Panic/Agoraphobia and Medication

We cannot list complete medication information on this page, due to individual differences, possible misinterpretation, medical complications, and other related problems. A consultation with a medical professional, such as a psychiatrist who specializes in the anxiety disorders, is an important and necessary step when medication is being considered for an anxiety disorder.

The following is only a guide to what we have found to be clinically useful. However, empirical research in this area has tended to support these clinical findings.

In the first place, not everyone with panic needs to be on medication. There are many factors that need to enter into this judgment, such as conferring with your anxiety specialist,  and the way you know your body responds to medication in general.

When a person with panic and/or agoraphobia faces anxiety problems related to panic every day of their lives, we recommend that medication may be useful. Please keep in mind that while medication can be very helpful in some cases, it is NOT a cure. It will not get you to where you want to be -- it will not be a "cure" or a permanent "solution".

If we recommend medication it is for the purpose of using it as a "tool" or as an "encouragement" while undergoing cognitive-behavioral therapy. If medication allows the individual to practice better and clearer at home on CBT material, and if the anxiety is cut somewhat in daily functioning, then medication can be beneficial and helpful. It is the CBT, however, that changes your brain pathways (neural pathways) permanently, NOT the medication.

If you are looking for a band-aid, get the medication and ignore CBT therapy.

If you are looking for a permanent solution -- a change in your brain's chemistry and neural pathways --  stick with CBT and practice, practice, practice until it becomes an automatic habit. Research evidence demonstrates that neural pathways actually change physiologically over time by using cognitive-behavioral therapy. Medication changes brain chemistry temporarily; CBT has the power to make it permanent.

Each and every person is an individual.  When medication is addressed, what works for one person may not work for another. Therefore, we are only talking in generalities and in approximate percentages. If a medication works for you, as you are under the care of a qualified psychiatrist who specializes in the anxiety disorders, stick with it.

Tri-cyclic antidepressants (TCAs): Some of the TCAs have been shown to be helpful in the treatment of panic.  They do not seem to be the medication of choice for people with agoraphobia, however. 

Buspirone: May provide limited help, however empirical research is flimsy.  We have had only two people with anxiety who have seemed to benefit somewhat from this medication.   It more often causes negative side effects.  Not a medication of choice for panic/agoraphobia.

SSRIs, such as Prozac, Zoloft, Paxil: Some reports have found a 15-45% success rate in temporarily reducing anxiety symptoms, a finding that is optimistic compared to our clinical observations. Currently, among our panic/agoraphobia client base, we have had only two people  who may have been helped by one of the SSRI medications.  On the other hand, over 70% of our people who been prescribed an SSRI have had fairly negative results.   Should not be among the first medications prescribed.   (Yes, we are aware the FDA has approved Paxil for the use of panic.  Most of our people who have been an SSRI before coming to the clinic have not reported success with these medications.)

If people are on an anti-depressant, or have tried anti-depressants, they usually have been prescribed one of the SSRIs.  The side effects these medications cause appear to be particularly strong and negative for people with anxiety disorders.  Better results may come by tapering ON these medications, because many people with panic disorder are hypersensitive to medications. 

Anti-anxiety agents, such as Ativan and Klonopin: These are typically the agents of choice for starting anxiety management.

Many "primary care" physicians (GPs) have not been trained in the anxiety disorders and see these medications as being "addictive".

However, these medications are NOT addictive for people with clinical anxiety disorders.

Over three dozen research studies report that people with clinical anxiety disorders do not become drug addicts as a result of temporary anti-anxiety use. These medications can be very helpful for people with panic/agoraphobia. Find a psychiatrist who understands this.  These medications are tolerated well and almost always help. There are few side effects (e.g., tiredness at first) and they work quickly.  There seems to be more research support for the use of  Klonopin (clonazepam) in the treatment of anxiety than for the other anti-anxiety medications. 

If a professional tells a person with a definable, DSM-IV anxiety disorder that the anti-anxiety agents may prove addictive to them, the professional (a) is not aware of research in the area of anxiety, and (b) should probably not be treating you.  The anti-anxiety agents work, they are safe, and people with anxiety disorders usually stay on a low dosage while going through CBT.  These medications are nothing to worry about.    When stopping anti-anxiety use, it is necessary to taper off the medication slowly, by reducing the dose over a period of 3 to 4 weeks. 

MAOIs: These drugs, in general, have been shown to work effectively approximately 60-85% of the time for people with clinical anxiety disorders. Most  people with panic do not need this medication, however.   

If a medication is needed in addition to the anti-anxiety agents, these medications have been shown to work best for panic/agoraphobia.  Although most of our anxiety people do NOT need to be on these medications, some of our people, especially people with agoraphobia, DO need the added benefits of an MAOI. 

We have found that, in general, Parnate, as opposed to Nardil, is more effective with many of the anxiety disorders, provided there are no other anxiety or mental health care complications.   Although these medications require slight food restrictions, the current list (even as far back as 1998) is quite small.  No responsible adult who needs to be on an MAOI has ever complained about the food restrictions.

Our more severely agoraphobic individuals probably do need to try these medications, under proper psychiatric care. Talk with your social anxiety therapist about this first, and get a recommendation to a psychiatrist who understands the anxiety disorders and this particular medication in general. You will not normally be able to obtain one of the MAOIs from your general practitioner, as they are usually unaware of the positive effects this medication can play in helping people with anxiety.

The reversible MAOIs or RIMAs are available almost everywhere else in the world except the United States.  Currently, it is possible to have your psychiatrist write a prescription for a RIMA  and have it filled at a pharmacy in Australia, New Zealand, or Europe.  It will then be mailed to you.   In general, moclobemide appears from the early data to be much less effective for anxiety than Parnate or Nardil.  We do not recommend its use based on the available data. 

NOTE: If you are given any type of medication for psychosis, you have been misdiagnosed. Panic and/or agoraphobia is an anxiety disorder and is therefore the "opposite" of psychosis. If this happens to you, please seek another therapeutic source.

IMPORTANT NOTICE: This information is intended as a general guide only. It is essential you consult with your psychiatrist about any medication, due to individual and/or interaction effects, and additional medical complications. It is also essential that you work with a psychiatrist that FULLY understands anxiety and has kept up with the latest research on medical treatment for anxiety. Please notice that we are specifically referring here to people who have been diagnosed as having panic disorder with or without agoraphobia.

The Anxiety Bookstore