CONDITIONS

What Is Panic Disorder

A panic disorder is a psychiatric disorder that causes intense periods of anxiety or panic (panic attacks) that can last for several minutes or longer. Panic disorder falls under the category of anxiety disorders. Estimates as to how many Americans live with panic disorder range from 1 in 20 to 1 in 75. People who have panic attacks often experience their first one while in their teens or early adulthood, when major changes are occurring. The National Institute of Mental Health notes that people who do have a panic attack may never have another one, so having one attack will not necessarily lead to a panic disorder.

Panic attacks are not the usual type of fear or anxiety that can occur in a stressful or frightening situation. Unlike the normal, expected responses to frightening events, panic attacks can happen at any time, even during sleep, without any seemingly obvious reason. A person who is experiencing a panic attack may have a combination of physical and psychological symptoms, making it difficult for them to function during the attack and sometimes after.

 

The fear response during a panic attack is usually out of proportion to the event or trigger. If you experience frequent panic attacks over time, your overall anxiety could increase in anticipation of a next panic attack. This may feed into a vicious cycle and affect every day life.

What Causes Panic Disorder

What causes panic disorder is not yet understood. Research does show that some panic disorder may be caused by genetics, previous life experience, or changes in the brain:

  • Genetics. Some people who have panic disorders have family members who have a type of anxiety disorder. This connection hasn’t been proven.
  • Previous stresses and predisposition to anxiety.  Some researchers believe that you can have a predisposition to panic disorder. Humans have a fight-or-flight response to danger or perceived danger. For people with a predisposition to anxiety, a trauma could trigger an overreaction, and lower their resistance to anxiety, creating a panic attack.
  • Physical illnesses. Experiencing a severe physical illness may cause panic disorder
  • Brain changes. Some researchers are looking at how the brain reacts to stresses, as they believe that changes in the brain could affect how you react to danger.
  • Drug or alcohol abuse. There is some research that indicates drug and alcohol abuse may trigger panic disorder.

 

Risk Factors For Panic Disorder

Since researchers don’t know what causes panic disorder, risk factors aren’t well defined. However, it is known that more women live with panic disorder than men.

You are more likely to experience a panic disorder if:

  • You have a family history of panic attacks or panic disorder
  • You are under a significant amount of stress
  • You have experienced a death or serious illness of a loved one
  • You have experienced major changes in your life, such moving, a new job, a baby
  • You have a history of trauma, such as childhood physical or sexual abuse, an accident, or an assault

Diagnosing Panic Disorder

Only a qualified physician or therapist can diagnose a panic disorder. While panic disorder is a psychiatric disorder, your doctor will need to rule out any medical or physical reason for the panic attack symptoms that may be treatable.

Your doctor will:

Take a medical history. Your doctor will want to know:

  • How long you have been experiencing the symptoms
  • If you have been ill
  • If you have had any serious stress or trauma recently
  • If any family members have panic disorder
  • If you take any medications
  • If you have used drugs or alcohol

A physical exam will allow your doctor to look for anything that might cause the symptoms. He or she may order:

  • Blood tests, to assess how your organs are working, particularly your thyroid
  • Heart tests, such as an electrocardiogram (ECG) to rule out a heart attack
  • Glucose levels, hypoglycemia can cause feelings of panic

Your doctor may ask you to complete a self-assessment form that is designed to look for signs of anxiety and panic.

If your doctor has ruled out any physical cause for your symptoms, you may be referred to a psychiatrist or psychologist for further assessment. A psychiatrist is a medical doctor who has specialized mental illnesses. He or she can prescribe medications. A psychologist has an advanced degree (usually a PhD) and focuses on treating the behavior, and may not prescribe medications.

