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Johns Hopkins Symptoms and Remedies

Johns Hopkins Medicine

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Panic Disorder

What is it?

Panic disorder is an anxiety state marked by unpredictable, short-lived attacks of intense fear that begin during nonthreatening activities. These attacks usually peak after 10 minutes and are over within 30 minutes. Along with feelings of terror, panic attacks trigger a combination of physical symptoms that range from shortness of breath and chest pains to a choking sensation and nausea. Another symptom of panic disorder is constant worry about having repeated panic attacks. This can lead to avoidance of certain places or situations that have triggered attacks in the past. As panic disorder worsens, anticipatory anxiety can lead to agoraphobia— the fear of being in public places—which affects about one-third of people with panic disorder. Agoraphobia can be incapacitating; sufferers may curtail activities, such as socializing or working, or even become housebound for prolonged periods. People who suffer panic disorder are also at increased risk for major depression, alcohol and drug dependency, and suicide. Panic disorder affects 1 to 2 percent of the population, and is twice as common in women as in men. Attacks usually begin before age 25, but due to the physical nature of symptoms, sufferers often believe they have a medical condition and undergo a series of unnecessary tests, prolonging proper diagnosis and treatment.One study estimated that only one in four people with panic attacks receives appropriate care.

What Causes It?

  • Genetics plays a role in the development of panic disorder. If you have a family history of panic disorder, there is a greater chance that you will be vulnerable to this condition.
  • Various stimulants and substances may trigger a panic attack; these include caffeine, cocaine, and alcohol.
  • Certain brain or biochemical abnormalities may play a role in the development of panic disorder.

Prevention

  • Early treatment may help prevent future panic attacks and the progression of the disorder.

Diagnosis

  • A physical examination will rule out medical conditions that may be causing symptoms, such as cardiac arrhythmias, overactive thyroid, or certain types of epilepsy.
  • A thorough patient history and psychiatric evaluation help to establish the diagnosis.

How to Treat It

  • Antidepressant medications, which include the selective serotonin reuptake inhibitors (SSRIs) sertraline (Zoloft) and paroxetine (Paxil), monoamine oxidase (MAO) inhibitors, and tricyclic medications, are effective in blocking or decreasing the frequency of panic attacks. However, these medications may require up to 12 weeks to take effect.
  • Benzodiazepines, such as alprazolam, lorazepam, and clonazepam, are effective immediately but are not recommended for long-term use as they can lead to dependency.
  • Beta-blockers—a class of drugs used to treat angina, high blood pressure, irregular heart rhythms, and migraine—can halt the physical symptoms of panic attacks but do not prevent the fear or panic itself.
  • Psychotherapy—especially a form known as cognitive- behavioral therapy—may be recommended, either alone or in combination with medication.
  • Relaxation techniques, such as deep breathing exercises or meditation, help reduce anxiety and enable a patient to feel in control of the symptoms of panic disorder.
  • Substances that trigger panic attacks, such as caffeine and alcohol, should be limited or discontinued.

When to Call a Doctor

  • Consult a physician if you experience repeated panic attacks or intense fear about having another panic attack, or if symptoms of panic disorder begin to interfere with your quality of life.