Panic Disorder treatment in Texas
Telehealth psychiatric care for adults — based in Austin, serving patients statewide.
A panic attack is a sudden surge of intense fear or discomfort that peaks within minutes — racing heart, shortness of breath, chest pain, sweating, dizziness, a sense that something terrible is about to happen or that you might be dying. Panic attacks can feel so physically convincing that many patients first end up in an emergency room for what they believe is a heart attack. Panic disorder is when these attacks recur and you start to live in fear of the next one — which often leads to avoidance of situations where attacks happened before, sometimes narrowing into agoraphobia.
Panic disorder is highly treatable. The biology is real — your nervous system has learned to misfire — and the unlearning is also real. With the right combination of medication, brief but specific therapy, and skill-building, most patients experience significant reduction in attack frequency and intensity within months, and many become essentially attack-free.
Signs you may benefit from treatment
- Sudden, intense surges of fear or discomfort that peak within 10 minutes
- Racing or pounding heart, chest pain or tightness
- Shortness of breath or feelings of being smothered
- Trembling, shaking, or sweating
- Dizziness, lightheadedness, or feeling faint
- Numbness or tingling in hands, feet, or face
- Nausea or stomach upset during attacks
- Feeling detached from yourself (depersonalization) or your surroundings (derealization)
- Fear of dying, losing control, or “going crazy” during the attack
- Persistent worry about when the next attack will happen
- Avoidance of places, situations, or activities where attacks have occurred (agoraphobia)
- Repeated medical workups (EKGs, ER visits) that come back normal
How Eki Mental Health PLLC treats panic disorder
The first step is making sure we understand what we're treating. Panic-like symptoms can also come from thyroid problems, cardiac arrhythmias, asthma, caffeine or stimulant use, perimenopause, and certain medications — so we review your recent medical history, current medications, and any relevant labs. If you haven't had a recent medical workup, we coordinate with your primary-care doctor to rule out contributors before settling on a psychiatric diagnosis.
Once we agree on the diagnosis, treatment combines medication (SSRIs or SNRIs as the first line for prevention) with cognitive-behavioral therapy — particularly the CBT-for-panic protocol that includes interoceptive exposure (deliberately bringing on physical sensations like a fast heartbeat in a safe setting so your nervous system stops interpreting them as danger). The combination is more effective than either alone for most patients.
Treatment options
1. SSRIs and SNRIs (first-line)
Daily antidepressants from the SSRI or SNRI families are the gold standard for panic disorder prevention. The most evidence-supported options:
- Sertraline (Zoloft), paroxetine (Paxil), escitalopram (Lexapro), fluoxetine (Prozac) — SSRI options with strong panic evidence.
- Venlafaxine (Effexor XR), duloxetine (Cymbalta) — SNRI options with strong evidence as well.
- For panic disorder, we typically start at a lower dose than for depression because SSRIs can briefly increase anxiety in the first 1–2 weeks. Slow start, steady titration, and clear expectations make this much more tolerable.
2. CBT for panic — therapy referral
CBT for panic is one of the best-evidenced therapies in psychiatry — typically 8–16 sessions of focused work that includes psychoeducation about the panic cycle, cognitive reframing, and interoceptive exposure. It's short, structured, and durable. I coordinate referrals to Austin therapists who specialize in CBT for panic and anxiety, and we work as a team across medication and therapy.
3. Skills you can use today
While medications take 4–8 weeks to reach effect and therapy unfolds over months, there are skills that help in the moment: paced breathing (slowing the exhale), grounding techniques, and cognitive reframing of the physical sensations. These won't cure panic disorder on their own, but they help reduce the intensity of attacks and lower the fear of the next one. We'll go through them together.
4. About benzodiazepines
Benzodiazepines (Xanax, Klonopin, Ativan, Valium) reliably reduce acute panic — but they don't treat the underlying disorder, can interfere with the learning that makes CBT work, and carry significant dependence and tolerance risk. They have a limited role: occasional short-term use during severe acute episodes or short bridge periods while an SSRI takes effect. If used, they are time-limited, dose-limited, and not the long-term plan. The full prescribing approach is in our controlled-substance policy.
5. Lifestyle factors that meaningfully change panic
Caffeine, nicotine, sleep deprivation, and stimulant use directly worsen panic disorder. Aerobic exercise, regular sleep, and reducing caffeine often do more for panic than people expect. We'll talk through what's realistic for your life.
What to expect at your first visit
Your first visit is a comprehensive 60–90-minute evaluation. We will review your panic history — when attacks happen, what they feel like, what you associate them with — along with any medical workups, current medications, caffeine and stimulant use, sleep, and avoidance patterns that have developed. We'll outline a treatment plan together and, if you're open to it, identify a CBT therapist to work with alongside medication management.
Optional: GeneSight pharmacogenomic testing
If you'd like, we can order GeneSight at your first visit — a simple cheek-swab genetic test that analyzes how your body metabolizes psychiatric medications and provides a clinician-facing report to guide prescribing.
Benefits:
- Reduces medication trial-and-error by predicting which medications you're likely to tolerate well
- Identifies medications you may metabolize too quickly (less effective) or too slowly (more side effects)
- Especially useful if you've had a hard time tolerating medications in the past or first-line options haven't worked
- Covers 60+ psychiatric medications — antidepressants, antipsychotics, mood stabilizers, anxiolytics, ADHD meds
- One-time test — your genes don't change, so results stay relevant for life and follow you to future prescribers
- Non-invasive cheek swab; results typically return within 2–3 days
Entirely optional — we only order it if you want it. Insurance coverage varies; we'll review cost and coverage with you before ordering.
Insurance & cost
In-network with Aetna and UnitedHealthcare / Optum; most insured patients pay $20–$60 per visit after benefits. Self-pay rates: $400 initial evaluation, $250 standard follow-up. Superbill provided for out-of-network reimbursement. Full pricing & insurance details →