Q. I get episodes of intense anxiety with frightening sensations of a pounding heart, chest pain, sweating, shortness of breath and dizziness, along with a fear of dying or losing control. My doctor diagnosed me with panic attacks. I've tried vitamins, herbs and supplements, but nothing works. What can I do?

A. A panic attack is a sudden rush of fear that peaks in less than 10 minutes. It often comes out of the blue, and often with great worry of having more attacks or of fainting, vomiting, dying, going crazy, losing control or of having a heart attack. There may be a dependence on things, such as a bottle of medicine or cell phone, to feel safe.

We need to do better at treating this common malady that causes much misery, as only a minority receives any treatment. In fact, on Sept. 15, Dr. Peter P. Roy-Byrne and others from the University of Washington in Seattle published an article showing that only 19 percent to 40 percent receive treatments demonstrated to be effective, which include antidepressant drugs such as fluoxetine, sertraline and citalopram, and the equally effective option of cognitive behavioral therapy.

Drugs may take two or three months for full effectiveness. Herb and supplement treatments are not considered evidence-based because they have not been subjected to good quality randomized studies for panic attacks, so we don't know if they really work.

Cognitive behavioral therapy is superior to drug therapy in terms of lower relapse rates after therapy is stopped. It's also more cost-effective because it has more permanent effects than drug treatment.

Cognitive behavioral therapy takes anywhere from five to 15 sessions, and some experts believe group therapy works better than individual.

But start drugs if you can't find a CBT therapist. If you delay treatment, you may develop agoraphobia, a condition that causes people to avoid crowds, stores, theaters and planes. It may become so bad that you can't leave home.

Sedative-type drugs such as clonazepam (Klonopin) and alprazolam (Xanax) work quickly, but unlike antidepressants, do not correct the underlying neurotransmitter imbalance leading to panic attacks in the first place, and carry the risk of dependence. But these may be added for a short while if side effects such as jitteriness occur with antidepressants.

Panic disorder is a chronic affliction that causes much misery and disability. If you feel you have this, see your family physician or therapist right away for either CBT or drug therapy — and, potentially, a new lease on life.

Dr. Landis Lum is a familypractice physician for Kaiser Permanente and an associate clinical professor at the University of Hawai'i's John A. Burns School of Medicine. Send questions to: Prescriptions, Island Life, The Advertiser, P.O. Box 3110, Honolulu, HI 96802; islandlife@honoluluadvertiser.com; or fax 535-8170. This column is not intended to provide medical advice.