Panic Disorder

Definition

Panic disorder is a type of anxiety disorder characterized by recurrent and unpredictable bursts of terror known as panic attacks. A panic attack is accompanied by physical symptoms that may feel similar to a heart attack or other life-threatening condition.

Intense anxiety often develops between episodes of panic. As panic attacks become more frequent, people begin avoiding situations that could trigger them. Panic attacks can lead to agoraphobia , which is the fear of unknown places.

Causes

Scientists continue to look for the exact cause or causes of panic disorder. It is believed to be related to:

  • Family history
  • Other biological factors
  • Stressful life events
  • Increased sensitivity to physical sensations

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.

  • Sex: female
  • Age: young adult
  • History of another anxiety disorder
  • Family history of panic disorders

Symptoms

Panic attacks usually occur unexpectedly and repeatedly. They include many of the following symptoms:

  • Sudden and intense episodes of fear
  • Racing, pounding, or skipping heartbeat
  • Chest pain, pressure, or discomfort
  • Difficulty catching breath
  • Choking sensation or lump in the throat
  • Excessive sweating
  • Lightheadedness or dizziness
  • Nausea
  • Tingling or numbness in parts of the body
  • Chills or hot flashes
  • Shaking or trembling
  • Feelings of unreality, or being detached from the body
  • An urge to flee
  • Fear of impending doom, such as death, a heart attack, suffocation, loss of control, or embarrassment
  • Stomach pain

Panic Attack / Anxiety Symptoms

Physical reaction anxiety

© 2008 Nucleus Medical Art, Inc.

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam. Since some panic disorder symptoms are similar to heart, digestive, and/or thyroid problems, a physical exam and tests can rule out physical causes of your symptoms. Tell your doctor about your physical symptoms and how the symptoms make you feel. Your doctor will want to know if your attacks keep you from your normal activities. You should also tell your doctor if you have been feeling sad or hopeless, or have been drinking or using drugs to control symptoms.

Treatment

The goal of treatment is to decrease the frequency and intensity of panic attacks. Your doctor or mental health care specialist will provide treatment. The following treatments may be provided:

Cognitive-Behavioral Therapy

This can prepare patients for situations that may trigger panic attacks. Therapy focuses on:

  • Learning how to recognize what causes your fears
  • Gradually changing distorted thinking patterns to more healthful ones
  • Breathing exercises that increase relaxation
  • Reducing fear and feelings of terror

Medications

Your doctor or mental health care specialist may prescribe one or more of the following:

Antidepressants

  • Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac) and sertraline (Zoloft)

    Please Note: On March 22, 2004, the Food and Drug Administration (FDA) issued a Public Health Advisory that cautions physicians, patients, families, and caregivers of patients with depression to closely monitor both adults and children receiving certain antidepressant medications. The FDA is concerned about the possibility of worsening depression and/or the emergence of suicidal thoughts, especially among children and adolescents at the beginning of treatment, or when there’s an increase or decrease in the dose. The medications of concern—mostly SSRIs (Selective Serotonin Reuptake Inhibitors)—are: Prozac (fluoxetine), Zoloft (sertraline), Paxil (paroxetine), Luvox (fluvoxamine), Celexa (citalopram); Lexapro (escitalopram), Wellbutrin (bupropion), Effexor (venlafaxine), Serzone (nefazodone), and Remeron (mirtazapine). Of these, only Prozac (fluoxetine) is approved for use in children and adolescents for the treatment of major depressive disorder. Prozac (fluoxetine), Zoloft (sertraline), and Luvox (fluvoxamine) are approved for use in children and adolescents for the treatment of obsessive compulsive disorder. For more information, please visit http://www.fda.gov/cder/drug/antidepressants

  • Tricyclics such as clomipramine (Anafranil) or imipramine (Tofranil)
  • Monoamine oxidase inhibitors (MAOs) such as phenelzine (Nardil) or tranylcypromine (Parnate)

Anti-anxiety Medicines (Benzodiazepines)

  • Alprazolam (Xanax)
  • Clonazepam (Klonopin)
  • Lorazepam (Ativan)

Dietary Changes

Some people find that avoiding caffeine (found in coffee, tea, chocolate, colas, diet sodas) may help reduce panic attacks.

A recent review of over 20 clinical trials comparing psychotherapy and antidepressant medication for treatment of panic disorder in approximately 1,700 adults found that a combination of the two therapies was significantly more effective than either treatment method used alone. *

Prevention

  • Avoid caffeine.
  • Avoid alcohol.
  • Avoid drug use, unless prescribed by your doctor.
  • Get plenty of rest.
  • Schedule a regular "quiet time" for yourself at home.

RESOURCES:

American Psychiatric Association
http://www.psych.org

Anxiety Disorders Association of America
http://www.adaa.org

CANADIAN RESOURCES:

Canadian Mental Health Center
http://www.cmha.ca

Canadian Psychological Association
http://www.cpa.ca

References:

Answers to your questions about panic disorder. American Psychological Association website. Available at: http://www.apa.org/pubinfo/panic.html . Accessed October 14, 2005.

National Institute of Mental Health, National Institutes of Health website. Available at: http://www.nimh.nih.gov/ . Accessed October 14, 2005.

*Updated section on Treatment on 8/22/06 according to the following study, as cited by DynaMed's Systematic Literature Surveillance http://www.dynamicmedical.com/what.php : Furukawa TA, Watanabe N, Churchill R. Psychotherapy plus antidepressant for panic disorder with or without agoraphobia: systematic review. Br J Psychiatry. 2006;188:305-312.



Last reviewed December 2007 by Theodor B. Rais, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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