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Anxiety and Stress Disorders

Medication Options for Panic Attacks

12/04/2007

Question:

My girlfriend is getting frequent panic attacks along with OCD. Her doctor has built her up to 150mg of sertaline (zooloft)which is helping the ocd a little but not doing much for her panic attacks. Should she ask for some beta blockers,Valium or buspar? She has tried rescue remedy which has not helped much, would Valerian be worth a try?

Answer:

The most important thing for your girlfriend to do is to continue to follow up with her physician -- a change of medicine or dosing of her medicine may be indicated.  If she is not getting regular counseling or therapy, that would also be very helpful.  Various therapies, including behavioral cognitive therapy (CBT), have found to be very useful for people with anxiety disorders, especially when used along with medications like the sertraline (a selective serotonin reuptake inhibitor (SSRI)).

Beta blockers tend to block some specific symptoms that sometimes occur with an excess stimulation of a specific kind of receptor in the body called Beta receptors.  These include increased heart rate, increased blood pressure and palpitations.  Beta blockers take a while (at least 30 - 90 minutes, minimum) to take effect, and are not often used in acute panic attacks, which often resolve on their own in less time than that.

Valium (a benzodiazepine, like Xanax) and Buspar (buspirone) are anxiolytics -- that mean they temporarily decrease many symptoms of anxiety.  They do NOT treat the underlying cause of the anxiety disorder, like the SSRIs and CBT do.  They are sometimes used temporarily while other medications and therapy are instituted, as those treatments may take weeks to make a significant difference.  Anxiolytics should not be taken for extended periods of time, because especially the benzodiazepines are addictive.

Rescue Remedy is a trade marked homeopathic suspension which is given a few drops at a time.  It likely has no serious side effects, but there is no good evidence to show it is effective in anxiety disorders.  Valerian is an herb that has been used for many purposes over the years, including anxiety and to help with sleep.  Unfortunately, valerian can have some significant side effects (including heart disturbances and liver toxicity), and can interact with some prescription medications.  There is no good evidence it is effective in anxiety disorders, either.  I would not recommend your girlfriend take valerian until she has discussed it with her physician or medical provider.

Good Luck.

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Response by:

Nancy   Elder, MD Nancy Elder, MD
Associate Professor
College of Medicine
University of Cincinnati