Treatment process for panic disorder characterized by recurrent panic attacks and anticipatory anxiety, in which psychotherapy (CBT) and, when appropriate, SSRI-class medications are used together.
Indication
- Recurrent, unexpected panic attacks (palpitations, shortness of breath, sweating, fear of losing control)
- Disruption of daily functioning due to fear of having another panic attack (anticipatory anxiety)
- Avoidance behavior of environments where panic attacks occurred (agoraphobia)
- Cases of unexplained chest pain or palpitations with normal cardiology evaluation
- Significant restriction of work, school, or social life due to panic attacks
- Coexisting depression, alcohol, or substance use history
- Recurrent emergency department visits due to untreated panic disorder
Preparation
- Medical history and general health evaluation (excluding physical conditions that may mimic panic attacks such as thyroid tests, ECG)
- Sharing all medications used and substance use (caffeine, alcohol) with the physician
- Noting when attacks began, their frequency, and triggers
- In the presence of suicidal thoughts, informing the family and preparing a safe environment
How it's performed
- A detailed psychiatric evaluation is performed at the first appointment; panic disorder is confirmed by DSM-5 / ICD-10 diagnostic criteria
- Necessary laboratory tests are requested to rule out medical causes
- Cognitive behavioral therapy (CBT) — correcting misinterpretations of bodily sensations, breathing exercises, reality testing, and gradual exposure techniques are planned
- In moderate-severe cases, SSRI-class antidepressants (sertraline, paroxetine, escitalopram) are started at low doses as first-line medication; dose is gradually increased
- Time-limited and controlled benzodiazepine use may be considered during acute intense anxiety periods
- Medication and therapy response are reassessed at 4-6 week intervals
Post-procedure
- Weekly or biweekly check-ups for the first 2-3 months; then monthly follow-up
- Once response is achieved, medication treatment is continued for at least 6-12 months; early discontinuation increases relapse
- When discontinuing medication, gradual tapering is performed; abrupt cessation is not recommended
- CBT sessions generally last 12-16 weeks; maintenance sessions may be planned afterward
- Lifestyle adjustments: regular sleep, caffeine-alcohol restriction, physical activity
Risks
- Nausea, headache, sleep disturbance, and sexual dysfunction in the first weeks of SSRI medications
- Rare temporary increase in suicidal thoughts at medication initiation in young adults (close monitoring required)
- Risk of dependence and tolerance development with long-term benzodiazepine use
- Treatment non-response or partial response — medication change or combination may be needed
- Symptom recurrence (relapse) after treatment — maintenance treatment is important
FAQ
Can panic disorder be resolved with medication alone?
No. Cognitive behavioral therapy (CBT) can also be effective on its own. In moderate-severe cases, treatment response is better when therapy and medication are used together.
When will I respond to treatment?
The effect of SSRI-class medications generally becomes apparent in 4-6 weeks. It is important to be patient in the first weeks and remain under physician follow-up.
Will I become dependent on the medication?
SSRI-class antidepressants do not cause dependence. Benzodiazepines, however, carry a risk of dependence with long-term use, so they are given in a controlled and limited manner.
Should I go to the emergency department during a panic attack?
During the first panic attack, ruling out cardiac or respiratory conditions is important. After diagnosis, going to the ER for every attack is not necessary; learned breathing and calming techniques are applied. If suicidal thoughts arise, 112 should be called immediately.
Related Information
Related Medical Services
Other services in the same specialty or with similar indications you may want to explore.
Cognitive Behavioral Therapy
Psychiatry Services
CBT — an evidence-based therapy that works on the link between thoughts, emotions and behavior in a structured way.
Treatment of anxiety disorders
Psychiatry Services
Anxiety disorders — treatment of generalized anxiety, panic and social anxiety with therapy and, when needed, medication.
Obsessive-Compulsive Disorder Treatment
Psychiatry Services
Obsessive-compulsive disorder (OCD) treatment — exposure and response prevention (ERP) therapy combined with high-dose SSRIs.
Sleep disorders treatment
Psychiatry Services
Sleep disorders treatment — CBT-I (cognitive behavioral therapy for insomnia) and, when needed, medication for insomnia, delayed sleep phase and psychiatric-related sleep problems.
Psychiatric Evaluation
Psychiatry Services
Comprehensive clinical evaluation of mental health — diagnosis, differential diagnosis, and treatment planning.
Individual Psychotherapy
Psychiatry Services
One-on-one mental health counseling — addressing emotional and behavioral difficulties with evidence-based methods.
Depression Treatment
Psychiatry Services
Depression treatment — a holistic approach combining psychotherapy, medication when needed, and lifestyle adjustments.
Bipolar Disorder Follow-up
Psychiatry Services
Bipolar disorder follow-up — long-term monitoring of manic, hypomanic and depressive episodes and treatment with mood stabilizers.