Panic Disorder

Comfort During a Panic Attack
Comfort During a Panic Attack

The Good News About Panic Disorder

The panic disorder news is all good. The diagnosis has become straightforward by almost any medical professional. And, these clinicians not only know about panic disorder but also are very understanding and able to help if you’re having a panic attack. Both the approach to stop a panic attack and treatments to prevent panic attacks are well known. The medicines we have now are good and getting better. Therapies for panic disorder help a lot, so much so that one or another type of therapy is now built into any treatment plan. So whether your panic attacks are new or you’ve had them for a while, be encouraged. All is getting better. As always, we remain on your side to praise what works, debunk anything that doesn’t work, and encourage you to better health and better health care. So read on about panic disorder.

Before We Start On Definitions Here’s a Story About Someone’s First Panic Attack

A healthy and relatively calm woman is walking quickly down the stairs to the subway. Relatively calm, but she has just been through a tense interview for a new job. Suddenly she has a severe pain in her chest and feels dizzy. She grabs the metal stair rail, feeling nauseated, and then her vision goes strange. Everything seems to look small and far away then everything starts to go black. She can’t catch her breath and starts to fall despite her death grip on the metal handrail. Thinking to herself as she sinks to the ground, “Oh, God, what’s happening, I must be dying, I must be having a heart attack, I’m dying of a heart attack”. She tries to fumble in her purse for her cell phone but can’t think and can’t see what she’s doing.

The Rest of the Story About Someone’s First Panic Attack

One of the people coming down the stairs sees her struggling, breathing hard, and sweating profusely. This Good Samaritan calls 911 and stays with her. Her chest pain has eased a bit but she says she can’t catch her breath. She’s still confused when the paramedics arrive. They get her into the ambulance and rush off to the Emergency Department. The medical tests begin. Three hours later she’s feeling better though still upset and shaken by the whole experience. The doctor comes in to talk with her. She says that the tests were all normal. She smiles at the woman and says, “You’ve had a panic attack.”

What Are The Symptoms of a Panic Attack and Panic Disorder?

The story above of the woman having her first panic attack provides a good description. A person having a panic attack is suddenly overcome with overwhelming anxiety and fear. Usually the attacks come “out of the blue” with no warning and no reason for being anxious. If there is some stress that might have caused it (in her case, maybe the job interview) it doesn’t feel like it directly caused the attack. The stress feels in the past, not something that would cause a big problem right now. The person feels like they have lost all control of themselves. Sometimes people feel terrified that they are going insane. Or, more common, the person might think they’re dying. The terror might be worse during the first several attacks.

They Become More Annoying Than Terrifying As Time Goes By

Often when the individual thinks back on the panic attack it doesn’t make sense. How did this happen, why did it happen? Perhaps they might even feel a bit silly. Winding up in the Emergency Department over panicking. But, in that moment of frightening terror it feels as if death or insanity or something is real and right now. Then, surviving the first few, there’s always the worry that there’ll be another attack. With medicine and therapy one learns how to manage through a panic attack. As they come under better control and understanding they start to feel more annoying than terrifying. Until, finally, they might just go away.

Physically, What Is Panic Disorder? What Are Panic Attacks?

There was a famous scientist in the 1920s, W. B. Cannon, that studied what a person’s (or an animal’s) body does when scared and ready to fight an enemy or run away. He called it the fight or run response. (Journalists changed it to the “fight or flight” response.) When threatened and needing to choose between fighting or running, stress hormones are blasted into the blood stream. Heart rate speeds up, the heart pounds, and breathing is fast. The body slows blood flow to the gut for digestion in order to instead push all the blood to the large muscles. The body is readied almost instantly for a maximal burst of physical energy. Just as with exercise, all this muscle tension makes heat. So the body sweats to get rid of the excess heat.

So A Panic Attack Readies You to Fight or Run from a Threat That Is Not There

A panic attacks seems to be a burst of all the energy that goes into W. B. Cannon’s fight or run response. But, it happens without a real enemy in front of you. The feeling of threat rises from somewhere deep within you and boom, the attack hits. Often the person is not aware of the source of this feeling of threat, just the panic attack reaction. Likely the sense of threat was from some previous time. And the threat feeling, for whatever reason, stayed buried until it surged up later as a panic attack.

