Panic Disorder Treatment

How is Panic Disorder Diagnosed?

Before treatment for panic disorder begins, a psychiatrist or qualified mental health professional assesses the symptoms, medical history, medication use, substance use and level of functional impairment. The assessment helps determine whether the symptoms are consistent with panic disorder and whether another physical or mental health condition may be contributing to them.

Diagnosis of panic disorder may involve:

• A psychiatric interview and mental status examination

• Assessment of the frequency, severity and pattern of panic attacks

• Evaluation of avoidance behaviour and its effect on daily activities

• Review of medical history, prescribed medicines and substance use

• Physical examination or appropriate medical investigations to rule out physical conditions that can produce similar symptoms

• Assessment for coexisting conditions such as depression, other anxiety disorders or substance use disorders

How Is Panic Disorder Treated Based on Severity?

Treatment for panic disorder is individualised rather than determined by a fixed severity-based treatment pathway. The choice between psychological therapy, medication or combined treatment depends on the severity of symptoms, functional impairment, previous response to treatment, co-existing conditions and treatment preferences.

The table below explains the commonly considered treatment approaches for panic disorder according to the general level of symptom severity:

Oral Medications for Panic Disorder

Medication for panic disorder should be prescribed and monitored by a qualified mental healthcare professional. The oral medications prescribed for panic disorder are as follows:

• Selective Serotonin Reuptake Inhibitors (SSRIs): Sertraline, paroxetine, fluoxetine, citalopram and escitalopram may be used for panic disorder, subject to appropriate clinical assessment.

• Serotonin-Noradrenaline Reuptake Inhibitors (SNRIs): Venlafaxine may be used for panic disorder.

• Tricyclic Antidepressants (TCAs): Imipramine and clomipramine may be considered when appropriate, particularly when SSRI treatment is unsuitable or ineffective.

Antidepressants are generally introduced at a low dose and increased gradually because anxiety or other adverse effects may temporarily increase when treatment starts. Treatment should not be stopped abruptly because discontinuation symptoms may occur.

Other Treatments for Panic Disorder

Other treatments recommended for panic disorder are as follows:

Ayurvedic and Alternative Treatments for Panic Disorder

Alternative approaches may be considered as complementary measures but should not replace evidence-based treatment for panic disorder. The alternative and Ayurvedic treatments recommended for panic disorder are as follows:

• Yoga and Pranayama: May be used as complementary practices to support relaxation and stress management.

• Meditation: May support relaxation when practised alongside standard treatment.

• Progressive Muscle Relaxation: May help reduce physical tension and can be used as a supportive technique.

Home Care for Panic Disorder

Home care measures can support formal treatment and help a person manage symptoms between therapy sessions. These measures should complement, rather than replace, treatment prescribed by a healthcare professional.

Recommended home care measures for panic disorder are as follows:

• Take prescribed medicines according to the recommended dose and schedule.

• Do not change or stop prescribed medication without medical advice.

• Practise CBT-based strategies and relaxation techniques as advised by the treating professional.

• Maintain a regular sleep and meal schedule.

• Perform regular physical activity according to individual capacity.

• Limit caffeine and other stimulants if they worsen panic symptoms.

• Avoid using alcohol or other substances to manage anxiety.

• Continue usual daily activities as far as possible rather than unnecessarily restricting activities because of fear of panic attacks.

How Long Does Panic Disorder Treatment Take?

The duration of panic disorder treatment varies according to the severity of symptoms, response to treatment, risk of relapse and type of treatment used. CBT is generally delivered over several structured sessions, whereas antidepressant treatment may continue for several months after improvement.

The table below explains the approximate duration of the major treatment approaches used for panic disorder:

Medication should generally be reduced gradually when treatment is being discontinued. The timing and pace of dose reduction should be decided by the treating professional according to the medicine used and the individual's response.

Panic Disorder Treatment Side Effects

Common side effects of panic disorder treatment may include:

• SSRIs and SNRIs: Nausea, headache, sleep disturbances, sweating, gastrointestinal symptoms and sexual side effects

• TCAs: Dry mouth, constipation, blurred vision, drowsiness, dizziness and changes in heart rate

• Antidepressants During Treatment Initiation: Temporary increases in anxiety or other adverse effects may occur

• CBT with Exposure: Temporary anxiety or discomfort when confronting feared sensations or situations

Any significant or persistent adverse effect should be discussed with the treating healthcare professional rather than managing the medicine independently.

Lifestyle Changes for Panic Disorder

Lifestyle measures can support the treatment of panic disorder and may help reduce factors that aggravate anxiety or interfere with recovery. The lifestyle changes recommended for panic disorder are as follows:

• Maintain a consistent sleep schedule.

• Perform regular physical activity according to individual capacity.

• Limit caffeine and other stimulants, particularly when they increase anxiety or palpitations.

• Avoid using alcohol or recreational drugs to manage anxiety.

• Practise relaxation or breathing techniques recommended by a healthcare professional.

• Maintain regular daily activities as far as possible.

• Follow the prescribed treatment plan and attend recommended follow-up appointments.

• Maintain regular meals and avoid prolonged periods without food when this contributes to physical sensations that increase anxiety.

Triggers That Can Worsen Panic Disorder Symptoms

Identifying individual triggers can help the treating doctor and patient develop a more effective treatment plan. Common triggers that may worsen panic disorder symptoms include:

• Excessive caffeine or other stimulants

• Lack of sleep

• Significant or prolonged stress

• Alcohol or recreational drug use

• Physical exhaustion

• Major changes in routine

• Situations associated with previous panic attacks

• Avoidance of situations because of fear of another panic attack

Panic Disorder Treatment Cost in India

The cost of panic disorder treatment in India varies according to the healthcare provider, location, treatment duration and whether the person receives psychiatric consultations, psychotherapy, medication or a combination of these. A consultation with a psychiatrist may cost between ₹500 and ₹2,500, whereas CBT therapy may be around ₹1,000 to ₹3,000 per session.

Does Health Insurance Cover Panic Disorder Treatment in India?

Yes. Health insurance plans in India provide coverage for the treatment of mental illness, including panic disorder. Mental health cover usually includes in-patient treatment, therapy sessions and pre and post-hospitalisation expenses. Outpatient consultations, medicines and psychotherapy may be covered under the OPD benefit.

The amount payable depends on the policy's sum insured, coverage, applicable sub-limits, and policy terms. Hence, the policy wording should be checked before claiming the treatment cost.