David Baxter PhD
Late Founder
Panic attacks and panic disorder
By Mayo Clinic Staff
Mar 28, 2008
A panic attack is a sudden episode of intense fear that develops for no apparent reason and that triggers severe physical reactions. Panic attacks can be very frightening. When panic attacks occur, you might think you're losing control, having a heart attack or even dying.
You may have only one or two panic attacks in your lifetime. But if you have panic attacks frequently, it could mean that you have panic disorder, a type of chronic anxiety disorder.
Panic attacks were once dismissed as nerves or stress, but they're now recognized as a real medical condition. Although panic attacks can significantly affect your quality of life, treatment ? including medications, psychotherapy and relaxation techniques to help prevent or control panic attacks ? is very effective.
Signs and symptoms
Panic attack symptoms can make your heart pound and cause you to feel short of breath, dizzy, nauseated and flushed. Because panic attack symptoms can resemble life-threatening conditions, it's important to seek an accurate diagnosis and treatment.
Panic attack symptoms can include:
If you have frequent panic attacks, you may have a condition called panic disorder. Panic attacks can greatly interfere with your life ? and perhaps even endanger you or others.
Panic attacks can strike at almost any time without warning ? when you're driving the school car pool, at the mall, sound asleep or in the middle of a business meeting. And you may fear having a panic attack so much that you avoid situations where they may occur. You may even be unable to leave your home (agoraphobia), because no place feels safe.
Causes
It's not known what causes panic attacks or panic disorder. Things that may play a role include:
Risk factors
It's hard to pinpoint how many people have panic attacks or panic disorder because of diagnostic issues, but it's estimated that 2 million to 6 million Americans have panic disorder. Symptoms of panic disorder often start either in late adolescence or in your 30s. More women than men are diagnosed with panic disorder. Many people have just one or two panic attacks in their lifetimes, and the problem goes away, perhaps when a stressful situation ends.
Factors that may increase the risk of developing panic attacks or panic disorder include:
If you have any symptoms of panic attacks, seek medical help as soon as possible. Panic attacks are hard to manage on your own, and they may get worse without treatment. And because panic attack symptoms can also resemble other serious health problems, such as a heart attack, it's important to get evaluated by your health care provider if you aren't sure what's causing your symptoms.
In fact, many people visit the emergency department or seek care from numerous doctors or hospitals because they believe they have a serious undiagnosed physical condition. You can generally seek help first from your primary care provider for panic attack. If he or she believes your symptoms are indeed related to panic attacks, you may be referred to a psychiatrist or psychologist for treatment.
If you're reluctant to seek treatment for your panic attacks, try to work up the courage to confide in someone, whether it's a friend or loved one, a health care professional, a faith leader or someone else you trust. They can help you take the first steps to successful treatment.
Screening and diagnosis
To help pinpoint a diagnosis for your symptoms, you'll likely have several exams and tests. Your doctor or other health care provider must determine if you have panic attacks, panic disorder or another condition, such as heart or thyroid problems, that resembles panic symptoms.
Tests and exams you may have include:
Not everyone who has panic attacks has a full-blown panic disorder. To be diagnosed with panic disorder, you must meet the criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.
Diagnostic criteria for panic disorder are:
Complications
Left untreated, panic attacks and panic disorder can result in severe complications that affect almost every area of your life. You may be so afraid of having more panic attacks that you live in a constant state of fear, ruining your quality of life.
Complications that panic attacks may cause or be associated with include:
Treatment for panic attacks and panic disorder is very effective. The goal of treatment is to eliminate all of your panic attack symptoms. With effective treatment, most people are eventually able to resume everyday activities. The main treatment options for panic attacks are medications and psychotherapy. Both are equally effective.
Medications
Medications can help reduce symptoms associated with panic attacks, as well as depression if that's an issue for you. Several types of medication have been shown effective in managing symptoms of panic attacks, including:
Psychotherapy
Psychotherapy, also called counseling or talk therapy, can help you understand panic attacks and panic disorder and how to cope with them. The main type of psychotherapy used to treat panic attacks and panic disorder is cognitive behavioral therapy. Some experts recommend that you have therapy with a psychiatrist or psychologist with experience in treating panic disorder.
Cognitive behavioral therapy can help you change thinking (cognitive) patterns that trigger your fears and panic attacks. It can also help you change the way you react (behave) to anxious or fearful situations. During therapy sessions, you learn to recognize things that trigger your panic attacks or make them worse, such as specific thoughts or situations. You also learn ways to cope with the anxiety and physical symptoms associated with panic attacks. These may include breathing and relaxation techniques.
In addition, working carefully with your therapist, you may re-create the symptoms of panic attacks in the safety of his or her office. This is an important step because it can help you learn to control and master the symptoms so that they don't continue to be a source of intense fear. Doing this can also help you overcome fear of certain situations that you may avoid, such as crowded malls or driving.
Your therapist may suggest weekly meetings when you first start treatment. You may start to see improvements in panic attack symptoms within several weeks, and often symptoms go away within several months.