Symptoms of Panic Disorder

The symptoms of panic disorder vary between people. They include:

  • Feeling of dread, that something bad is going to happen, impending doom
  • Feeling of anxiety or intense worry that you are going to have a panic attack
  • Fear of loss of control
  • Fear of places or activities that could trigger anxiety
  • Avoiding places or activities that could trigger anxiety
  • Panic attacks

People may experience panic attacks differently, some with one or two symptoms, some with several. The most common symptoms usually last less than 30 minutes  and include:

  • Fear
  • Anxiety
  • Inability to concentrate
  • Fear of dying
  • Pounding, rapid heart rate
  • Sweating
  • Trembling, shaking
  • Feeling cold or hot
  • Shortness of breath, difficulty breathing
  • Hyperventilation
  • Abdominal cramping, stomach pain
  • Chest pain
  • Headache
  • Dizziness
  • Tightness in the throat
  • Trouble swallowing
  • Tingling in your hands or feet

Prognosis

Many people who have panic disorder may get better with treatment—but this disorder can be long lasting and challenging to treat. Panic disorder treatment can be differ considerably between people, and it may take a few attempts to find the right treatment or combination of treatments to manage your panic disorder. Once found, however, proper treatment reduces or completely prevents panic attack in 70% to 90% of people.

Living With Panic Disorder

Living with panic disorder and panic attacks may seem daunting, but with support and treatment, panic doesn’t have to run your life.

The first and most important step is to ask for help. By visiting your doctor or a mental health practitioner, you are taking the first step to being healthier. Asking your friends and loved ones for help may also make living with panic disorder easier.

Although panic disorder and panic attacks are psychological, you need to take care of your body physically as well:

  • Exercise regularly—both vigorous cardiovascular exercise for, along with more holistic mind-body practices like yoga, are both great for helping with panic disorder
  • Eat healthy meals—particularly whole grains, fresh fruit, leafy greens, raw nuts, and lots of water
  • Get enough sleep—strive for at least 8 hours a night to best support your mental health
  • Participate in activities that you enjoy

Support groups can also be helpful for people living with panic disorder. Joining a group where people can understand what you are going through may help you find ways to cope and not feel alone.

Feed your soul. Whether this means making time to work on a hobby, read a book, attend worship services, or take long hot baths, take care of yourself.

If you are being treated for panic disorder, follow your treatment plan and speak to your doctor if you are have any concerns about your treatment or if you feel it isn’t working.

Screening

If you feel you may have panic disorder, your doctor has screening tests and questionnaires that may help determine your state of mind.

 

Prevention

Since researchers don’t know yet what causes panic disorder, prevention focuses on reducing or preventing repeat episodes of anxiety. Here are some tips:


Move your body. Many people have found that keeping physically active helps reduce their feelings of anxiety.

  • Work out at the gym, join an exercise class, or take up a physical activity such as running or cycling
  • Take up yoga
  • Go for regular walks, garden, go dancing

Occupy your mind

  • Take classes
  • Start or return to a hobby
  • Get out of the house

Treat yourself well

  • Eat a well-balanced diet
  • Avoid smoking, caffeine, alcohol, and illegal drugs
  • Join a support group

Keep a journal. By keeping a journal, you may be able to see patterns of events that may trigger anxiety or panic.

Medication And Treatment

Treatment for panic disorder varies considerably and it may take several tries before you find the treatment or combination of treatments that work for you. It is important that you keep this in mind, to try to keep from getting discouraged if it takes time. Panic disorder is usually treated with a cognitive behavior therapy (CBT), and medication when needed.


Cognitive behavioral therapy

When you undergo CBT, you work with a mental health care professional who helps you to identify triggers for your feelings of panic and anxiety. Once the triggers have been identified, you work with the therapist to break the cycle of anxiety. One way to do this is by recreating the situations that trigger your panic, and working through them within a safe and supportive setting. Some therapists also teach relaxation techniques, such as meditation and mindfulness, to help you calm your mind.


Medication

Medications may be taken alone or in combination with CBT. Both anti-anxiety and antidepressants have helped many people with anxiety disorder, but it may take trying several medications before you find one that may work for you. It is important to give the medicine time to work because it can take up to several weeks to see  a noticeable difference. Some people find that medication is helpful as they begin CBT, until the therapy starts to have its effect.

