatrists, and the field of neuroleptics is not depression, not anxiety, as they are purely understood in outpatient practice, but true severe mental illness. Neuroleptics are needed for true hallucinations, if there is delirium, if there is a manic episode or psychosis. Neuroleptics are needed in the treatment of schizophrenia, for episodes of physical aggression in these patients, and in severe cases of obsessive-compulsive disorder.

But when combined with antidepressants, many studies have shown atypical antipsychotics to be quite effective for severe and resistant panic disorder that could not be treated with a separate drug. Thus, Risperidone is indicated for all the conditions described above, and is chemically a blocker not only of serotonergic receptors, but also of receptors to dopamine and alpha 1 – adrenergic receptors. As a result, it suppresses fear, which dominates the formation of anxiety in panic disorder, and in psychiatric practice reduces aggression, and enhances the deep stage of sleep.

The dosage of Risperidone is usually determined by the treating psychiatrist. The starting dose for panic disorder should be less than that for schizophrenia, or hallucinations. It usually starts at a dose of 0.25 mg per day, followed by a slight increase. But the drug should not be taken in a dose greater than 10 mg per day, under any circumstances. Rimperidone is available in 2 mg tablets, in a pack of 20 tablets. There is also a dosage of 4 mg. A pack of 20 mg tablets costs from 120 to 480 rubles., Manufactured by the domestic company Organica. The original drug may be considered Rispolett, manufactured by Janssen cilag, Johnson johnson. And a pack of Rispolettes, similar to the previous one, will cost from 300 to 700 rubles.

Advantages and disadvantages

The disadvantage of Risperidone is the rare possibility of malignant neuroleptic syndrome, specific side effects peculiar to neuroleptics, which are dose-dependent. These include insomnia, headache, muscle rigidity and hypersalivation, slowed movements, constipation, impaired erections and ejaculation, reflex tachycardia, and so on. Neuroleptics treat only severe panic disorder, and probably also in shorter courses. Only psychiatrists, who have experience in treating neuroleptics, use neuroleptics. Patients should be advised not to overeat during treatment because neuroleptics promote weight gain.

In lieu of a conclusion

In order not to bore the reader without medical education, we stop here to enumerate in detail the medications used all over the world for treating panic disorder in the “cold phase”, between panic attacks. There are entire other classes of drug compounds that could be included in the list, but this would greatly increase the length of the article.

Thus, for influence on the cognitive component of anxiety and prevention of various phobias, so-called minor neuroleptics, such as sulpiride (Eglonil), Teraligen and Sonapax (Thioridazine) are successfully used. Minor depressants that have no group affiliation of their own are used. Sometimes prescribing them is enough to relieve a patient of mild panic, and these include trazodone (or Trittico), Valdoxan, and other drugs.

To improve mood in patients with panic disorder are very widely used and various anticonvulsants, or anticonvulsants. The list of these remedies is extremely broad. These are valproic acid and lamotrigine, pregabalin or gabapentin, and a little-used drug such as Trileptal, or oxcarbazepine.

It should be said that the recommended duration of treatment for panic disorder of moderate severity, is, on average, three to six months. But this time is counted after the therapeutic effect has just occurred, the patient’s mood has improved, and the anxious anticipation of the next panic attack has disappeared, and not at all from the first day of taking the medication. Therefore, it is quite possible to take the medication even for more than 6 months, under the control of the necessary tests, taking into account the side effects.

But in any case, the universal rule remains as small as possible dosages, with a flexible approach, the possibility of replacing the drug and an emphasis on non-pharmacological therapies. All together, this leads to the elimination of panic attacks, reducing their number, lengthening the “light intervals” between them, improving mood, disappearance of anxiety and improving the quality of life in patients.

*The popularity rating is based on the analysis of demand data of the wordstat service..