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Panic Disorder Explained

Panic disorder involves sudden and repeated attacks of anxiety that last a few minutes. Symptoms may sometimes last longer. These are called panic attacks, and they are characterized by a fear of the worst or of losing control despite the absence of any real danger. Strong physical reactions are not uncommon during panic attacks. In fact, people often confuse panic attacks for what they think are heart attacks. Panic attacks can occur at any time, and often people with panic disorder worry about and dread the possibility of having another attack. People with panic disorder can become discouraged and feel ashamed because of not being able to carry out normal routines like going to the grocery store or driving. Panic disorder also often interferes with work and school.

What Causes Panic Disorder?

Panic disorder often runs in families, however, no one knows for sure why some people have it while others don't. Scientists have found several parts of the brain that are involved in fear and anxiety. By learning more about fear and anxiety in the brain, scientists may be able to create better treatments. Significant research is currently being devoted to looking for ways in which stress and environmental factors may play a role.

Symptoms of Panic Disorder

People with panic disorder have some combination of the following symptoms:

  • 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.

Who Can Develop Panic Disorder?

Panic disorder occurs in approximately 6 million American adults and is twice as common in women as men. The panic attacks themselves usually begin in adolescence or early adulthood, although not everyone who experiences panic attacks will develop panic disorder. Many people have just one attack and never have another, or go on to develop additional symptoms. Research suggests proneness to develop panic attacks appears to be inherited.

Accurately Diagnosing Panic Disorder

Panic attacks can occur at any time, even during sleep. An attack usually peaks within 10 minutes, but some symptoms may last much longer. Individuals who experience repeated panic attacks can become disabled by their condition and are advised to seek treatment before they start to avoid places or situations they fear will trigger another panic attack. For instance, if a panic attack happened in a grocery store, someone with panic disorder may develop a fear of public places that could affect where that person can work, seek medical attention, or enjoy entertainment. Some individual's lives become so restricted that they avoid normal activities, such as grocery shopping or driving. About one-third become housebound or are able to confront a feared situation only when accompanied by a spouse or other trusted person.  When the condition progresses this far, it is called Panic Disorder With Agoraphobia,  which is a fear of open spaces due to panic attacks.

Intervening and seeking treatment early can often prevent agoraphobia, but people with panic disorder may sometimes go to numerous medical doctors for years or visit the emergency room repeatedly before being correctly diagnosed. This is unfortunate, as panic disorder is one of the most treatable of all the anxiety disorders, responding in most cases to certain kinds of Cognitive Behavioral Therapy (CBT), which help change thinking patterns that lead to fear and anxiety.

Panic disorder can be accompanied by other serious conditions, such as depression and alcohol or drug abuse. Research suggests these conditions need to be treated separately. Symptoms of depression include feelings of sadness or hopelessness, changes in appetite or sleep patterns, low energy, and difficulty concentrating. Most people with depression can be effectively treated with antidepressant medications, Cognitive Behavioral Therapy (CBT), or a combination of the two.

Treatment for Panic Disorder and Panic Attacks

The most effective treatments for Panic Disorder include Cognitive Behavioral Therapy (CBT), medication, or both. Cognitive Behavior Therapy is especially useful for treating panic disorder. Follow this link to a chart comparing the effectiveness of CBT to other treatments for panic disorder. It teaches people different ways of reacting to thoughts and feelings, behaving in ways that help them feel less anxious and fearful.

Click for more information about What CBT is and How it Works 

A licensed psychologist typically provides psychotherapy. However, social workers and Marriage and Family Therapists (MFT) can also legally provide therapy, though their training is of shorter duration. Your psychologist should work with your psychiatrist to track your progress. Your unique treatment needs should determine the number and frequency of sessions. Following the doctor's instructions for any psychotherapy will likely provide the greatest benefit. 

 Doctors also commonly prescribe medication to help treat panic disorder. The most commonly prescribed medications for panic disorder are anti-anxiety medications and antidepressants. Anti-anxiety medications are powerful and there are different types. Many types begin working right away, but they generally should not be taken for long periods. The latest research suggests the relapse rate for individuals taking medications is much higher than that of individuals using only CBT. Interestingly, there is evidence to suggest the combination of medication and CBT also leads to high relapse rates, indicating CBT is the treatment of choice for Panic Disorder. 

Although antidepressants were designed to treat depression, they can also be marginally helpful for panic disorder. The downside is that they may take several weeks to start working. Some cause side effects such as headache, nausea, or difficulty sleeping. Antidepressants can be safe and effective for many people, however, they may be risky for some, especially children, teens, and young adults. A "black box"—the most serious type of warning that a prescription drug can have—has been added to the labels of antidepressant medications. These labels warn people that antidepressants may cause some people to have suicidal thoughts or make suicide attempts. Anyone taking antidepressants should be monitored closely, especially when they first start treatment with medications.

Beta-blockers, another variety of medication can help control some of the physical symptoms of panic disorder such as excessive sweating, a pounding heart, or dizziness. Beta blockers are not commonly prescribed, although they may be helpful in certain situations that bring on a panic attack. Usually once beta-blockers are discontinued, the panic symptoms return.

This information is provided courtesy of the National Institute of Health.