Types of Medication

Class of Medication	Most Common Medications Used	How They Are Used	Precautions	Common Side Effects
Benzodiazepines	lorazepam (Ativan®) alprazolam (Xanax®)	High-potency benzodiazepines relieve symptoms quickly and have few side effects, although drowsiness can be a problem. These medications may be used for six months to a year.	May make it dangerous to drive or operate some machinery. Do not drink alcohol when taking benzodiazepines, because the interaction can cause serious problems and even death. May have withdrawal symptoms when stopping. Sometimes can rebound.	Few side effects. But may cause drowsiness, loss of coordination, tiredness and mental slowing or confusion.
Beta-blockers	propranolol (Inderal® and Inderide®)	Your doctor may prescribe a beta-blocker if you are anticipating an attack. The beta-blocker can keep your heart from pounding, your hands from shaking and other physical symptoms from developing.	If propranolol is stopped suddenly, it may cause chest pain or heart attack in some people.	Side effects not common. But if they are severe or do not go away, call your doctor. Side efffects: dizziness or lightheadedness, trouble sleeping, feeling very tired, stomachache, throwing up, rash, diarrhea or constipation.
Anxiolytic	buspirone (Buspar®)	Must be taken consistently for at least two weeks before improvement noted. Cannot be used as an as-needed basis. Can keep heart from pounding, hands from shaking and other physical symptoms from developing	Certain medications such as anticonvulsants, antihistamines, sleeping pills, vitamins, sedatives and painkillers may interact.	Side effects are uncommon, Tell your doctor if any of these symptoms are severe or do not go away: Tiredness, stomachache, vomiting, constipation, diarrhea, headache, dry mouth, depression, excitement, trouble sleeping and lightheadedness
SSRIs (selective serotonin reuptake inhibitors) and SNRI (serotonin and norepinephrine reuptake inhibitor)	fluoxetine (Prozac®) paroxetine (Paxil®) escitalopram (Lexapro®) sertraline (Zoloft®) citalopram (Celexa®) fluvoxamine (Luvox®) venlafaxine (Effexor®)	These are medications that doctors may use first in treating depression because of low rate of side effects.	Do not take with MAOIs, an older antidepressant class. Must be used carefully if given to people with bipolar disorder. See alerts below.	Side effects may include sexual problems, which might not go away unless the medication is stopped. Side effects that usually go away may include headache, nausea, trouble sleeping and agitation. Venlafaxine may be associated with sustained hypertension.
Tricyclics	imipramine (Tofranil®) nortriptyline (Pamelor®) clomipramine (Anafranil®)	Older than SSRIs, and can work just as well as the SSRIs, but many doctors prefer newer drugs because the tricyclics sometimes cause side effects. Can treat co-occurring anxiety disorders and depression.	Talk to your doctor about using this during pregnancy. May interact with other drugs. Be sure to tell your doctor everything you take. They also can cause cardiac arrhythmias, or irregular heartbeats. See alert below.	More likely to cause side effects than SSRIs. Can cause dizziness, drowsiness, dry mouth and weight gain.
MAOIs (monoamine oxidase inhibitors)	phenelzine (Nardil®) isocarboxazid (Marplan®) tranylcypromine (Parnate®).	MAOIs are the oldest class of antidepressants.	Must follow a restrictive diet because MAOIs can interact with some foods and beverages, such as cheese and red wine. May also interact with medications, including SSRIs, which may cause dangerous elevations in blood pressure or other life-threatening reactions. See alert below.	Signs of unusually high blood pressure: Chest pain, large pupils, change in heartbeat, headache, sensitivity to light, heavy sweating, vomiting and stiff or sore neck Common: Blurred vision, less urine, sexual problems, dizziness or lightheadedness, feeling tired, mild headache, increased hunger or weight gain; sweating, muscle twitching during sleep, nausea, restlessness, trembling, tiredness, trouble sleeping

A warning: taking SSRIs (selective serotonin reuptake inhibitors) with medicines called triptans used for migraines can result in a serious condition. Taking these medicines together can cause serotonin syndrome. Signs of this syndrome include restlessness, fast heart beat, diarrhea, hallucinations, and coma. Makes sure to tell your doctor about all the medicines you take before taking an SSRI.

Children, teens and adults being treated with antidepressants, particularly people being treated for depression, should be watched closely for worsening of depression and for increased suicidal thinking or behavior. Close watching may be especially important early in treatment or when the dose is changed - either increased or decreased. Bring up your concerns immediately with a doctor.

Paxil may increase the risk for birth defects, particularly heart defects, when women take it during the first three months of pregnancy, according to a 2005 advisory from the Food and Drug Administration (FDA). The FDA is waiting for the results of recent studies to better understand the higher risk. Discuss with your doctor about the health risks of Paxil if you plan to become pregnant or are in the first three months of pregnancy. You may want to consider taking a different antidepressant. Do not stop taking the drug without first talking to your doctor.

More on Panic Disorder

This article was reviewed and updated June 2007.