Panic Disorder

Overview

What is panic disorder?

Panic disorder is a condition in which a person has episodes of intense fear or anxiety that occur suddenly, often without warning. Suppose one day you’re getting out of your car to go to work. Suddenly, your chest feels tight. Your heart races. You begin to feel dizzy and faint. You start to choke. You feel as if you could be dying. Was it all in your head? No. Most likely, you had a panic attack.

Panic attacks can last from minutes to hours. They may occur only once in a while, or they may occur quite frequently. The cause, or "trigger," for these attacks may not be obvious. A diagnosis of panic disorder is usually made after a person experiences at least 2 panic attacks that occur without reason and are followed by a period of at least 1 month of fear that another attack will happen. Panic attacks can lead to phobias if they aren’t treated.

What is a phobia?

A phobia is an extreme, unreasonable fear in response to something specific. There are lots of different phobias, including fear of crowds, bridges, snakes, spiders, heights, open places or social embarrassment.

A phobia is only considered a problem when it keeps you from living a normal life. An example is being afraid to leave home because you are afraid of one of the things listed above.

Symptoms

What happens during a panic attack?

Panic attacks are associated with physical symptoms that include the following:

A person may also have an extreme fear of losing control, going crazy or dying during a panic attack. It is very rare for a person to have all of these symptoms at once. However, the presence of at least 4 symptoms strongly suggests that a person has panic disorder.

Many of the symptoms that occur during a panic attack are the same as the symptoms of diseases of the heart, lungs, intestines or nervous system. The similarities between panic disorder and other diseases may add to the person’s fear and anxiety during and after a panic attack. For example, you may believe that you are actually having a heart attack.

Just the fear of having a panic attack is often enough to trigger the symptoms. This is the basis for a condition called agoraphobia. A person who has agoraphobia finds it difficult to leave home (or another safe area) because he or she is afraid of having a panic attack in public or not having an easy way to escape if the symptoms start.

  • Shaking or trembling

  • Feeling that your heart is pounding or racing

  • Sweating

  • Chest pain or discomfort

  • Shortness of breath

  • Feeling that you are choking

  • Nausea

  • Cramping

  • Dizziness or weakness

  • An out-of-body feeling

  • Tingling or numbness in your hands, arms, feet or legs

  • Chills or hot flashes

  • Sense of unreality or dreamlike sensations

Diagnosis & Tests

Should I see my doctor if I’m having panic attacks?

Many people who have panic attacks don’t seek medical care because of embarrassment or the fear of taking medicine. If you have panic attacks, it is very important to seek medical care and discuss your problem with your doctor. After you have been evaluated thoroughly, your doctor will be able to tell you if your panic attacks are related to panic disorder or are caused by another problem. Simple treatments are available to help control panic attacks and panic disorder.

Treatment

Can medicines help people who have panic attacks and panic disorder?

Several medicines can make panic attacks less severe or stop them altogether.

Paroxetine and sertraline are antidepressant medicines that have been approved by the U.S. Food and Drug Administration (FDA) to treat panic disorder. Antidepressants are very effective in preventing anxiety and panic attacks. Often they completely stop the attacks. You don’t have to be depressed for them to help. Side effects are usually mild. Antidepressants will not make you lose control or change your personality. These medicines can be used for as long as necessary, even for years.

Alprazolam and clonazepam are also medicines approved by the FDA to treat panic disorder. These medicines give relief from fear and anxiety. They should be used only for a short period of time (a few weeks to a few months), unless you absolutely can’t function without them. Never suddenly stop taking either of these medicines. If you need to stop, these medicines should be slowly tapered off over several weeks under your doctor’s supervision.

Can counseling help people who have panic attacks and panic disorder?

Several kinds of counseling are very effective in treating panic attacks and panic disorder. You can ask your doctor about the different kinds of counseling that are available. Counseling does not work as fast as medicine, but it can be just as effective. The combination of both counseling and medicine seems to be an effective treatment for panic attacks and panic disorder.

How long does treatment last?

How long treatment continues depends on you. Stopping panic attacks completely is a reasonable goal. Your doctor will design a treatment plan just for you. A treatment period lasting at least 6 to 9 months is usually recommended. Some people taking medicine for panic disorder are able to stop treatment after only a short time. Other people need to continue treatments over a long period of time, or even for their lifetime.

Other Organizations

Questions to Ask Your Doctor

  • What is causing my panic disorder?

  • What treatment is best for me?

  • Should I take a medicine?

  • Will I have to take medicine the rest of my life?

  • Is there any kind of therapy I should try?

  • How long will I have to be in therapy?

  • I’m afraid to leave my house. What should I do?

  • Is there a possibility that my panic attacks will come back after treatment?