Panic Disorder and Panic Attacks are Remarkably Frightening and Upsetting

Here’s the odd thing about panic disorder. It’s almost not possible to believe that the experience of a panic attack doesn’t hurt you. How can it feel so terrifying in the moment and yet medically not do any damage? The episode is so ghastly that people are not comforted to learn that a panic attack won’t kill you. Or, even harm you. But it is true that, frightening as they are, especially the first few attacks, one can eventually learn to control them and tolerate them. And it’s also true, and good news, that they are not medically dangerous. Once a person understands the panic attacks and has had a few attacks they can become less frightening. Each attack does go away at some point without any help. Even though you might go to an Emergency Department with the first few. 

Well, Okay, Yes, But… They Scare Me to Death! – Panic Disorder

Well, yes, it’s unfortunate, but it’s not so simple as, “Okay, now I get it.” Despite a person having had panic attacks and knowing what’s happening, no one wants to have one. Most certainly no one wants to have one in a public place or while driving. This fact means that the person with untreated panic disorder tends to go out less, to socialize less, and starts to become a loner. They might narrow life to only going to work or school. Other joys of social life might shrink. Without proper treatment having panic disorder can easily become socially crippling.

Official Diagnosis of Panic Disorder

Doctors in the U.S. use the DSM 5 as the guide to diagnose panic disorder. (DSM 5 is the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition). In DSM 5 panic disorder has the diagnosis code number 300.01.  Here’s a link to a Medscape page that lists the specific signs and symptoms used diagnose it.

How Panic Disorder Is Usually Treated

The silver lining to this panic disorder cloud is that there are many good treatments for panic disorder. (For a more complete discussion see our free page on Panic Disorder Treatment.) There are a whole variety of therapies that don’t involve medicines and several good medicines that help a lot. There are a few medicines that people carry with them in case they feel an attack coming on or have a panic attack. But just a medicine by itself is not that helpful in the long run. The best treatment is a good doctor-prescribed medicine along with being in one of the really good therapies.

The Medicines for Panic Disorder

The medicines typically tried first are from a family of medicines that usually come to mind for treating depression, the SSRIs (selective serotonin reuptake inhibitors). Panic disorder is not depression and most people with panic disorder are not depressed. It just so happens that these medicines work for both. Another family of medicines that was originally developed for depression, the “tricyclics” or TCAs, also at times work really well for panic disorder. Finding the best medicine depends both on how well a medicine works and its side effects.

More Medicines for Panic Disorder

There’s also a group of medicines that come to mind for anxiety. These are popular medicines with familiar names (like Valium, Xanax, and Ativan) that are used just to relieve here-and-now anxiety but they might not work as well or be as safe for ongoing, long-term use. The medical concern with them is a risk of abuse and addiction. There are some people who become badly trapped by needing to use these medicines.

Educational Therapy – Psychotherapy – Behavioral Therapy

Many People Like the Therapies

All sorts of excellent therapies are available to help treat panic disorder. Over time these therapies help people to have fewer and fewer, and less and less severe, panic attacks.  And, when they do feel a bit of a panic the attack is milder. There are “tricks and tips”, special ways of doing things, that when learned, practiced, and used can be really helpful to make panic attacks less frequent and less severe. One popular therapy is CBT, or Cognitive Behavioral Therapy. It’s popular because it often works well and is easy to follow. It’s a therapy that’s makes rational sense to many people who see themselves as reasonable and logical and don’t want “psychotherapy”. Then there are relaxation skills, supportive group therapy, and individual interpersonal psychotherapy. Try more than one method, find what helps you the most, and make it yours.

Helpful links:

National Institute of Mental Health on Panic Disorder

Medline Plus on Panic Disorder  

Anxiety and Depression Association of America on Panic Disorder

The Mayo Clinic on Panic Attacks and Panic Disorder

American Psychological Association with Answers to Your Questions about Panic Disorder

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