Panic Disorder

Overview

What is a panic attack?

A panic attack causes sudden, brief feelings of fear and strong physical reactions in response to ordinary, nonthreatening situations. When you’re having a panic attack, you may sweat a lot, have difficulty breathing and feel like your heart is racing. It may feel as if you’re having a heart attack.

Panic disorder can develop when you worry too much about having another panic attack or change behaviors to avoid having a panic attack.

How common are panic attacks?

Every year, up to 11% of Americans experience a panic attack. Approximately 2% to 3% of them go on to develop panic disorder.

Who might have panic attacks?

Anyone can experience a panic attack. These factors play a role:

  • Age: Panic attacks typically first occur during the teen or early adult years. But people of all ages, including children, can have panic attacks.
  • Gender: Women are twice as likely as men to develop panic disorder.

Symptoms and Causes

What causes panic attacks?

Experts don’t know why some people experience panic attacks or develop panic disorder. The brain and nervous system play key roles in how you perceive and handle fear and anxiety. Your risk of having panic attacks increases if you have:

  • Family history: Anxiety disorders, including panic disorders, often run in families. Experts aren’t sure why.
  • Mental health issues: People who have anxiety disorders, depression or other mental illness are more prone to panic attacks.
  • Substance abuse problems: Alcoholism and drug addiction can increase the risk of panic attacks.

What are the symptoms of a panic attack?

Panic attacks occur suddenly and without warning. There’s no way to stop a panic attack after it starts. Symptoms usually peak within 10 minutes after an attack starts. They disappear soon after. Signs of a panic attack include:

  • Chest pain.
  • Chills.
  • Choking or smothering sensation.
  • Difficulty breathing.
  • Fear of losing control.
  • Feeling like you’re going to die.
  • Intense feeling of terror.
  • Nausea.
  • Racing heart.
  • Sweating.
  • Tingling or numbness in fingers or toes.
  • Trembling or shaking.

Diagnosis and Tests

How are panic attacks diagnosed?

Serious health problems, such as heart disease, thyroid disease and respiratory problems, cause symptoms similar to panic attacks. Your healthcare provider may run tests to rule out a physical problem. If there’s no physical cause, your provider may make a diagnosis based on your symptoms and risk factors.

How is panic disorder diagnosed?

Medical or mental health providers can diagnose panic disorder. Your provider may diagnose panic disorder when you have repeated panic attacks and you:

  • Persistently worry about having more panic attacks or their consequences.
  • Obsess about losing control during a panic attack.
  • Change your behaviors to avoid situations that may trigger a panic attack.

Management and Treatment

How are panic attacks managed or treated?

Psychotherapy, medications or a combination are very effective at stopping panic attacks. How long you’ll need treatment depends on the severity of your problem and how well you respond to treatment. Options include:

  • Psychotherapy: Cognitive behavioral therapy (CBT) is a type of psychotherapy, or talk therapy. You discuss your thoughts and emotions with a mental health professional, such as a licensed counselor or psychologist. This specialist helps identify panic attack triggers so you can change your thinking, behaviors and reactions. As you start to respond differently to triggers, the attacks decrease and ultimately stop.
  • Antidepressants: Certain antidepressant medications can make panic attacks less frequent or less severe. Providers may prescribe serotonin selective reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs) or tricyclic antidepressants (TCAs). SSRIs include fluoxetine (Prozac®) and paroxetine (Paxil®). SNRIs include duloxetine (Cymbalta®) and venlafaxine (Effexor®). TCAs include amitriptyline (Elavil®) and doxepin (Sinequan®).
  • Anti-anxiety medications: Benzodiazepines are the most commonly prescribed anti-anxiety medication to treat and prevent panic attacks. They help with anxiety but have risks of addiction or dependence. These medications include alprazolam (Xanax®) and lorazepam (Ativan®).

What are the complications of panic attacks?

Panic attacks are highly treatable. Unfortunately, many people put off seeking help because they’re embarrassed. Untreated panic attacks or panic disorder can interfere with your ability to enjoy life. You may develop:

  • Anticipatory anxiety: The possibility of having a panic attack triggers extreme anxiety.
  • Phobias: A phobia is an extreme, unreasonable fear of something specific. For instance, acrophobia is a fear of heights, while claustrophobia is a fear of enclosed spaces.
  • Agoraphobia: Approximately two-thirds of people with panic disorder develop agoraphobia. This anxiety disorder makes you afraid to be in places or situations where a panic attack might happen. The fear can become so extreme that you become too afraid to leave your house.

Prevention

How can I prevent panic attacks?

Your healthcare provider can help you identify triggers that bring on panic attacks. During psychotherapy, you learn strategies to manage triggering events and prevent an attack. You can also take these actions to lower your odds of having a panic attack:

  • Cut back on caffeine.
  • Exercise regularly.
  • Eat a healthy diet.
  • Manage stress.
  • Talk to your doctor before taking herbal supplements or over-the-counter medications. Certain substances can increase anxiety.

Outlook / Prognosis

What is the prognosis (outlook) for people who have panic attacks?

With treatment for panic attacks, most people get better. Taking the positive step to seek treatment is key to stopping the attacks so that you can enjoy — and not fear — life.

Living With

When should I call the doctor?

Some panic attacks have signs that can be confused with a physical problem like a heart attack. If you have chest pain or trouble breathing or lose consciousness, seek emergency medical care.

You should call your healthcare provider if you have panic attacks and experience:

  • Chronic anxiety that interferes with daily life.
  • Difficulty concentrating.
  • Extreme irritability.
  • Fear of leaving your home (agoraphobia).
  • Panic attack symptoms that last longer than 15 minutes.
  • Sleep problems.

What questions should I ask my doctor?

If you have panic attacks, you may want to ask your healthcare provider:

  • Why am I having panic attacks?
  • What is the best treatment for panic attacks?
  • How long will I need therapy?
  • How long do I need to take medications?
  • Should I look out for medication side effects?

A note from Cleveland Clinic

Panic attacks can be extremely uncomfortable. Although they’re not physically harmful, they can take a toll on your mental health and stop you from doing the things you love. Don’t be embarrassed to tell your healthcare provider that you have panic attacks. Your provider can help you overcome fears and anxieties that trigger attacks. You can get better with treatments like psychotherapy and medications.

Last reviewed by a Cleveland Clinic medical professional on 08/12/2020.

References

  • American Association of Family Physicians. Accessed 8/13/2020.Panic Disorder. (https://familydoctor.org/condition/panic-disorder/)
  • Anxiety and Depression Association of America. . Accessed 8/13/2020.Panic Disorder (https://adaa.org/understanding-anxiety/panic-disorder)
  • Merck Manual. . Accessed 8/13/2020.Panic Attacks and Panic Disorder (https://www.merckmanuals.com/home/mental-health-disorders/anxiety-and-stress-related-disorders/panic-attacks-and-panic-disorder)
  • National Institute of Mental Health. . Accessed 8/13/2020.Panic Disorder: When Fear Overwhelms (https://www.nimh.nih.gov/health/publications/panic-disorder-when-fear-overwhelms/index.shtml)

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