Panic Disorder

Panic Attacks

What is Panic disorder?

Panic disorder is characterized by sudden and unpredictable panic attacks - brief episodes of intense fear, a sense of an impending disaster, and bodily sensations such as a fast heart rate, breathlessness, and dizziness. The attack comes "out of the blue," and usually lasts less than one hour.

Panic disorder is present in one to three percent of people at some time in their lives. Age at onset is usually between the late teens and mid-30s. Women are two to three times as likely than men to have panic disorder. Individuals who have a close relative with panic disorder have an increased chance of developing the disorder. The panic attacks are not due to drug abuse, a medical condition (such as an overactive thyroid gland), or side effects of a medication. The panic is not explained by other anxiety disorders such as a specific or social phobia, posttraumatic stress disorder, obsessive-compulsive disorder, or separation anxiety disorder.

How is it diagnosed?

Signs and symptoms of panic attacks

Physical symptoms:

  • Palpitations; rapid heartbeat; chest pains.
  • Shortness of breath; choking feeling; hyperventilation; weakness or faintness; fainting (occasionally); sweating and trembling.
  • Numbness and tingling around the mouth, hands and feet.
  • Muscle spasms or contractions in the hands and feet.
  • Feeling of "butterflies" in the stomach.

Emotional symptoms:

  • Intense fear of losing one’s mind (fear of going crazy); fear of dying; sense of terror, doom or dread.
  • Sense of unreality, loss of contact with people and objects.

Onset of the attack is sudden, with symptoms reaching a peak in ten minutes or less. There is worry for at least a month about having another attack or that the attacks indicate a serious medical or mental disease.

Physical exam if performed during a panic attack, could demonstrate a rapid heart rate and elevated blood pressure. The physical exam does not typically contribute to this diagnosis.

Tests: Psychological tests can be consistent with this disorder but do not prove the diagnosis.

How is Panic disorder treated?

Panic disorder is treated with both cognitive behavioral therapy and drug therapy. Cognitive therapy is done to suggest that panic is a misinterpretation of body sensations and that the danger is not as extreme as is perceived. Relaxation training and progressive muscle relaxation can be done, along with training in breath control. Drug therapy is usually with a potent benzodiazepine or a selective serotonin reuptake inhibitor, antidepressant. Tricyclic antidepressants and monoamine oxidase inhibitors are occasionally prescribed. Supportive psychotherapy is provided as needed.

Medications

Information Brand Generic Label Rating
Amitriptyline tablets Elavil Amitriptyline Off-Label
Venlafaxine Oral Effexor Venlafaxine Off-Label
Gabapentin 600mg Neurontin Gabapentin Off-Label
Buy Lexapro Lexapro Escitalopram Off-Label
Paxil Antidepressant Paxil Paroxetine Off-Label
Sertraline Zoloft Sertraline On-Label

Celexa (Citalopram), Pamelor (Nortriptyline), Prozac (Fluoxetine), Tofranil (Imipramine), Remeron (Mirtazapine), Ativan (Lorazepam), Xanax (Alprazolam), Klonopin (Clonazepam), Valium (Diazepam)

Activity

  • Get physical exercise regularly.
  • Get adequate rest at night.

Diet

Consider giving up caffeine (coffee, tea, soft drinks). You may experience withdrawal symptoms of headache or tiredness, but they will stop in a few days.

What might complicate it?

Fear of a panic attack in public can result in staying at home (agoraphobia) resulting in the loss of employment and most relationships. Some individuals may become convinced that they have an undiagnosed life threatening disease or that they are going crazy and may limit their activities even further. Major depressive disorder occurs at some point in half of people. Alcohol and substance abuse can occur, as can suicide attempts.

Predicted outcome

Outcome is variable. The panic attacks may come and go over the years. Most individuals become able to live normal lives with only ten to twenty percent becoming impaired.

Alternatives

Some medical conditions can create anxiety, such as an overactive thyroid, a seizure disorder, low blood sugar (hypoglycemia), mitral valve prolapse, or a rapid heart rhythm such as supraventricular tachycardia. Substance abuse with stimulants such as cocaine or amphetamines can precipitate a panic attack. Other anxiety disorders such as phobias or separation anxiety disorder can have sudden anxiety as a feature.

Appropriate specialists

Psychiatrist or psychologist.

Seek Medical Attention

  • You or a family member has symptoms of panic disorder that don't diminish with self-treatment.
  • Treatment program fails after 8 weeks.

Last updated 15 December 2011


©2007-2012. Nmihi.com All rights reserved. This site is for information and support only.