Panic Disorder

Panic disorder is a type of anxiety disorder. It causes panic attacks, which are sudden feelings of terror when there is no real danger. People with panic disorder may feel as if they are losing control, and they may experience physical symptoms of fear and anxiety, including a fast heartbeat, chest or stomach pain, breathing difficulty, or sweating.

Panic attacks can happen anytime, anywhere, and without warning. People may live in fear of attacks and may avoid places where they have had an attack. For some people, fear takes over their lives and they cannot leave their homes.

Panic disorder is more common in women than men. It usually starts when people are young adults. Sometimes it starts when a person is under a lot of stress. Panic disorder is often accompanied by other serious problems, such as depression, drug abuse, or alcoholism. These conditions need to be treated in order to effectively manage the panic disorder. Most people with panic disorder get better with treatment, which can include therapy and medicines.

Panic attacks are the hallmark symptom of panic disorder. Panic attacks typically begin suddenly and without warning. They can strike at any time. You may have occasional panic attacks or they may occur frequently.

Panic attacks have many variations, but symptoms usually peak within minutes. You may feel fatigued and worn out after a panic attack subsides.

Panic attacks typically include some of these symptoms:

• sense of impending doom or danger
• fear of loss of control or death
• rapid, pounding heart rate
• sweating
• trembling or shaking
• shortness of breath, difficulty breathing, or tightness in your throat
• chills
• hot flashes
• nausea
• abdominal cramping
• chest pain
• headache
• dizziness, lightheadedness, or faintness
• numbness or tingling sensation
• feeling of unreality or detachment

People with panic disorder may live in constant fear of having an attack. They may have:

• sudden and repeated attacks of fear
• a feeling of being out of control during a panic attack
• an intense worry about when the next attack will happen
• a fear or avoidance of places where panic attacks have occurred in the past
• physical symptoms during an attack, such as a pounding or racing heart, sweating, breathing problems, weakness or dizziness, feeling hot or a cold chill, tingly or numb hands, chest pain, or stomach pain.

The cause of panic disorder is not fully understood. It is likely caused by a combination of genetics, stress, temperament, and changes in brain function. Panic disorder sometimes runs in families, but it is not clear why.

If you have symptoms that suggest panic disorder, your doctor will probably conduct several tests to confirm the diagnosis and rule out other causes of your symptoms. A complete physical exam, blood tests, and a psychological evaluation will help establish the diagnosis.

The following criteria, which are published in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), must be met for a diagnosis of panic disorder:

• You have frequent, unexpected panic attacks.
• At least one of your attacks has been followed by one month or more of ongoing worry about having another attack; continued fear of the consequences of an attack, such as losing control, having a heart attack or "going crazy"; or significantly changing your behavior, such as avoiding situations that you think may trigger a panic attack.
• Your panic attacks are not caused by drugs or other substance use, a medical condition, or another mental health condition, such as social phobia or obsessive compulsive disorder.

Panic disorder benefits from professional treatment, but you can also help manage symptoms on your own. Lifestyle and self-care steps can help control and manage your symptoms.

• Stick to your treatment plan. Facing your fears can be difficult, but treatment can help you feel like you are in control of the situation.
• Join a support group. Joining a group for people with panic attacks or anxiety disorders can connect you with others facing the same problems.
• Avoid caffeine, alcohol, smoking and recreational drugs. All of these can trigger or worsen panic attacks.
• Practice stress management and relaxation techniques.
• Get physically active. Aerobic activity may have a calming effect on your mood and protect against anxiety].
• Get sufficient sleep. Get enough sleep so that you do not feel drowsy during the day, which can trigger an attack.

Treatment can help reduce the intensity and frequency of your panic attacks and improve your function in daily life. The main treatment options are psychotherapy and medications. Depending on your preference, your medical history, the severity of your panic disorder, and whether you have access to therapists who have special training in panic disorders, you may receive either treatment alone or a combination of both.

Psychotherapy, also called talk therapy, is the first choice treatment for panic attacks and panic disorder. Psychotherapy can help you understand panic attacks and panic disorder and learn how to cope with them.

A form of psychotherapy called cognitive behavioral therapy can help you learn through your own experience that panic symptoms are not dangerous. Successful treatment can also help you overcome fears of situations that you have been avoiding because of panic attacks.

Medications can also help reduce symptoms associated with panic attacks, as well as depression if that is a factor in your panic disorder. Several types of medication have been shown to be effective in managing symptoms of panic attacks, including:

• Selective serotonin reuptake inhibitors (SSRIs). SSRI antidepressants are typically recommended as the first choice of medications to treat panic attacks. SSRIs approved by the Food and Drug Administration (FDA) for the treatment of panic disorder include fluoxetine (Prozac), paroxetine (Paxil, Pexeva), and sertraline (Zoloft).
• Serotonin and norepinephrine reuptake inhibitors (SNRIs). SNRIs are another class of antidepressants. Venlafaxine hydrochloride (Effexor XR) is FDA approved for the treatment of panic disorder.
• Benzodiazepines. These sedatives are central nervous system depressants. Benzodiazepines approved by the FDA for the treatment of panic disorder include alprazolam (Xanax) and clonazepam (Klonopin).