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Panic Disorder

Overview

Panic disorder paralyzes people with overwhelming anxiety and fear. It affects an estimated 2.4 million people in the United States annually. It is a severe disorder in the family of chronic anxiety disorders that includes obsessive-compulsive disorder, post-traumatic stress disorder, social phobia and generalized anxiety disorder. Twice as many women as men are prone to the disorder. The symptoms of the disorder can worsen over time without treatment.

In the United States, 1.6 percent of the adult population, or more than 3 million people, will have panic disorder at some time in their lives.

Symptoms typically begin when an individual is in their late teens or early twenties. Studies by the National Institute of Mental Health (NIMH) show that one in ten people experience panic attacks during their lifetime. While everyone experiences mild, short-term anxiety in reaction to a pending social or business event, people with panic disorder experience severe, debilitating attacks in everyday situations. After enduring such an attack, individuals may begin to fear future attacks. This can create addtional fear and anxiety which, in fact, brings on more attacks. Fortunately, panic disorder can be successfully treated with a combination of medications and therapy.

Symptoms

Panic disorder is characterized by an attack of overwhelming anxiety and fear that appears to strike out of nowhere. It may occur repeatedly in stressful situations like driving in traffic or walking through crowded stores. It can also occur in familiar settings for no apparent reason. Attacks may occur during the day or night or even when a person is asleep. They may last minutes or hours. The physical reaction to whatever has stimulated the attack is unaccountably intense. A person may experience a racing heart, shallow breath, dizziness or chest pain. Some people believe they are having a heart attack or other life-threatening experience and rush to the hospital emergency room for assistance. Many people struggle with the disorder for years before getting an appropriate diagnosis and effective treatment.

According to NIMH, a person may be diagnosed with panic disorder if these attacks occur one or more times each month, accompanied with four of the following symptoms: dizziness, sweating, shortness of breath, heart palpitations, chest pain, a choking or smothering feeling, tingling, hot or cold flashes, fainting, trembling, nausea, feelings of unreality and specific fears of losing control, dying or going insane. People may or may not experience the same combination of symptoms from one panic attack to another. However, if they have the disorder, they will experience some or many of the symptoms listed.

Individuals with panic disorder may have other phobias and anxieties related to panic disorder. For example, they might fear being around other people or fear being alone. People with panic disorder can also have problems with depression and drug or alcohol abuse. As the disorder progresses, the person may avoid appointments or situations and locations that they associate with the attacks. Panic disorder can disrupt people’s routines at work, school and with friends and family. In rare cases, individuals with panic disorder can end up housebound with what is known as agoraphobia. Agoraphobia is a much more severe form of the disorder which prevents the individual from leaving their home.

There is no medical test for panic disorder. Diagnosis is made on the basis of symptoms, the course of illness, and family history.

Causes, Genetic Factors and Cultural Influences

The exact cause of panic disorder is not well understood.

Panic disorder runs in families. Thus, it appears that some genetic factor, in combination with environmental factors, may be responsible for an individual’s vulnerability to this condition. Other research has demonstrated that panic attacks can be caused by chemical imbalances in the brain.

Current research has not found definite cultural factors in panic disorder. Panic disorder may well be hereditary along with the depression that accompanies many sufferers. Twice as many women are affected as men.

Some treatments are found to be more effective in cultural segments than in others. In exposure therapy, an individual is presented with situations that trigger emotional or physical responses in an effort to desensitize them. This therapy has been found to be ineffective among African Americans.

Experts believe that anxiety disorders are caused by a combination of biological and environmental factors such as brain chemistry, life events, personality, and genetic predisposition. This makes an anxiety disorder much like other physical disorders, such as heart disease or diabetes.

Scientists also believe that stimulants such as caffeine can contribute to panic attacks.

Potential Risks

Panic attacks can occur at any time. If a person experiences a panic attack while driving a car or operating heavy equipment, they can put themselves and others at serious risk of harm. It is important for an individual who is experiencing a panic attack to get help and/or get into a safe situation as soon as possible.

People who have panic disorder may also experience severe depression. Depression can result in suicidal thoughts and actions. If a person talks about or exhibits signs of suicide, they should be taken seriously. Do not hesitate to contact 911 emergency services in a crisis.

Individuals with panic disorder may use alcohol and drugs to medicate themselves. This may lead to the abuse of alcohol and/or drugs and related problems.

Treatment

While panic disorder cannot presently be cured, up to 90 percent of people who have it are helped by therapy and medication. Intensive treatment usually lasts from 6 months to one year, although medication may be required for the remainder of the person’s lifetime.

