Panic Disorder

Characterized by recurrent and unpredictable episodes of intense apprehension, terror, and impending doom, panic disorder represents anxiety in its most severe form. Initially unpredictable, these "panic attacks" may come to be associated with specific situations or tasks. The disorder may exist concurrently with agoraphobia (an irrational fear of being in places where the person may feel trapped or unable to escape), leading to restrictions in the person's lifestyle.

Panic disorder typically has an onset in late adolescence or early adulthood, often in response to a sudden loss. The first attack usually occurs outside the home. It also may be triggered by severe separation anxiety experienced during early childhood. Without treatment, panic disorder can persist for years, with alternating exacerbations and remissions.

Causes

The etiology of panic disorder is unknown but may have a genetic predisposition, involve autonomic responses, and be related to social learning. Like other anxiety disorders, panic disorder may stem from a combination of physical and psychological factors.

Panic disorder is associated with increased noradrenergic discharge; serotonin has been implicated. The individual appears to have a heightened sensitivity to somatic symptoms, triggering the autonomic system and setting off a panic attack.

Signs and symptoms

Symptoms of a panic attack, which often last about 10 minutes, include:

• Difficulty breathing.
• Headache
• Pounding heart or chest pain.
• Chills or hot flashes.
• Dizziness
• Intense feeling of terror.
• Abdominal cramping
• Chest pain
• Tingling or numbness in the fingers and toes.
• A fear that you are losing control or are about to die.

Other health problems - such as an impending heart attack, an overactive thyroid gland (hyperthyroidism) or drug withdrawal - can cause similar signs and symptoms.

Treatment

Tricyclic antidepressants, imipramine, and clomipramine benefit 75% to 90% of panic disorder patients when given in low doses initially. Selective serotonin re-uptake inhibitors are also affective and have fewer adverse effects. Monamine oxidase inhibitors are particularly helpful for individuals with comorbid features of atypical depression (hypersomnia and weight gain). Anti-anxiety agents take 2 to 6 weeks to become effective. Benzodiazepines such as alprazolam are useful for immediate relief but are dependance-prone.

Early psychotherapeutic intervention (such as deep breathing) and education about physiologic changes enhance the effectiveness of pharmacologic treatments.

Prevention

Panic disorder cannot be prevented, however, there are some things you can do to reduce stress and decrease symptoms by doing some exercise daily and eat a healthy, balanced diet.

Avoid stimulants such as caffeine and cocaine and avoid alcohol use if you are prone to panic attacks.