As your symptoms improve, maintenance therapy with visits once a month can help ensure that your panic attacks remain under control. Eventually you can stop therapy when your symptoms completely go away, which may be a year or so. However, panic attack symptoms do sometimes come back. Seek prompt treatment if they do, and make sure that you're managing any stressful life situations.
Prevention
There's no sure way to prevent panic attacks or panic disorder. However, getting treatment for panic attacks as soon as possible may help stop them from getting worse or becoming more frequent. Sticking with your treatment plan can help prevent relapses or worsening of panic attack symptoms. Practicing relaxation and stress management techniques can be helpful, too.
Self-care
While panic attacks and panic disorder benefit from professional treatment, you can also help manage your symptoms on your own. Some of the lifestyle and self-care steps you can take include:
By Mayo Clinic Staff
Mar 28, 2008
A panic attack is a sudden episode of intense fear that develops for no apparent reason and that triggers severe physical reactions. Panic attacks can be very frightening. When panic attacks occur, you might think you're losing control, having a heart attack or even dying.
You may have only one or two panic attacks in your lifetime. But if you have panic attacks frequently, it could mean that you have panic disorder, a type of chronic anxiety disorder.
Panic attacks were once dismissed as nerves or stress, but they're now recognized as a real medical condition. Although panic attacks can significantly affect your quality of life, treatment ? including medications, psychotherapy and relaxation techniques to help prevent or control panic attacks ? is very effective.
Signs and symptoms
Panic attack symptoms can make your heart pound and cause you to feel short of breath, dizzy, nauseated and flushed. Because panic attack symptoms can resemble life-threatening conditions, it's important to seek an accurate diagnosis and treatment.
Panic attack symptoms can include:
- Rapid heart rate
- Sweating
- Trembling
- Shortness of breath
- Hyperventilation
- Chills
- Hot flashes
- Nausea
- Abdominal cramping
- Chest pain
- Headache
- Dizziness
- Faintness
- Tightness in your throat
- Trouble swallowing
- A sense of impending death (or doom)
If you have frequent panic attacks, you may have a condition called panic disorder. Panic attacks can greatly interfere with your life ? and perhaps even endanger you or others.
Panic attacks can strike at almost any time without warning ? when you're driving the school car pool, at the mall, sound asleep or in the middle of a business meeting. And you may fear having a panic attack so much that you avoid situations where they may occur. You may even be unable to leave your home (agoraphobia), because no place feels safe.
Causes
It's not known what causes panic attacks or panic disorder. Things that may play a role include:
- Genetics
- Stress
- Certain changes in the way parts of your brain function
Risk factors
It's hard to pinpoint how many people have panic attacks or panic disorder because of diagnostic issues, but it's estimated that 2 million to 6 million Americans have panic disorder. Symptoms of panic disorder often start either in late adolescence or in your 30s. More women than men are diagnosed with panic disorder. Many people have just one or two panic attacks in their lifetimes, and the problem goes away, perhaps when a stressful situation ends.
Factors that may increase the risk of developing panic attacks or panic disorder include:
- A family history of panic attacks or panic disorder
- Significant stress
- The death or serious illness of a loved one
- Big changes in your life, such as the addition of a baby
- A history of childhood physical or sexual abuse
- Undergoing a traumatic event, such as an accident or rape
If you have any symptoms of panic attacks, seek medical help as soon as possible. Panic attacks are hard to manage on your own, and they may get worse without treatment. And because panic attack symptoms can also resemble other serious health problems, such as a heart attack, it's important to get evaluated by your health care provider if you aren't sure what's causing your symptoms.
In fact, many people visit the emergency department or seek care from numerous doctors or hospitals because they believe they have a serious undiagnosed physical condition. You can generally seek help first from your primary care provider for panic attack. If he or she believes your symptoms are indeed related to panic attacks, you may be referred to a psychiatrist or psychologist for treatment.
If you're reluctant to seek treatment for your panic attacks, try to work up the courage to confide in someone, whether it's a friend or loved one, a health care professional, a faith leader or someone else you trust. They can help you take the first steps to successful treatment.
Screening and diagnosis
To help pinpoint a diagnosis for your symptoms, you'll likely have several exams and tests. Your doctor or other health care provider must determine if you have panic attacks, panic disorder or another condition, such as heart or thyroid problems, that resembles panic symptoms.
Tests and exams you may have include:
- Physical exam. This may include measuring height and weight; checking vital signs, such as heart rate, blood pressure and temperature; listening to the heart and lungs; and examining the abdomen.
- Laboratory tests. These may include a complete blood count (CBC) as well as thyroid tests and other blood tests. You may also have tests on your heart, such as an electrocardiogram to help determine how well your heart is functioning.
- Psychological evaluation. A doctor or mental health provider will talk to you about your symptoms, such as what they feel like, how often they occur, when they occur and how long you've had them. You'll also be asked about stressful situations in your life, fears or concerns you have, relationship problems and other issues affecting your life. You may fill out psychological self-assessments and questionnaires. And you may be asked about substance or alcohol abuse.
Not everyone who has panic attacks has a full-blown panic disorder. To be diagnosed with panic disorder, you must meet the criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.
