Panic attacks

Definition

Panic disorder is an anxiety disorder that causes repeated, unexpected attacks of intense fear. These attacks may last from minutes to hours.

See also: Generalized anxiety disorder

Alternative Names

Causes

The exact cause of a panic disorder is unknown. Genetics may play a role in this disorder. Studies suggest that if one identical twin has panic disorder, 40% of the time, the other twin will also develop the condition. However, panic disorder also often occurs in family members who are not blood relatives.

Panic disorder occurs twice as often in women as in men. A person with panic disorder often lives in fear of another attack and may be afraid to be alone or to be far from medical help.

Symptoms usually begin before the age 25. Although panic disorder may occur in children, it is often not diagnosed until you are older. Persons with this condition often have medical tests and exams for symptoms related to heart attack

Symptoms

With panic disorder, at least 4 of the following symptoms suddenly occur within 10 minutes. Attacks may be followed by at least 1 month of persistent fear of having another attack.

• Sensation of shortness of breath
• 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.

Exams 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 try to cope with fear by using alcohol or illegal drugs.

Cardiovascular, endocrine, respiratory, and neurologic disorders may be suspected, and can be present at the same time as panic disorders. Specific diagnostic tests will vary between individuals 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 (working with a therapist) have been successfully used to treat panic disorders. The medications act on the central nervous system to reduce the occurrence 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 (learning to recognize and replace panic-inducing thoughts). 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.

Outlook (Prognosis)

The disorder may be long-lasting 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 therapies.

Possible Complications

Possible complications of this condition include avoiding 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 uncontrolled use of a substance despite negative results. Dependence and addiction often occur together, but dependence itself is not always a problem.

When to Contact a Medical Professional

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.