Panic Disorder

Panic Attack

A panic attack is a sudden surge of overwhelming anxiety and fear that can happen to anyone at any time during a normal activity, such as going to work or to a store, riding in an elevator or watching TV. They can even occur when a person is asleep. 

After onset, most panic attacks peak after 10 to 20 minutes, but the episode can last for as long as an hour or more. At least 20% of Americans will suffer from a panic attack at some point in their lives and it may be a one-time occurrence. Women are twice as likely to experience them as men.

A panic attack can result from the stress of a life-changing event, such as the loss of a loved one, a job or relationship change, having a baby, etc.


Someone who is suffering a panic attack may believe he is having a heart attack and may seek medical treatment, because the symptoms of both are similar. He may have chest pain, shortness of breath and a pounding or racing heart. This is because when facing stressful situations, the body releases adrenalin to fuel the "fight or flight" impulse. This causes several changes in the body. It speeds up breathing and heart rate to take in more oxygen so the body can convert more sugar into energy to confront or escape from danger. The senses also become more acute, muscles can become tense and stiff, the digestion slows and perspiration increases. 

Other symptoms include:

  • Dizziness or Lightheadedness
  • Feeling out of control
  • Nausea
  • Shaking
  • Feeling disconnected from reality
  • Tingling sensations
  • Fear of impending doom or dying
  • Feeling of choking
  • Excessive sweating, hot flashes or chills

Panic Disorder

Panic Disorder can develop when a person who experiences multiple panic attacks or begins to fear having another attack (anticipatory anxiety). These attacks can have lasting effects that may interfere with work, family obligations and social situations. For example, people with panic disorder may associate their panic attacks to situations, objects or locations where their previous attacks have occurred. This may cause them to have anxiety about normal activities, such as grocery shopping or driving.

Panic Disorder with Agoraphobia

Some people with panic disorder may develop agoraphobia, which is the intense fear of situations and places that they think might lead to another panic attack. Home becomes a safe haven from the embarrassment of having a panic attack in a public place, or being in a place where help may not be available.


Panic disorder may occur as a result of another disorder, such as a social phobia, schizophrenia, and post traumatic stress disorder (PTSD) or depression. Genetics have been shown to be a factor as it may be passed down by a parent. Certain drugs can cause panic attacks, too. Abuse of drugs and alcohol can contribute to panic disorder and people with chronic pain are prone to panic attacks, although it is unclear whether it is due to the anxiety caused by pain or the medication they are using to treat it.


Before a panic attack can be diagnosed, a physician will order blood tests and x-rays to rule out other medical conditions which can cause panic attack symptoms, such as: heart attack, mitral valve prolapse, hyperthyroidism, hypoglycemia or stimulant drugs.


Once a physical cause is ruled out, the individual and practitioner can discuss the severity of the condition. In many cases medication is used along with cognitive-behavioral therapy. Medication may be prescribed to help with anxiety. Cognitive behavior therapy helps panic attack sufferers recognize irrational fears and how to deal with them. 

Cognitive Behavior Therapy 

Cognitive behavior therapy is used to help clients learn how negative thoughts (cognitions), contribute to anxiety. Behavior therapy helps clients learn how to respond to anxiety-causing situations or physical sensations, by replacing them with healthier behaviors. 

Exposure therapy helps clients cope with situations that are causing panic attacks. For example, if someone has had a panic attack in an elevator, he may relate the attack to going into an elevator. The panic attack has now been erroneously connected to the elevator, but it doesn’t guarantee a panic attack will not happen elsewhere. So, avoiding elevators does not eliminate the possibility of having another panic attack. Cognitive behavior therapy is used to help the individual disconnect an attack with a place. It also helps individuals deal with intervals of being in situations that cause anxiety for gradually longer periods of time.

Lifestyle Changes

Reducing stress through exercise and deep breathing; eating healthy and getting adequate sleep all can help reduce panic attacks.


Below are different types of drugs that may be used in combination with psychotherapy to help control symptoms.

  • Antidepressant Drugs
  • Selective Serotonin re-uptake inhibitors (SSRIs)
    These are the most commonly prescribed medications used for anxiety disorders. SSRIs work by regulating the activity of Serotonin, a neurotransmitter which is a chemical substance that carries messages between nerve cells. Serotonin affects mood, sleep, temperature, learning, memory, social behavior and several other functions. SSRIs correct serotonin imbalances by reducing the re-uptake (re-absorption) of serotonin into the brain and enabling it to build up. Increasing the level of serotonin in the brain increases brain activity, which in turn boosts mood in people with OCD, depression, and some types of anxiety disorders. Examples of SSRI antidepressants include:
    • Citalopram (Celexa);
    • Escitalopram (Lexapro, Cipralex)
    • Paroxetine (Paxil, Seroxat) – Also used to treat panic disorder, OCD, social anxiety disorder, generalized anxiety disorder and PTSD;
    • Fluoxetine (Prozac)– Also used to treat OCD, bulimia, and panic disorder.
    • Fluvoxamine (Luvox)–Although primarily used in the treatment of OCD, a doctor may prescribe it for depression.
    • Sertraline (Zoloft, Lustral)– Also used to treat panic disorder, OCD, PTSD, social anxiety disorder, premenstrual dysphoric disorder.
  • Serotonin-norepinephrine re-uptake inhibitors (SNRIs)
    These medications influence the activity of brain chemicals (neurotransmitters) thought to play a role in anxiety disorders. They work by increasing the levels of the neurotransmitters serotonin and norepinephrine by blocking their re-absorption into cells in the brain. Examples of  antidepressants include:
    • Desvenlafaxine (Pristiq): Similar to Venlafaxin;
    • Duloxetine (Cymbalta):
    • Venlafaxine (Effexor): Also used to treat generalized anxiety disorder, panic disorder and social anxiety disorder.
  • Anti-anxiety Drugs
  • Benzodiazepines
    Examples include lorazepam (Ativan), diazepam (Valium), chlordiazepoxide (Librium) and alprazolam (Xanax). This class of drugs is frequently used for short-term management of anxiety. Benzodiazepines are effective in promoting relaxation and reducing muscular tension and other physical symptoms of anxiety. Long-term use may require increased doses to achieve the same effect, which may lead to problems related to tolerance and dependence. They can be habit forming and can cause a number of side effects, including drowsiness, reduced muscle coordination, and problems with balance and memory.