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Panic disorder

Panic attacks; Anxiety attacks; Fear attacks; Anxiety disorder - panic attacks

Panic disorder is a type of anxiety disorder in which you have repeated attacks of intense fear that something bad will happen.

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Causes

The cause is unknown. Genes may play a role. Other family members may have the disorder. But panic disorder often occurs when there is no family history.

Panic disorder is twice as common in women as it is in men. Symptoms often begin before age 25 but may first occur in the mid-30s. Children can also have panic disorder, but it is often not diagnosed until they are older.

Symptoms

A panic attack begins suddenly and most often peaks within 10 to 20 minutes. Some symptoms continue for an hour or more. A panic attack may be mistaken for a heart attack.

A person with panic disorder often lives in fear of another attack, and may be afraid to be alone or far from medical help.

People with panic disorder have at least 4 of the following symptoms during an attack:

• Chest pain or discomfort
• Dizziness or feeling faint
• Fear of dying
• Fear of losing control or impending doom
• Feeling of choking
• Feelings of detachment
• Feelings of unreality
• Nausea or upset stomach
• Numbness or tingling in the hands, feet, or face
• Palpitations, fast heart rate, or pounding heart
• Sensation of shortness of breath or smothering
• Sweating, chills, or hot flashes
• Trembling or shaking

Panic attacks may change behavior and function at home, school, or work. People with the disorder often worry about the effects of their panic attacks.

People with panic disorder may misuse alcohol or other substances. They may feel sad or depressed.

Panic attacks cannot be predicted. At least in the early stages of the disorder, there is no trigger that starts the attack. Recalling a past attack may trigger panic attacks.

Exams and Tests

Many people with panic disorder first seek treatment at the emergency room. This is because the panic attack often feels like a heart attack.

Your health care provider will perform a physical exam and a mental health assessment.

Blood tests may be done. Other medical disorders must be ruled out before panic disorder can be diagnosed. Disorders related to substance use will be considered because symptoms can resemble panic attacks.

Treatment

The goal of treatment is to help you function well during everyday life. Using both medicines and talk therapy works best.

Talk therapy (cognitive-behavioral therapy, or CBT) can help you understand panic attacks and how to cope with them. During therapy, you will learn how to:

• Understand and control distorted views of life stressors, such as other people's behavior or life events.
• Recognize and replace thoughts that cause panic and decrease the sense of helplessness.
• Manage stress and relax when symptoms occur.
• Imagine the things that cause the anxiety, starting with the least fearful. Practice in real-life situations to help you overcome your fears.

Certain medicines, often also used to treat depression, may be very helpful for this disorder. They work by preventing your symptoms or making them less severe. You must take these medicines every day. Do not stop taking them without talking with your provider.

• Selective serotonin reuptake inhibitors (SSRIs) are most often the first choice of antidepressant.
• Serotonin-norepinephrine reuptake inhibitors (SNRIs) are another choice.

Other medicines used to treat depression or medicines used to treat seizures may also be tried.

Medicines called sedatives or hypnotics may also be prescribed.

• These medicines should only be taken under your provider's direction.
• Your provider will prescribe a limited amount of these medicines. They should not be used every day.
• They may be used when symptoms become very severe or when you are about to be exposed to something that always brings on your symptoms.
• If you are prescribed a sedative, do not drink alcohol while on this type of medicine.

The following may also help reduce the number or severity of panic attacks:

• Do not drink alcohol.
• Eat at regular times.
• Get plenty of exercise.
• Get enough sleep.
• Reduce or avoid caffeine, certain cold medicines, and stimulants.

Support Groups

You can ease the stress of having panic disorder by joining a support group. Sharing with others who have common experiences and problems can help you not feel alone.

Support groups are usually not a good substitute for talk therapy or taking medicine, but can be a helpful addition.

• Anxiety and Depression Association of America -- adaa.org/supportgroups
• National Institute of Mental Health -- www.nimh.nih.gov/health/publications/panic-disorder-when-fear-overwhelms

Outlook (Prognosis)

Panic disorders may be long-lasting and hard to treat. Some people with this disorder may not be cured. But most people get better when treated correctly.

People with panic disorder are more likely to:

• Misuse alcohol or use illegal drugs
• Be unemployed or less productive at work
• Have difficult personal relationships, including marriage problems
• Become isolated by limiting where they go or who they are around

When to Contact a Medical Professional

Contact your provider for an appointment if panic attacks are interfering with your work, relationships, or self-esteem.

If you or someone you know is thinking about suicide, call or text 988 or chat 988lifeline.org. You can also call 1-800-273-8255 (1-800-273-TALK). The 988 Suicide and Crisis Lifeline provides free and confidential support 24/7, anytime day or night.

You can also call 911 or the local emergency number or go to the hospital emergency room. DO NOT delay.

If someone you know has attempted suicide, call 911 or the local emergency number right away. DO NOT leave the person alone, even after you have called for help.

Prevention

If you get panic attacks, avoid the following:

• Alcohol
• Stimulants such as caffeine and cocaine

These substances may trigger or worsen the symptoms.

Related Information

References

American Psychiatric Association website. Anxiety disorders. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Text Revision (DSM-5-TR), Washington, DC: American Psychiatric Association Publishing; 2022.

Gehl C, Paulsen JS. Behavior and personality disturbances. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley and Daroff's Neurology in Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 9.

Lyness JM, Lee HB. Psychiatric disorders in medical practice. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 362.

National Institute of Mental Health website. Anxiety disorders. www.nimh.nih.gov/health/topics/anxiety-disorders. Updated April 2024. Accessed May 21, 2024.

Review Date: 5/4/2024  

Reviewed By: Fred K. Berger, MD, addiction and forensic psychiatrist, Scripps Memorial Hospital, La Jolla, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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