Three types of drugs are prescribed to treat panic attacks, panic disorder and some of their individual symptoms: 1) anti-anxiety drugs, 2) anti-depressants, and 3) beta blockers.

All of these medications produce side effects in some people. They must taken under proper supervision, and your prescribing physician needs complete information about any other prescription and non-prescription medications and/or supplements you are taking.

Benzodiazepines (Anti-anxiety Drugs)

The four most commonly prescribed medications in this group are alprazolam (Xanax), clonazepam (Klonopin), diazepam (Valium) and lorazepam (Ativan). Their toxicity is relatively low, meaning that an overdose is unlikely to be fatal, unless they are taken in combination with other drugs. The combination of benzodiazepines and alcohol is particularly dangerous.

Anti-anxiety drugs can cause drowsiness, poor concentration, loss of coordination, impaired speech, double vision, muscle weakness, vertigo and confusion. They can also slow reaction time and impair driving. Some people experience heightened excitability, irritability, and aggressiveness, along with reduced impulse control. Nursing mothers should not use benzodiazepines, since they are passed along through breast milk.

The most commonly cited side effect of all of these is dependence or addiction. Extended use is also not recommended because their effectiveness wears off fairly quickly for many patients, as their bodies develop a tolerance for the drugs.

Anti-depressants

All antidepressants cause side effects, most frequently sleepiness, a dry mouth, constipation, nausea and sexual problems. Each of the individual classes also has its own set of risks.

Selective serotonin reuptake inhibitors (SSRIs) include Citalopram (Celexa), Escitalopram (Lexapro), Fluoxetine (Prozac), Paroxetine (Paxil, Pexeva), and Sertraline (Zoloft). There is some variation in their side effects, and patients who have trouble with one often can find another they are able to tolerate. The most common side effects are nausea, sexual dysfunction (both reduced libido and responsiveness), weight gain, sweating and dry mouth, increased nervousness, agitation and restlessness, insomnia, drowsiness, and sometimes diarrhea and rashes.

Occasionally SSRIs can lead to an excessive accumulation of serotonin in the brain, particularly if they are taken along with or soon after taking any MAOIs or some other serotonin builders like St. John’s Wort, the pain relief medication tramadol, or certain migraine medications.

SSRIs have also been found to increase depression and suicidal thoughts in younger patients.

Tricyclic anti-depressants, which used to be the first choice for panic and anxiety disorders, are less favored since the development of the SSRIs, in part because they can cause cardiac damage.

Monoamine oxidase inhibitors (MAOIs) include Phenelzine (Nardil), Tranylcypromine (Parnate), Isocarboxazid (Marplan), Selegiline (Emsam). MAOIs are generally only prescribed for people after other antidepressant have failed, because they can have serious side effects and interactions with a number of foods and beverages. People taking MAOIs must limit their consumption of many cheeses, pickled foods, chocolates, certain meats, beer, wine, and alcohol-free or reduced-alcohol beer and wine. These foods contain tyramine, which interacts with MAOIs to cause increased in blood pressure that can lead to a stroke.

Like the SSRIs, MAOIs can lead to serotonin syndrome and should not be combined with certain over-the-counter decongestants and herbal supplements, including St. John’s Wort.

Beta Blockers

Beta blockers are sometimes prescribed to prevent the onset of the rapid pulse and increase in blood pressure that can initiate a panic attack. Common side effects of beta blockers include weakness, dizziness, tiredness, and cold hands. Less often they can contribute to insomnia, depression, decreased libido, and shortness of breath. They are contraindicated for people with asthma and can mask some of symptoms of diabetes.

If you do develop significant side effects on any of these prescribed medications, don’t just stop taking them. Discontinuing these drugs suddenly can create other problems. If stopped suddenly, all of the major anti-depressants can lead to something called discontinuation syndrome, which causes headaches, nausea, flu-like symptoms, dizziness and lethargy. Talk to your doctor. Particularly with anti-depressants, you may have fewer negative effects with another drug. But it can take time to find the right one for you.