Your Health - Panic Disorder

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

These factors increase your chance of developing panic disorder. Tell your doctor if you have any of these risk factors:

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

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
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 specialist will provide treatment. The following treatments may be provided:

Cognitive Behavioral Therapy

Cognitive behavioral therapy 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 may prescribe one or more of the following:

Antidepressants

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

FDA Public Health Advisory for Antidepressants

The FDA advises that people taking antidepressants should be closely observed. For some, the medications have been linked to worsening symptoms and suicidal thoughts. These adverse effects are most common in young adults. The effects tend to occur at the beginning of treatment or when there is an increase or decrease in the dose.

Although the warning is for all antidepressants, of most concern are the SSRI class such as:

Prozac ( fluoxetine ), Zoloft ( sertraline ), Paxil ( paroxetine ), Luvox ( fluvoxamine ), Celexa ( citalopram ), Lexapro( escitalopram )

For more information, please visit: http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/UCM096273

Anti-anxiety Medicines (Benzodiazepines)

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

Studies have found that people with panic disorder get the most benefit from a combination of treatment (therapy and medication).

Dietary Changes

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

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 Association
http://www.cmha.ca/bins/index.asp/

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.

Antidepressant use in children, adolescents, and adults. US Food and Drug Administration website. Available at: http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/UCM096273 . Published May 22, 2009. Accessed July 15, 2009.

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

¹8/22/2006 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/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 November 2009 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.