Panic Disorder: Symptoms & Treatment

What Is Panic Disorder?

Panic disorder is characterized by multiple panic attacks that come on unexpectedly when you’re working, shopping, or even sleeping. If you suffer from panic disorder, you may also live in fear of having additional panic attacks. Many people diagnosed with the disorder also develop agoraphobia, an extreme fear of public places, especially those with large crowds. If you experience panic attacks in response to known triggers, like a phobia of flying on an airplane, you’re more likely experiencing generalized anxiety disorder in relation to phobias.

Panic disorder can be extremely disruptive to your life, causing you to miss work, social engagements, and travel opportunities for fear of having panic attacks. You may even avoid everyday tasks and situations like shopping, driving, or leaving the house. Fortunately, there are medications and forms of therapy that are effective in easing panic disorder and its symptoms.

It is worth noting that panic attacks and anxiety attacks are not the same. While the symptoms are similar, panic attacks are recognized by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), while anxiety attacks are not. Symptoms for both can include shaking, sweating, trembling, dizziness, and nausea. However, panic attacks come on suddenly and, at times, without warning.

Causes of Panic Disorder

Although doctors haven’t identified an exact gene or situation that causes panic disorder, they’ve determined it is likely caused by a variety of factors, including:

• Genetics: If someone in your family has panic disorder, you and other family members are more likely to have it.

• Gender: Twice as many women experience panic disorder compared to men.

• Age: Panic disorder most often appears in people in their teen or young adult years, usually by the age of 25.

• Sensitivity to stress: If your natural disposition makes you more sensitive to stress or negative emotions, it could increase your likelihood of having panic disorder.

• Previous traumatic events: Experiencing a major stress or traumatic event early in life, such as sexual assault, serious illness, or death of a loved one, can also make you more susceptible.

According to the Anxiety and Depression Association of America, about 2-3% of Americans experience panic disorder every year, and about 5% will experience it at some point in their lives. The World Health Organization with the Harvard School of Public Health reported that panic disorder is the fifth most disabling mental health problem in the developed world.

Symptoms of Panic Disorder

Panic disorder is characterized by panic attacks that occur suddenly. Panic attacks often build quickly and reach their highest intensity in a matter of minutes. They usually last between 5-20 minutes, and can occur several times a day, week, month, or even just a few times a year.

Panic attacks usually include at least five or more of the following symptoms:

• Sweating
• Shaking
• Dizziness
• Fast or pounding heartbeat
• Feeling like you can’t catch your breath or can’t breathe
• Feeling like you’re choking
• Gastrointestinal upset like nausea, diarrhea, dry mouth, or abdominal cramping
• Feeling chilled or hot
• Numbness or tingling in hands and feet
• Feeling like you need to escape
• Feeling depersonalization or derealization
• Fearing that you could go crazy or completely lose control
• Fearing that you’ll die

Many people go to the doctor or emergency room the first time they have a panic attack, thinking they are having a heart attack or stroke. After the panic attack subsides, people often feel exhausted.

According to the National Institute of Mental Health, panic disorder is characterized by:

• Recurring, unexpected panic attacks
• Worry about or fear of having a panic attack in the future
• Fear or avoidance of places and situations where you’ve experienced panic attacks
• A fear of losing control, or of death, during a panic attack

How Is Panic Disorder Diagnosed?

If you suspect you’re experiencing panic attacks, you should visit your primary care provider, who can properly diagnose your condition and confirm that you don’t have another condition with similar symptoms, like cardiovascular or thyroid disorders.

To diagnose panic disorder, your doctor may:

• Give you a complete physical exam to rule out other conditions that could cause your symptoms.
• Order labs to check your thyroid, and other tests like an electrocardiogram (ECG or EKG) to check your heart.
• Ask questions about your family history of panic and anxiety disorder, your symptoms and experiences with panic attacks, and life circumstances like work stressors, major life changes, or more.
• Ask you to fill out a self-assessment or questionnaire about anxiety or depression.

In order to diagnose panic disorder, your doctor will look for symptoms that satisfy the diagnostic requirements in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). These are:

• Having unexpected panic attacks
• Worrying for at least a month after a panic attack about having another one
• Persistent fear of losing control, having a heart attack, or going crazy as a result of panic attack
• Avoiding situations or experiences that you fear could cause a panic attack
• Having panic attacks that aren't caused by substance use or abuse (such as drugs or alcohol), medical condition, or other mental health conditions

Panic Disorder Treatment Options

While panic disorder can be an extremely frightening and disabling condition, it can respond well to treatment. Treatment typically consists of a combination of therapy and medicine.

Psychotherapy

Through psychotherapy, or talk therapy, a clinician can help you learn more about panic disorder, what triggers your panic attacks, and tools for dealing with them. The most effective form of psychotherapy for panic attacks, and most anxiety disorders, is called cognitive behavioral therapy (CBT). CBT helps you reduce the intensity and frequency of panic attacks, as well as cope with them better when they do happen, by focusing on the following:

• Learning about the condition: Many people with panic disorder find comfort when they understand what they are experiencing. Education about the physiology, psychology, and neurochemistry of panic attacks and panic disorder can be very valuable to help you understand your condition.

• Cognitive restructuring: CBT therapists will help you recognize and change anxiety-provoking thought patterns and cognitive distortions, like negative life-outlook, catastrophic thinking, or all-or-nothing thinking.

• Stress-reduction techniques: Learning to relax your body when you feel a panic attack building can help you stave off panic attacks, shorten the duration, or lessen the intensity of a panic attack. CBT tools may include specific breathing exercises, practicing progressive muscle relaxation, and other relaxation techniques.

