Panic and anxiety

23 year old female with chronic anxiety and panic since age 14.  Treated intermittently with xanax prn.  ON two different occasions  used Prozac 5 mg per day with resolution of anxiety,  but did not like the blunting of the natural highs of day to day living.

Has two sisters with identical symptoms which have nearly disappeared as they entered their 30s, none of them take any medications.

All grew up in a healthy home with no trauma or dysfunction.  The mother also had anxiety as a teen which disappeared as she got married.

Has gone to counseling, but counselors have nothing to chew on because she had a non-dysfunctional upbringing.

She hates to take xanax and will only use it in an emergency.  ALways uses the lowest dose (0.25 mg) because she hates any sedation.

Has considered CBT on her own and she understands the concept, but cannot prevent the episodes of panic.

As I said extremely low doses of Prozac work, but she does not want to take medication.  Lately she has considered daily physical workouts to see if she gets better.

She just graduated from college and is about to embark a new career.  This is a stressor and she is now more anxious.  

Any thoughts would be appreciated.

Interesting case.

Looks like she is a good candidate for therapy, preferable CBT from experienced therapist.
Quick question: were underlying medical causes ruled out for her early onset of anxiety and panic attacks.

Keep us posted

Retired non-psychiatrist here. Very very long shot but what is her menstrual history, birth control and possible symptoms related to her cycle.

Consider asking her to keep a diary related to activities esp mood, food, cycle and exercise including intercourse as well as environment surrounding attacks.