Panic Disorder

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KEY POINTS

• Panic disorder is having sudden surges of intense fear that happen repeatedly and without warning.
• Panic disorder can be successfully treated with therapy and medicine.
• Seek immediate help if you have severe chest pain or trouble breathing.

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What is panic disorder?

Panic is a sudden surge of intense fear and physical symptoms that feel severe. When panic attacks happen repeatedly, without warning, it is called panic disorder. These attacks can happen many times every week.

Panic disorder may last for a short time or may continue for many years. With treatment, most people improve in less than a year.

What is the cause?

The exact cause of this disorder is not known.

• The brain makes chemicals that affect thoughts, emotions, and actions. Without the right balance of these chemicals, there may be problems with the way you think, feel, or act. People with this disorder may have too little or too much of some of these chemicals.
• Certain parts of the brain and nervous system cause the emotional and physical surge of fear. A stressful event may trigger the panic. But often panic begins with no identified stressful event.
• Panic disorder tends to run in families. If a parent has panic disorder, children are more likely to have panic disorder, too. However, more than half of those with panic disorder do not have a relative with a history of this disorder.
• You are at more risk if you were physically or sexually abused in the past.

Many people with panic disorder also have agoraphobia, which means you avoid going places or doing things because you are afraid you will panic and have no help. It is common to have depression along with panic disorder.

Panic disorder usually starts when you are a teen or a young adult. It may start after age 30, but almost never in middle age or later. Panic disorder is more common in women than men.

What are the symptoms?

Symptoms of a panic attack may include:

• Feeling intense fear that something terrible is about to happen
• Worrying about losing control
• Worrying about dying, going crazy, or having a heart attack
• Having physical symptoms such as a pounding heart, upset stomach, diarrhea, shaking, sweating, or being hot or cold
• Feeling like you are choking or can't breathe
• Being dizzy, faint, or lightheaded
• Feeling numbness or tingling in the arms, legs, or other parts of the body
• Feeling detached or as if you are watching yourself from outside the body

These feelings start suddenly and get very strong, usually within 10 minutes. Symptoms usually last from 20 to 30 minutes. The attacks happen without warning.

If you have panic disorder, these symptoms come repeatedly. You fear that another attack will happen and change your behavior to try to avoid another panic attack.

Because common symptoms of a panic attack include chest pain and shortness of breath, you may mistake a panic attack for a heart attack. If you have severe chest pain or trouble breathing, get medical treatment right away to find out the cause.

How is it diagnosed?

Your healthcare provider or therapist will ask about your symptoms. He will make sure you do not have a medical illness or drug or alcohol problem that could cause the symptoms.

It is important to make sure that medical problems are not causing the panic attacks. Some medicines may cause or increase panic attacks. You may need to change your medicines to make sure they are not part of the problem.

No lab tests can diagnose panic disorder.

How is it treated?

Panic disorder can be successfully treated with therapy and medicine.

Medicine

Several medicines can help treat panic disorder. Your healthcare provider will work with you to select the best medicine. You may need to take more than one type of medicine.

Therapy

There are several kinds of therapy that can help a person with panic disorder. Support groups are also very helpful.

Cognitive behavioral therapy (CBT) is a form of therapy that is very effective with panic disorder. CBT is a way to help you identify and change thoughts that lead to panic attacks. Replacing negative thoughts with more positive ones can help you to control panic attacks and the fear that a panic attack will happen.

Other treatments

Claims have been made that certain herbal and dietary products help control panic disorder symptoms. No herb or dietary supplement has been proven to consistently or completely relieve symptoms of panic disorder. Supplements are not tested or standardized and may vary in strength and effects. They may have side effects and are not always safe.

Learning ways to relax may help. Yoga and meditation may also be helpful. You may want to talk with your healthcare provider about using these methods along with medicines and therapy.

How can I take care of myself?

Maintaining a healthy lifestyle is important. To help control panic disorder:

• Get support. Talk with family and friends. Consider joining a support group in your area.
• Learn to manage stress. Ask for help at home and work when the load is too great to handle. Find ways to relax. For example take up a hobby, listen to music, watch movies, or take walks. Try yoga, meditation, or deep breathing exercises when you feel stressed.
• Take care of your physical health. Try to get at least 7 to 9 hours of sleep each night. Eat a healthy diet and don't skip meals. Low blood glucose can make you feel more nervous. Limit caffeine. If you smoke, quit. Avoid alcohol and drugs. Exercise according to your healthcare provider's instructions. Regular exercise can help calm you and make it easier for you to deal with stress.
• Check your medicines. To help prevent problems, tell your healthcare provider and pharmacist about all of the medicines, natural remedies, vitamins, and other supplements that you take. It is very important to take your medicine even when you are feeling and thinking well. Without the medicine, your symptoms may not improve or may get worse. Talk to your provider if you have problems taking your medicine or if the medicines don't seem to be working.
• Learn about your condition. Knowing how panic disorder affects you helps you better understand how treatments, medicines, and lifestyle changes can help. Know what symptoms you should call your healthcare provider or therapist about.
• Contact your healthcare provider or therapist if you have any questions or your symptoms seem to be getting worse.

Get emergency care if you or a loved one has serious thoughts of suicide or self-harm. Also seek immediate help if you have severe chest pain or trouble breathing.

For more information, contact:

• National Institute of Mental Health
  866-615-6464
  http://www.nimh.nih.gov/
• Mental Health America
  800-969-6642
  http://www.mentalhealthamerica.net/