Some of the most common medications used to treat panic disorder are:

 

  • Antidepressants* 
  • Selective serotonin reuptake inhibitors (SSRIs). These are often the first choice for treating panic disorder and the most commonly prescribed ones are fluoxetine (Prozac), paroxetine (Paxil, Pexeva) and sertraline (Zoloft).
  • Serotonin and norepinephrine reuptake inhibitors (SNRIs). Venlafaxine hydrochloride (Effexor XR) is FDA approved for the treatment of panic disorder.
  • Sedatives 
  • Benzodiazepines. These medications are mild sedatives and may cause drowsiness. They may provide quick relief of acute anxiety, but they can become habit forming. For this reason, they should not be taken for extended periods. Benzodiazepines approved by the FDA for the treatment of panic disorder include alprazolam (Niravam, Xanax), clonazepam (Klonopin) and lorazepam (Ativan).
  • Beta blockers. Medicines usually used to treat heart disease, called beta-blockers, can be effective in treating panic disorder in some people.

*Important note about antidepressants:  Antidepressant medications have been proven to be very effective for most people who need them. However, antidepressants may cause some people to have suicidal thoughts or suicide attempts. Anyone who takes antidepressants should be monitored closely for signs of increasing depression and suicidal thoughts or behavior, particularly if it is a new prescription.

Complementary and Alternative Treatment

Alternative or complementary treatments for panic disorder may be helpful in relieving symptoms. Always talk to your doctor about any natural, herbal, or vitamin supplements you would like to try before doing so. Some supplements can interact with medications you are already taking or cause serious side effects.

  • Acupuncture. The Anxiety and Depression Association of America reports that acupuncture, a form of traditional Chinese medicine, may help provide short-term relief from anxiety. To perform acupuncture, the practitioner inserts fine needles into specific parts of the body that are believed to conduct energy. This allows for the body’s energy to flow, promoting healing.
  • Yoga. is an activity that provides both physical exercise and relaxation. It promotes breathing exercises, meditation and visualization. It’s best to receive instruction for proper yoga poses before doing so alone.
  • Massage therapy. Relaxing massage therapy may help reduce anxiety.
  • Aromatherapy.  Some people find that certain scents can promote relaxation and reduce anxiety. Some of the more popular aromatherapies for anxiety are:
    • Lavender, which is also used to promote sleep
    • Lemon, which may improve mood, relieve stress
    • Bergamot, may lower, promote relaxation
    • Ylang-ylang, may help relieve tension

 

  • Herbal therapies.  Research for herbal remedies to manage anxiety and panic is limited. Some people have found relief using these:
    • Valerian root. While some studies have found that valerian root may be helpful for some people, it had no effect on others. Do not take valerian root for more than a few weeks at a time because it can cause headaches or sleepiness.
    • Passionflower. This herb is considered to be fairly safe if taken properly, but it may cause dizziness, drowsiness, or confusion. There is not enough information yet to know whether it is helpful for anxiety.
    • Avoid kava kava. This herb can cause liver damage, even when taken for short periods.

When To Contact A Doctor

It’s not unusual to feel fearful or anxious from time to time, but if your worries are turning into intense fear or panic, this may be a sign that you should speak to your doctor. Talk to your doctor if:

  • You are feeling anxious or scared about having a panic or anxiety attack
  • Your anxiety or fear is affecting your daily activities
  • Your loved ones have expressed concern about you
  • Your physical symptoms feel that they could be a serious medical problem, such as a heart attack

 

Find a Doctor

To find a doctor or mental healthcare practitioner in your area, click here or visit www.healthgrades.com.

 

Resources

For more information on panic disorder, visit:

Questions For A Doctor

  • Could there be something physical causing my symptoms?
  • What tests might I have to have?
  • Should I see a mental health practitioner or therapist?
  • What can I do to manage my symptoms now?
  • What treatments are available to me?
  • What side effects might these drugs have? (If you are prescribed medicines)
  • How long will I need treatment?
  • Who can I call/where do I go in case of emergency?
  • How can I reduce the risk of more panic attacks?