Dr. Jonathan Covey, M.D.

Yes, because the more panic attacks you have, the more you are going to have. The fewer panic attacks you have, the fewer you are going to have. Further, even after the panic symptoms have passed, most people are left with a heightened level of anxiety for a few to several hours. The standard of care is that one suffering panic attacks try an antidepressant from the selective serotonin reuptake inhibitor family (SSRI's) that include Prozac, Paxil, Zoloft, Celexa, and Lexapro or take an antidepressant out of the serotonin reuptake inhibitor and norepinephrine reuptake inhibitor family (SNRI's) that include Effexor, Cymbalta, Pristiq, and Fetzima to accomplish prevention of panic attacks and to make panic attacks less intense, less frequent, and of shorter duration.. The medication options to address a panic attack at the moment include Xanax out of the family of benzodiazepines or a beta-blocker such as propranolol. There is no more quickly acting oral medication than Xanax for a panic attack, but benzodiazepines taken frequently enough can lead to tolerance and dependence (and thus addiction), and daily benzodiazepine use has been linked to a significantly increased risk of Alzheimer's dementia. A beta-blocker is slower and less potent than Xanax but is safer.

The research literature indicates that cognitive behavioral therapy (CBT) provides roughly equivalent rates of improvement for people with major depression compared to those who take an antidepressant. However, the research literature indicates that those people with depression who improve as a result of CBT usually worsen with respect to their depression after they stop CBT. I think that any single antidepressant will provide benefits for 60 - 70% of people with depression. Any single antidepressant has a 30 - 33% chance of getting the depressed person to remission within 8 weeks (so the person no longer meets criteria for major depression). The exception is for the antidepressant, Trintellix. The clinical trial data for the Trintellix were that 50 - 60% of the depressed people taking it achieved remission within 8 weeks. The research literature indicates that the people with depression who do best (greatest improvement and largest percentage of people who improve) both undergo therapy with CBT and take antidepressant medication. And medication options include successive trials of antidepressants, combinations of antidepressants, addition(s) of medication that can make an antidepressant work better (including ketamine and Spravato), transcranial magnetic stimulation (TMS), and, for those whose depression is severe and unresponsive to treatment, electroconvulsive therapy (ECT).