• Exposure treatment: CBT focuses on helping you face the places or situations you’re beginning to avoid out of fear of having a panic attack. A CBT therapist will work with you to take small, manageable steps to help you be desensitized to what scared you. The goal is to resume the activity or behavior that was causing you panic.

Medications

Medications can help reduce physical symptoms of panic attacks, decrease your likelihood of experiencing an attack, and reduce the anxiety of having another panic attack. Commonly prescribed medications for panic disorder include:

• Selective serotonin reuptake inhibitors (SSRIs): This class of medications is the most commonly prescribed for anxiety and panic disorders. These medications prevent the reuptake of serotonin after it has been released, increasing available serotonin in the brain, which helps to regulate mood and decrease anxiety and panic. SSRIs are safe and have a low risk of serious side effects. Effective SSRIs for panic disorder include escitalopram (Lexapro), fluoxetine (Prozac), and sertraline (Zoloft).

• Serotonin and norepinephrine reuptake inhibitors (SNRIs): If SSRIs aren’t effective for you, you can try SNRIs, which improve symptoms of panic disorder by increasing available levels of the neurotransmitters serotonin and norepinephrine in the brain. Commonly prescribed SNRIs for panic disorder include venlafaxine (Effexor XR), duloxetine (Cymbalta), and desvenlafaxine (Pristiq).

• Benzodiazepines: Benzodiazepines can be especially effective for acute relief of panic attacks while they’re happening, or for help tolerating triggering situations like phobias. These medications are sedatives, meaning they are central nervous system depressants that inhibit or stop the fight-or-flight response that causes panic symptoms. Benzodiazepines that can help treat panic disorder include alprazolam (Xanax), clonazepam (Klonopin), and lorazepam (Ativan). However, because benzodiazepines can be habit-forming, they are not ideal for long-term use or for those with a history of drug or alcohol addiction or abuse.

There are other medications available to treat panic disorder, and sometimes a combination of multiple medications can be the most effective treatment for you. Some medications can take several weeks to reach full effectiveness, and some may have side effects that improve once your body gets used to them. Work closely with your doctor when beginning, taking, or tapering off of a medication in order to monitor side effects, effectiveness, and risks.

Home Remedies for Panic Disorder

In addition to psychotherapy and medication, certain lifestyle changes can help manage or improve panic disorder symptoms, including:

• Exercise: Exercise is an excellent way to release feel-good hormones called endorphins, and to help your body to metabolize and eliminate stress hormones like adrenaline and cortisol. In order to reap the benefits of exercise, try to get at least 150 minutes per week of moderate aerobic exercise like swimming or brisk walking, or 75 minutes per week of vigorous aerobic activity like running, dancing, or taking the stairs.

• Get enough rest: Sleep is crucial for a properly functioning nervous system, which controls anxiety levels and panic attacks. When you don’t get enough sleep, it’s much easier to succumb to anxious ways of thinking and to experience panic attacks.

• Eat well: Try to eat a healthy, balanced diet full of fruits, vegetables, whole grains, and lean proteins. This keeps your blood sugars stable, which is important because low blood sugar can cause feelings similar to panic, like shakiness, dizziness, anxiety, and sweating. Try to avoid stimulants like caffeine and sugar—these substances activate your sympathetic nervous system, which can trigger the fight-or-flight response, causing panic attacks or panic-like symptoms.

• Practice relaxation techniques: Meditation, progressive relaxation, mindfulness, and deep breathing exercises are excellent tools for preventing panic attacks, or for shortening their duration. It’s best to practice relaxation techniques when you’re relatively calm, so that they’ll be second nature when a panic attack begins.

• Avoid alcohol, caffeine, smoking, and recreational drugs: These substances can not only trigger attacks, they can also have negative interactions with any anti-anxiety medications you may be taking.

• Practice acceptance: It can be incredibly frustrating to deal with panic disorder, but feeling anger towards your mental health condition or resistance to your symptoms can make things worse. Instead of resisting a panic attack, remind yourself that accepting your experience, rather than fighting against it, can help resolve your symptoms.

Risk Factors for Panic Disorder

Certain experiences or traits can increase your risk of developing panic disorder. These include:

• Having a close family member who has anxiety, panic attacks, or panic disorder
• Experiencing major life stressors, like an illness or death of a loved one
• Experiencing a traumatic event, like a serious accident or sexual assault
• Having been physically or sexually abused when you were a child
• Major life changes, like a divorce or move
• Smoking, substance abuse, or excessive caffeine intake

Complications and Related Conditions for Panic Disorder

If untreated, panic disorder can cause other serious conditions or changes in behavior, including:

• Phobias like fear of driving or fear of flying
• Agoraphobia, the fear of leaving your home for any public place
• Health anxiety, meaning going to the doctor for frequent health concerns
• Avoidance patterns of certain places or situations where you’ve experienced panic or fear experiencing panic
• Depression or other types of anxiety disorders, like obsessive compulsive disorder or social phobias
• Alcohol or other substance abuse habits

When to Seek Help

While panic attacks aren’t dangerous, panic disorder does tend to worsen without treatment. If you’re experiencing what you think are panic attacks or panic disorder, it’s important to visit your primary care provider to ensure you don’t have a physiological condition with symptoms similar to panic disorder, like heart or thyroid problems.

How K Health Can Help

Anxiety and depression are among the most under-reported and under-treated diseases in America. Nearly 20% of adults in the US suffer from mental health illness and fewer than half receive treatment. Our mission is to increase access to treatment for those suffering in silence.

You can start controlling your anxiety and depression and get access to the treatment you need with K Health. Starting at $19/month get prescriptions for mental health medications plus unlimited doctor visits through the K Health app. Start your free assessment to see if you’re eligible.