Diagnostic criteria for panic disorder are:
- You have frequent, unexpected panic attacks
- You worry about having another panic attack or about losing control
- You avoid situations you think may trigger a panic attack
- Your panic attacks aren't caused by substance abuse or another mental health condition, such as social phobia or agoraphobia
Complications
Left untreated, panic attacks and panic disorder can result in severe complications that affect almost every area of your life. You may be so afraid of having more panic attacks that you live in a constant state of fear, ruining your quality of life.
Complications that panic attacks may cause or be associated with include:
- Development of specific phobias, such as fear of driving or leaving your home
- Avoidance of social situations
- Problems at work or school
- Depression
- Increased risk of suicide or suicidal thoughts
- Alcohol or substance abuse
- Financial problems
Treatment for panic attacks and panic disorder is very effective. The goal of treatment is to eliminate all of your panic attack symptoms. With effective treatment, most people are eventually able to resume everyday activities. The main treatment options for panic attacks are medications and psychotherapy. Both are equally effective.
Medications
Medications can help reduce symptoms associated with panic attacks, as well as depression if that's an issue for you. Several types of medication have been shown effective in managing symptoms of panic attacks, including:
- SSRIs. These medications are in the class of antidepressants called selective serotonin reuptake inhibitors. Because these medications are generally safe and have a low risk of causing serious side effects, SSRIs are typically recommended as the first choice in medication options to treat panic attacks. They include citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Prozac Weekly), paroxetine (Paxil, Paxil CR) and sertraline (Zoloft).
- SNRIs. These medications are in the class of antidepressants called serotonin and norepinephrine reuptake inhibitors. They include duloxetine (Cymbalta) and venlafaxine (Effexor, Effexor XR).
- TCAs. These medications are in the class of antidepressants called tricyclic antidepressants. While effective, they pose a risk of serious side effects, including heart and blood sugar problems. They include desipramine (Norpramin), imipramine (Tofranil) and nortriptyline (Pamelor).
- Benzodiazpines. These medications are mild sedatives. They belong to the group of medicines called central nervous system (CNS) depressants. Benzodiazepines may be habit-forming (causing mental or physical dependence), especially when taken for a long time or in high doses. These include alprazolam (Xanax), clonazepam (Klonopin) and lorazepam (Ativan).
- MAOIs. These medications are in the class of antidepressants called monoamine oxidase inhibitors. Because they can cause life-threatening side effects and require strict dietary restrictions, they're not commonly prescribed. They include phenelzine (Nardil), tranylcypromine (Parnate), isocarboxazid (Marplan) and selegiline (Emsam).
Psychotherapy
Psychotherapy, also called counseling or talk therapy, can help you understand panic attacks and panic disorder and how to cope with them. The main type of psychotherapy used to treat panic attacks and panic disorder is cognitive behavioral therapy. Some experts recommend that you have therapy with a psychiatrist or psychologist with experience in treating panic disorder.
Cognitive behavioral therapy can help you change thinking (cognitive) patterns that trigger your fears and panic attacks. It can also help you change the way you react (behave) to anxious or fearful situations. During therapy sessions, you learn to recognize things that trigger your panic attacks or make them worse, such as specific thoughts or situations. You also learn ways to cope with the anxiety and physical symptoms associated with panic attacks. These may include breathing and relaxation techniques.
In addition, working carefully with your therapist, you may re-create the symptoms of panic attacks in the safety of his or her office. This is an important step because it can help you learn to control and master the symptoms so that they don't continue to be a source of intense fear. Doing this can also help you overcome fear of certain situations that you may avoid, such as crowded malls or driving.
Your therapist may suggest weekly meetings when you first start treatment. You may start to see improvements in panic attack symptoms within several weeks, and often symptoms go away within several months.
As your symptoms improve, maintenance therapy with visits once a month can help ensure that your panic attacks remain under control. Eventually you can stop therapy when your symptoms completely go away, which may be a year or so. However, panic attack symptoms do sometimes come back. Seek prompt treatment if they do, and make sure that you're managing any stressful life situations.
Prevention
There's no sure way to prevent panic attacks or panic disorder. However, getting treatment for panic attacks as soon as possible may help stop them from getting worse or becoming more frequent. Sticking with your treatment plan can help prevent relapses or worsening of panic attack symptoms. Practicing relaxation and stress management techniques can be helpful, too.
Self-care
While panic attacks and panic disorder benefit from professional treatment, you can also help manage your symptoms on your own. Some of the lifestyle and self-care steps you can take include:
- Stick to your treatment plan. Facing your fears can be difficult, but treatment can help you feel like you're not a hostage in your own home.
- Join a support group for people with panic attacks or anxiety disorders so that you can connect with others facing the same problems.
- Avoid caffeine, alcohol and illicit drugs, all of which can trigger or worsen panic attacks.
- Practice stress management and relaxation techniques. Meditation, yoga and guided imagery may be good options.
- Get physically active, since aerobic activity may have a calming effect on your mood.
- Get sufficient sleep ? enough so that you don't feel drowsy during the day.
