TCM treatment of panic disorder

In fact, many people nowadays have some psychological problems. In this case, they need to adjust their psychology, otherwise they are prone to many psychological diseases. The most common one is panic disorder. When this disease occurs, the patient will feel headache and dizziness, and even whole body shaking. It is for this reason that Chinese medicine should be used for treatment as soon as possible.

1. Treatment

The purpose is to control panic attacks as early as possible, prevent recurrence and cause agoraphobia.

1. Early treatment:

When dealing with the first panic attack, the patient should be informed that the physical symptoms caused by anxiety may seem scary but are actually harmless, and that the patient's fear of losing self-control or dying is a cognitive disorder caused by anxiety, which will put anxiety into a vicious cycle, thereby preventing the further development of panic disorder. The patient should be informed of the importance of avoidance behavior, as avoiding places that produce panic disorders will lead to agoraphobia.

2. Drug treatment:

The following drugs are available:

(1) Tricyclic antidepressants: Some antidepressants have anti-panic effects when used in large doses, so they are often used as first-line drugs. Amipramine is often used, with a daily dose of 50-300 mg. It can be started with a small dose of 10 mg or 25 mg and gradually increased. For most patients, a daily dose of at least 150 mg is required to be effective. Clomipramine (25-200 mg/d) can also be used. For those who cannot tolerate anticholine side effects, desipramine (desimipramine) can be used instead. For the elderly who are prone to hypotension, nortriptyline can be used. Amitriptyline is similar to benzodiazepines in reducing panic attacks and rarely causes dependence and withdrawal reactions, but the drug is slow to take effect and has more adverse reactions.

In addition, the initial effect of amitriptyline on panic disorder is to increase the level of wakefulness, including anxiety, insomnia and sympathetic nerve excitement. Therefore, the drug needs to be started at a small dose. About 2/3 of patients who respond to benzodiazepines or amitriptyline relapse 6 weeks after stopping the drug and require further treatment.

(2) Serotonin reuptake inhibitors: They can be used as first-line drugs, especially for those who cannot tolerate the side effects of tricyclic drugs; they can be the first choice for patients with obsessive-compulsive symptoms or social phobia. Commonly used drugs include: paroxetine (20-60 mg/d), fluoxetine (5-20 mg/d), sertraline (50-150 mg/d) and fluvoxamine (150 mg/d), taken in the morning. SSRI (such as fluoxetine, paroxetine, fluvoxamine), SNRI (venlafaxine and its sustained-release agent), and new antidepressants such as NaSSA (mirtazapine) can also control the symptoms of panic attacks, and their effects are equivalent to amitriptyline.

This drug does not have the anticholesterol effect and adverse cardiovascular reactions of amitriptyline, but its unique adverse reactions may make some patients unable to tolerate it and stop taking the drug.

(2) Monoamine oxidase inhibitors: suitable for those who cannot tolerate other antidepressants; they can be the first choice for those with atypical depression or social phobia. Commonly used drugs include: phenelzine (15-60-90 mg/d) and tranylcypromine (10-80 mg/d), taken in the morning.