Panic Disorder

Understand what causes panic attacks and how to prevent and stop them.

What is panic disorder?

Pro Tip

A panic disorder is a type of anxiety disorder, which I think of as the common cold of mental health. It feels terrible—like you are having a heart attack and dying. But you are not in danger. And it is treatable. —Dr. Bobbi Wegner

Panic disorder is a type of anxiety disorder where you have repeated bouts of intense anxiety, called panic attacks. A panic attack feels like you are losing control or are dying. You may notice physical sensations like sweating, difficulty breathing, a warm feeling in your body, or chest pain.

At the same time, you are constantly worried about getting a panic attack. This fear can get in the way of your daily routines. Some people want to stay home because they are scared they will have an attack. It affects both children and adults, and is twice as common in women than men. Medication and psychotherapy can help.

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What are panic disorder symptoms?

The most common symptoms of panic disorder include intense anxiety (a panic attack) that occurs repeatedly over time. You may feel your chest tighten, have rapid breathing, shortness of breath, and tingling in your fingers. It often feels like it happens out of the blue, but may be triggered by situations that make you anxious. The first few minutes are the most intense.

But not everyone who has panic attacks develops panic disorder. A panic disorder means your life has been significantly affected for at least one month. This includes worrying about attacks happening again and/or changing your behavior to prevent them. You may do this by avoiding exercise, trying not to leave home, and limiting what you eat.

Main symptoms of a panic attack

You may have just a few of these symptoms or several.

  • Chest tightness, like feeling like you’re having a heart attack
  • Rapid breathing and shortness of breath
  • Increased heart rate or feeling like your heart is pounding
  • Tingling in your fingers
  • Feeling like you are dying or losing control
  • Feeling detached (disconnected) from reality or from yourself (like you’re outside your body)
  • Nausea or upset stomach
  • Temperature changes—like chills or feeling waves of heat
  • Difficulty breathing, feeling out of breath
  • Dizziness or lightheadedness, feeling like fainting
  • Headache
  • Shakiness
  • Sweating
  • Throat tightness
  • Difficulty falling asleep and staying asleep

What causes panic disorder?

Panic disorder occurs because of a combination of genes and environmental factors, like stressors or traumatic life experiences. Your genetics might affect parts of the brain that process anxiety.

For example, the brain may misinterpret a harmless sensation or stimulus as a danger. It then sends signals to increase your heart and breathing—to put you on alert—when it doesn’t need to. Also, negative thinking (where you always assume the worst) can lead to panic disorder.

Not all anxious people get panic attacks, but the more anxious you are, the more likely you are to get them. Think of panic as extreme anxiety that happens in one big burst. Bringing down your baseline anxiety is really important so when you (naturally) become anxious about something, you don't tip the scale into panic mode.

Dr. Rx

Patients always say, My panic attack came out of the blue. I know it feels that way, but there is always a trigger to that intense response. It could be a thought, something you notice in the environment, or something you are not even aware of. A big part of the treatment is learning to understand your particular triggers. —Dr. Wegner

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Panic disorder treatments

Pro Tip

Panic Disorder is more common than you think. And since it feels like a heart attack, before you jump into treatment talk with your doctor to rule out any cardiovascular issues. —Dr. Wegner

The best treatment for panic disorder is dealing with the underlying anxiety through a combination of regular meditation (to reduce everyday anxiety), exercise, talk therapy, and possibly medication.

Panic attacks can be triggered by many medical conditions—like arrhythmias, pulmonary diseases, neurologic diseases, and endocrine (hormonal) abnormalities. So it’s important to discuss with your doctor if you need to be checked for these diseases.

Psychotherapy

Talk therapy with a trained professional can be helpful. Cognitive behavioral therapy (CBT) is a type of therapy with a lot of research backing it up. You learn to understand what is triggering the panic attacks, how to change unhelpful thoughts, and notice the signs of it building.

There are exercises that help you deal with the physical feelings that you experience during panic attacks (such as shortness of breath). Practicing helps you feel less scared when you get those feelings in the future.

Medications

There are several medications for panic disorder. They have different side effects. Your doctor will choose the one that is the best fit for you. Always take medications as prescribed. Let your doctor know about any side effects. Research shows that people who stop taking medications without their doctor’s okay often start to have panic attacks again.

  • Antidepressants: Most antidepressants are effective for panic disorder. You usually have to take them for several weeks before they start to work. And it may take up to 2-3 months of daily use.
    • Selective serotonin reuptake inhibitors (SSRIs): escitalopram (Lexapro) or sertraline (Zoloft)
    • Serotonin-norepinephrine reuptake inhibitors (SNRIs): venlafaxine (Effexor)
  • Benzodiazepines: These work to reduce anxiety right away when you have a panic attack. But they can make you tired. With long-term use, you could get dependent on them. They are often prescribed for a short period of time while waiting for the antidepressant to take effect.
    • Lorazepam (Ativan)
    • Alprazolam (Xanax)
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What to do if you’re having a panic attack

Trust this will pass. Panic is like a wave. It hits a peak and then comes down. Fighting it often makes it worse. Find a comfortable area, try to slow your breathing (although this might be difficult), and know your job is to ride this tough wave and let it pass on its own.

Panic attacks can mimic symptoms of a heart attack or asthma attack. So if you have chest pain or difficulty breathing, call 911 or go to the ER to make sure it’s nothing more serious.

If you have repeated panic attacks, see a mental health professional. They will do a thorough medical and psychological evaluation. Then, together you will create a treatment plan. The best treatment is dealing with the underlying anxiety through a combination of regular meditation (to reduce everyday anxiety), exercise, talk therapy, and possibly medication.

Panic attacks can be triggered by many medical conditions—like arrhythmias, pulmonary diseases, neurologic diseases, and endocrine (hormonal) abnormalities. Discuss with your doctor about checking for these diseases.

Preventative tips

A few changes to your lifestyle can help reduce panic attacks (and even other forms of anxiety).

  • Avoid alcohol and other drugs. Alcohol, tobacco/nicotine, and other drugs may help you feel less anxious in the short-term, but they can worsen symptoms overall. Sometimes people may drink alcohol to help them fall asleep, but this often makes sleep worse and can cause you to wake up and have a panic attack out of the blue.
  • Get enough sleep. Being tired greatly affects mood and anxiety levels. Try to go to sleep at the same time each night. Avoid caffeine and big meals before bed. Stop looking at bright screens at least an hour before bed. Keep your bedroom quiet and comfortable.
  • Stay physically active. Exercise at least 3 times per week. Yoga can be good for calming the body and mind.
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