Panic Disorder

What is panic disorder?

Panic disorder is an anxiety disorder. When panic attacks occur repeatedly, without warning, it is called panic disorder. These attacks can happen many times every day or every week. People with this disorder might worry about having these attacks throughout the day. It can interfere with work and personal life.

How does it occur?

Panic is a "fight or flight" reaction. It is an adrenaline surge that goes wrong. How it happens is not known. Scientists know that certain parts of the brain and nervous system cause the emotional and physical surge of fear. A panic attack is very scary, but having one attack doesn't usually mean that you are developing panic disorder.

Panic disorder usually begins when you are a teenager or a young adult. Sometimes it begins after age 30, but almost never in middle age or later. It tends to run in families. Studies of identical twins suggest a genetic link to the disorder. However, one half or more of people with panic disorder do not have a close relative with the same problem.

Many people with panic disorder also have agoraphobia, which means you avoid going places or doing things because you are afraid you will panic and have no help. It is common to have depression along with panic disorder.

What are the symptoms?

Having at least 4 of the following symptoms means a person is having a panic attack:

• feeling intense fear and being afraid that something terrible is about to happen
• worrying about losing control
• worrying about dying, going crazy, or having a heart attack
• having many body symptoms such as a pounding heart, upset stomach, diarrhea, shaking, sweating, or being hot or cold
• feeling like they are choking or can't breathe
• being dizzy, faint, or lightheaded
• feeling numb or tingling sensations in the arms, legs, or other parts of the body
• feeling detached or as if they are watching themselves from outside the body.

These feelings start suddenly and become very strong, usually within 10 minutes. The attacks are often unpredictable.

The symptoms of panic disorder are the same as a panic attack except that the attacks come repeatedly, the person is quite fearful between attacks that another attack will happen, and changes behavior to avoid another panic attack. Panic attacks usually last from 20 to 30 minutes.

Because common symptoms of a panic attack include chest pain and shortness of breath, you may mistake a panic attack for a heart attack. If you have severe chest pain or trouble breathing, get medical treatment right away to find out the cause.

How is it diagnosed?

Your healthcare provider or a mental health professional can tell you if your symptoms are caused by panic disorder.

Your healthcare provider will ask about your symptoms and any drug or alcohol use. You may have lab tests to rule out medical problems such as hormone imbalances. It is important to make sure that medical problems are not causing the panic attacks. Some medicines may cause or increase panic attacks. You may need to change your medicines to make sure they are not part of the problem. No lab tests can diagnose panic disorder.

If you worry about having another panic attack, or have the symptoms of panic attacks for more than 30 days, it usually means that you have panic disorder.

How is it treated?

Do not try to overcome panic disorder all by yourself. Panic disorder can be successfully treated with psychotherapy and medicine. Discuss these treatment choices with your healthcare provider or a mental health professional.

Medicine

Several medicines can help treat panic disorder. Your healthcare provider will carefully select the best one for you. Some medicines are:

• antianxiety medicines such as lorazepam (Ativan), diazepam (Valium), alprazolam (Xanax), clonazepam (Klonopin), and buspirone (BuSpar)
• selective serotonin reuptake inhibitor (SSRI) antidepressants such as fluoxetine (Prozac), sertraline (Zoloft), fluvoxamine (Luvox), paroxetine (Paxil), citalopram (Celexa), and escitalopram (Lexapro)
• tricyclic antidepressants such as imipramine (Tofranil) and desipramine (Norpramin)
• other antidepressant medicines such as venlafaxine (Effexor) and mirtazapine (Remeron).

No nonprescription medicines are available to treat panic disorder.

Psychotherapy

Seeing a psychiatrist or psychotherapist is helpful. Therapy may last just a short time or for a year or more. Cognitive behavioral therapy (CBT) is a form of psychotherapy that is especially effective with panic disorder. CBT is a way to help you identify and change thoughts that lead to panic attacks. Replacing negative thoughts with more positive ones can help you to control panic attacks and the fear that a panic attack will happen.

Natural and Alternative Treatments

• Herbs and Supplements. Claims have been made that certain herbal and dietary products (kava root, lemon balm, lavender, passion flower, valerian) help control anxiety problems. None of these herbs will treat or prevent panic attacks. No herb or dietary supplement has strong research support to prove that it helps panic disorder.
• Biofeedback. With biofeedback you learn to control body functions such as heart rate, blood pressure, muscle tension, or brain wave patterns. Biofeedback can help with tension, anxiety, and concentration. It is an effective addition to medical treatment or psychotherapy.
• Massage Therapy. Massage therapy may help lower stress and muscle tension. This may help treat the general anxiety that goes along with panic disorder.
• Relaxation Therapies. Learning special relaxation methods can help you control the general anxiety that goes along with panic disorder. Relaxation may also help you to shorten or make panic disorders less severe. Yoga and meditation may be helpful.
• Hypnotherapy. Hypnosis can be useful in learning to control anxiety symptoms and environmental events that trigger panic attacks.
• Art and Music Therapies. Some people find art and music therapy, along with medicines and psychotherapy, help control the general anxiety that goes along with panic disorder.

How long will the effects last?

Panic disorder may affect you for a short time or may continue for many years. With treatment, most people improve in less than a year.

What can I do to help myself or my loved one?

Maintaining a healthy lifestyle is important. To help control panic disorder:

• Exercise for at least 20 minutes every day. For example, take a brisk walk.
• Learn which activities make you feel better and do them often.
• Talk to your family and friends.
• Eat a healthy diet.
• Avoid caffeine.
• Get 7 to 9 hours of sleep per night.
• Keep a regular schedule for going to sleep and getting up.
• Avoid using alcohol or drugs.
• Learn relaxation techniques or yoga.

Many towns and cities have support groups for panic disorder sufferers. Look in the telephone book under Support Groups or ask your local community mental health center.

When should I seek help?

Do not try to overcome panic disorder all by yourself. Seek help from your healthcare provider or a mental health professional.

Get emergency care if you or a loved one has serious thoughts of suicide or self harm. Also seek immediate help if you have severe chest pain or trouble breathing.