Initially the doctor may prescribe anti-anxiety medications from the family of benzodiazepines. Some of the better-known, effective panic disorder drugs are clonazepam (Klonopin®), lorazepam (Ativan®), and alprazolam (Xanax®). Benzodiazepines typically have few side effects, aside from drowsiness. If the doctor diagnoses an underlying depression that contributes to the disorder, they might prescribe tricyclic antidepressants like imipramine (Tofranil®), protriptyline (Vivactil®), clomipramine (Anafranil®). More recently, physicians have prescribed new-generation antidepressants such as fluoxetine (Prozac®), sertraline (Zoloft®), fluvoxamine (Luvox®), paroxetine (Paxil®), and citalopram (Celexa®). Even older-generation antidepressants, MAO inhibitors such as phenelzine (Nardil®) or tranylcypromine (Parnate®), are still effective for many. Since individuals with anxiety disorder have unique chemical reactions to medications, doctors may try drugs individually or in combination with each other until they find the most-effective regimen. In cases where the person has a predicable, highly stressful occasion on their calendar, doctors may order a beta blocker to relieve shaking, heart pounding, and other physical reactions.

Combined with medication, therapy may be a valuable resource in treating panic disorder. Cognitive therapy can also be helpful in assisting the individual to change thought patterns that create or amplify fear. Behavioral therapy may alter how a person reacts to growing anxiety. Relaxation techniques can reduce the intensity of the attack as well as eliminate stress between episodes. People with panic disorder can also learn to identify patterns that appear before an attack and take immediate action to stop the episode.

How You Can Help

If you think a friend or family member needs help, the National Institute of Mental Health (NIMH) recommends that you encourage the individual to get an evaluation from a mental health professional. Family members and friends can help an individual recognize that they have an illness that can be treated if they are willing. It is important to understand that diagnosing serious mental illness is not simple or straightforward. Your doctor may need to revise the initial diagnosis, treatment and drug therapies one or more times over a period of weeks or months to find the best treatment regimen.

Sometimes, family members and friends need to intervene if a loved one with serious mental illness refuses to obtain treatment. This can be a very difficult situation for both the individual with the illness and the family members and friends. It is important to obtain assistance from a mental health professional to guide you through the medical and legal issues involved in an intervention.

Family members and friends of a person with serious mental illness can help by offering their support and affection to the extent possible. It is important to understand that people with serious mental illness cannot simply “pull themselves together” and get better. The support of family members and friends over the long term can be invaluable to an individual with a serious mental illness. Support groups can also be invaluable. Consumer groups offer individuals with mental illness an opportunity to share their needs, concerns and struggles with others in the same situation. Consumer support groups are available in many communities.

Family members and friends need to become educated about serious mental illness. They also need to take care of their own emotional needs. Support groups can also help family members and friends cope with their loved one’s illness. Family support groups provide a place for family members to share their experiences and obtain current information and education about their loved one’s mental illness.

NAMI maintains a list of resources and support to individuals and families needing help with serious mental illness. The list includes information, contact persons, crisis numbers, telephone listings, and email contacts.

Family physicians, mental health professionals, religious counselors, community mental health centers, social service agencies, state and private hospitals are also available to provide help and support as needed. NAMI maintains a current list mental health professionals (psychiatrists, psychologists, care homes, etc.) that provide support for serious mental illness in your community.

NAMI also offers the “Family-to-Family” program to educate and support families who have members afflicted with a serious mental illness.

Finally, and most importantly, do not hesitate to get help from your local 911 emergency service or suicide hotline in a crisis.

For additional information, visit these web sites:

About Medications
Information about medications used in the treatment of serious mental illnesses
Find Support
Learn more about the full spectrum of programs and services that NAMI provides across the country for people living with mental illnesses, and their families and loved ones.

 

Online Discussion
Living with Panic Disorder
Find support, share knowledge, ask questions and meet people who’ve been there.

 

Mental Illness Discussion Groups
Dozens of online groups for consumers, parents, spouses, siblings, teens and more. Get connected and find support.

 

Related Links
Anxiety Disorders Association of America (ADAA)
National, non-profit membership organization dedicated to informing the public, providers, and policy-makers about anxiety disorders.
Clinicaltrials.gov
Panic disorder research studies identified through the U.S. National Library of Medicine’s link to federally and privately funded studies worldwide.
National Institute of Mental Health
Information from the NIH institute on panic disorder.

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