Panic Disorder

Panic Attack

A panic attack is a sudden wave of overwhelming fear and anxiety that can happen to anyone at any time during normal activity. Panic attacks can even occur when a person is asleep.

Most panic attacks peak after 10 to 20 minutes, but they can last for over an hour. At least 20% of Americans will suffer a panic attack at some point in their lives, and it can be a one-time event. Women are twice as likely as men to experience panic attacks.

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 suffers a panic attack may think they are having a heart attack and seek medical treatment because the symptoms of both are similar. They may have chest pain, shortness of breath and a throbbing or racing heart.

This is because in stressful situations, the body releases adrenaline to encourage the impulse "fight or flight." This causes several changes in the body. It speeds up breathing and heart rate to absorb more oxygen so that the body can convert more sugar into energy to face or escape the danger. Additionally, the senses sharpen, muscles become tense and stiff, digestion slows, and perspiration increases.

Other symptoms of a panic attack 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

A panic disorder can arise when a person experiences multiple panic attacks or begins to fear another attack (anticipatory attack). These attacks can have lasting effects that can affect work, family commitments and social situations. For example, people with panic attacks can associate their panic attacks with situations, objects or places where their previous attacks have occurred - this can cause fear of normal activities such as shopping at the grocery store or driving a car.

Panic disorder with agoraphobia

Some people with panic disorder may develop agoraphobia (an intense fear of situations and places that they think could lead to another panic attack). For such individuals, home becomes a safe haven from the embarrassment of having a panic attack in a public place or being in a place where help is unavailable.


Panic disorder can occur as a result of another disorder, such as social phobia, schizophrenia, post-traumatic stress disorder (PTSD), or depression. Genetics have been shown to be a factor, as panic attacks can be passed on from a parent.

Certain medications can also cause panic attacks. Drug and alcohol abuse can contribute to a panic disorder. People with chronic pain tend to have panic attacks, although it is unclear whether those attacks are caused by pain or the medications used to treat chronic pain.


Before a panic attack can be diagnosed, a doctor will order blood tests and x-rays to rule out other conditions that can cause symptoms of a panic attack (e.g., heart attack, mitral valve prolapse, hyperthyroidism, hypoglycemia, or stimulants).

Treatment options for panic disorder

Once a physical cause has been ruled out, the individual and the doctor can discuss the severity of the disease. In many cases, medication is used alongside cognitive behavioral therapy. Medicines can be prescribed to help with anxiety. Cognitive behavioral therapy helps sufferers of panic attacks to recognize and deal with irrational fears.

Cognitive behavioral therapy

Cognitive behavioral therapy is used to help clients learn how negative thoughts contribute to anxiety. Behavioral therapy helps clients learn how to respond to anxiety-inducing situations or physical sensations by replacing them with healthier behaviors. 

Exposure therapy helps clients cope with situations that cause panic attacks. For example, if someone has had a panic attack in an elevator, they can associate the attack with going into an elevator. Now, the panic attack has been mistakenly connected to the elevator, but it does not guarantee that a panic attack will not happen elsewhere. Thus, avoiding elevators does not rule out the possibility of another panic attack. Cognitive behavior therapy helps individuals separate an attack from a location and deal with intervals in which they find themselves in situations that gradually cause anxiety for longer periods of time.

Lifestyle Changes

Stress reduction through exercise and deep breathing, a healthy diet and sufficient sleep can help to reduce panic attacks.


Below are various types of medications that can be used in combination with psychotherapy to control symptoms.


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 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


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.

Examples include: 

  • Lorazepam (Ativan),
  • Diazepam (Valium), 
  • Chlordiazepoxide (Librium), and
  • Alprazolam (Xanax).