Panic Disorder

Panic attacks and symptoms of panic disorder often occur suddenly, without warning, for no apparent reason. The symptoms people experience may resemble the body’s “fight or flight” response activated in a dangerous situation or could appear to be a physical condition, like a heart attack, causing shortness of breath and chest pain. However, unlike a healthy fight-flight-freeze response, a panic attack can cause these symptoms to occur for no reason, even during harmless or calm conditions. 

Panic attack symptoms

Symptoms of a panic attack may include the following: 

• Racing heartbeat
• Difficulty breathing
• Paralyzing terror
• Dizziness
• Trembling
• Sweating
• Lightheadedness
• Nausea
• Shaking
• Choking
• Chest pain
• Pins and needles feeling in fingers or toes
• A fear that you are about to die

Panic attacks are not dangerous, but they can be scary because the person may believe that they are “out of control.” When physical symptoms arise with panic disorder, panic attacks can seem like they will never end. These attacks may reach their peak within minutes but can last up to an hour or longer. 

Panic disorder usually starts in young adulthood and is more common in women than men. It is associated with a high risk of suicidal ideation and a decreased quality of life as the person may experience deficits in social and family life. While panic disorder is treatable, it can be challenging to do so as it usually has other comorbidities. People who comply with panic disorder treatment are more likely to recover without a relapse.

There are multiple theories about what causes panic disorder. Some clinical trials indicate that chemical imbalances are a significant factor, and genetic and environmental factors, including adverse childhood conditions and health topics, may also play a role in developing panic disorder. 

There may be a genetic predisposition to panic disorder. Some people with the condition report that a close family member has either panic disorder or other behavioral disorders. However, scientists have not identified a specific gene, and the inheritance pattern is unclear.

Some researchers have also discovered that certain parts of the brain and the body’s physical responses may play a role in panic attacks. Panic attacks may result from false alarms in the body’s survival instincts that are activated too strongly, too often, or both. 

Another possible cause for panic disorder is changes in neurotransmitter and peptide activity in the central nervous system. Some brain imaging studies have found changes in flow and receptor activity in various areas of the brain, including the amygdala, which is involved in memory, emotions, and the fight or flight response.

Panic disorder is highly treatable, particularly if an individual also receives treatment for comorbid mental health conditions. Treatment often involves a combination of therapy, medication, and self-care. 

Medication

Medication can help some people with panic disorder. Below are some of the types of medication that may be used: 

• Selective serotonin reuptake inhibitors (SSRIs): SSRIs are prescribed for panic disorder, and include medications such as fluoxetine, paroxetine, and sertraline.
• Serotonin and norepinephrine reuptake inhibitor (SNRI):  Venlafaxine is approved for the treatment of panic disorder. 
• Benzodiazepines: During a panic attack, a fast-acting benzodiazepine, like lorazepam or clonazepam, may help. These medications may be prescribed for a short period for the patient to take on an as-needed basis. These medications are habit-forming, have serious side effects, and can interact with other medications and substances such as alcohol.

It is important to consult with a doctor or medical professional before beginning or changing any medication plan. The information provided in this article is not intended as medical advice; please consult a qualified healthcare professional for personalized guidance.   

Self-care

Recent research shows that engaging in self-care can improve mental health. Below are ways to get started: 

• Exercise regularly.
• Eat regular healthy meals and stay hydrated.
• Prioritize sleep.
• Make time for relaxing activities like breathing exercises, meditation, journaling, or yoga.
• Attend support groups to build community. 
• Stay positive by recognizing and challenging negative thoughts. 
• Stay connected to friends and family and reach out for support.

Relaxation techniques may help an individual with panic disorder cope with and get through a panic attack. These techniques can engage the body’s relaxation response, which may lower blood pressure, slow breathing, and lower heart rate. These physical responses are the opposite of the body’s stress response, which can help when someone is experiencing a panic attack. 

Relaxation techniques that may be useful for people with panic disorder include the following: 

• Progressive relaxation: This practice involves the controlled tensing of different muscles in the body before systematically releasing the tension. 
• Guided imagery: Also called visualization, this practice involves picturing scenes, events, or images that bring about calmness or relaxation to relax the body.
• Breathing exercises: Breathing exercises, such as taking timed deep breaths, have been proven to improve mental health and regulate the nervous system. 

Therapy is an effective treatment for panic disorder, and there are many ways to find a qualified therapist. Online therapy through a platform like BetterHelp can be an effective option for people who are afraid to leave the house or prefer not to meet with a therapist face to face. 

The Anxiety and Depression Association of America (ADAA) has numerous resources for people with panic disorder, including webinars, videos, blogs, and stories from people sharing their experiences. The ADAA also has information about various support groups, including online and in-person. 

If you’re looking for resources about relaxation techniques to help with panic disorder or panic attacks, the National Center for Complementary and Integrative Health offers a wealth of information, including links to research, ways to find a doctor, and explanations about how certain techniques can help.

For help with substance use, contact SAMHSA’s National Helpline at 1-800-662-HELP (4357).

For those with thoughts of suicide, contact 988 Suicide & Crisis Lifeline at 988. Please also see our Get Help Now page for more immediate resources.

Recent research has found that psychotherapy for panic disorder is not only effective but also has long-lasting results. This study looked at the long-term effects of therapy for panic disorder and how the outcome was affected by allowing patients to choose the type of therapy for their treatment. Participants were given a choice between psychodynamic therapy (PDT) and CBT. Half of the participants could select their own treatment, while the other half were randomly assigned to a treatment type. 

Researchers hypothesized that the people who could choose their treatment would have better results, but the results showed otherwise. Participants who decided PDT had better outcomes than those assigned to it, but those randomly assigned to CBT had better outcomes than those who chose it. Researchers are unsure about the cause of these specific results. However, this study found that two years after treatment, 70% of patients clearly improved, and 45% had decreased symptoms after 12 weeks of treatment. 

Another study on therapy and panic disorder showed impressive results in an even shorter time frame. A concentrated exposure-based treatment involving CBT delivered over four consecutive days significantly reduced panic disorder symptom severity. Post-treatment, 80% of patients met the criteria for remission; at follow-up, the rate was 86.7%. Participants were satisfied with their treatment, and no one dropped out of the study.

Below are several statistics about panic disorder: 

• About 2% to 3% of Americans live with panic disorder every year, and it is twice as common in women. 
• Panic disorder has a substantial comorbidity with other forms of mental illness. Between 50% and 65% of people with panic disorder also have major depressive disorder, and about 30% to 50% have agoraphobia.³
• Genetics may play a role in the development of panic disorder. First-degree relatives of someone who has been diagnosed with panic disorder have a 40% chance of developing the condition.
• Panic disorder is highly treatable, but successful treatment often relies heavily on adherence. About 60% of people with panic disorder who are in treatment achieve remission within six months.