Panic disorder

Definition

Panic disorder involves repeated, unpredictable attacks of intense fear accompanied by severe anxiety symptoms in the body that may last from minutes to hours. (See also generalized anxiety disorder.)

Causes, incidence, and risk factors

The exact cause of panic disorder is unknown. There is an influence of heredity -- studies suggest that if one identical twin has this disorder, the other will also develop panic disorder 40% of the time. In addition, panic disorder has environmental and learning influences, as it often occurs in family members who are not genetically related to each other.

Panic disorder occurs twice as often in women as in men. Approximately 2% of the population is affected each year. A person with panic disorder often lives in fear of another attack and may be reluctant to be alone or to be far from medical assistance.

Symptoms usually begin before the age of 25. Although panic disorder may occur in children, it is often not diagnosed until the person is older. People with this condition often undergo medical evaluations for symptoms related to heart attack or other conditions before the diagnosis of panic disorder is made.

Symptoms

With panic disorder, at least 4 of the following symptoms abruptly occur within 10 minutes, and attacks may be followed by at least a month of persistent fear of having another attack.

• Sensation of shortness of breath or smothering
• Dizziness or faintness
• Palpitations or pounding heart
• Trembling or shaking
• Sweating, chills, or hot flashes
• Feeling of choking
• Nausea or upset stomach
• Numbness or tingling
• Chest pain or discomfort
• Fear of dying
• Fear of losing control
• Feelings of unreality
• Feelings of detachment

There are often extreme changes in behavior -- at home, school, work, or with family. People with the disorder often worry about the significance of their panic attacks -- they may think they are "going crazy" or having a heart attack.

Signs and tests

A health care provider will perform a physical examination, including blood tests and a psychiatric evaluation. Underlying medical disorders must be ruled out before the diagnosis of panic disorder can be made.

Disorders related to substance abuse should also be considered, because some can mimic panic attacks. Substance abuse may result when individuals with panic attacks attempt to self-medicate to cope with fear.

Cardiovascular, endocrine, respiratory, and neurologic disorders may be suspected and can coexist with panic disorders. Specific diagnostic tests performed will vary and will be based on the symptoms.

Many people with panic disorder first seek treatment in the emergency room, because the panic attack feels like a heart attack.

Treatment

Anti-anxiety medications, antidepressants, and cognitive behavioral therapy have been successfully used to treat panic disorders. The medications act on the central nervous system to reduce the occurence of anxiety and associated symptoms.

A commonly-used class of anti-anxiety medications is benzodiazepines, including aprolazam (Xanax). However, this class of medications is associated with dependence and addiction. Ideally, these drugs are used only on a temporary basis.

Drugs from a class of antidepressant called SSRIs (selective serotonin reuptake inhibitors) are the most commonly used medications for panic disorder. If these do not help, longer-term use of benzodiazepines may be considered.

Behavioral therapies that may be used in conjunction with drug therapy include relaxation techniques, pleasant mental imagery, and cognitive restructuring. Psychological counseling and therapy techniques may be helpful in addition to medications.

Regular exercise, adequate sleep, and regularly scheduled meals may help reduce the frequency of the attacks. Caffeine and other stimulants should be reduced or eliminated.

Expectations (prognosis)

The disorder may be long-standing and difficult to treat. Although some people with this disorder may not be cured with treatment, most can expect rapid improvement with drug and behavioral therapy.

Complications

Possible complications of this condition include avoidance of situations or places that might bring on an attack, and an increased likelihood for other anxiety and mood disorders.

Dependence on anti-anxiety medications is a possible complication of treatment. Dependence involves needing a medication to be able to function and to avoid withdrawal symptoms. It is not the same as addiction, which involves the compulsive use of a substance despite negative consequences. Dependence and addiction often occur together, but dependence itself is not always a problem.

Calling your health care provider

Call for an appointment with your health care provider if panic attacks are interfering with work, relationships, or self-esteem.

Prevention

Avoid stimulants such as caffeine and cocaine and avoid alcohol use if you are prone to panic attacks. These substances may induce or worsen the symptoms.

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