Skip navigation
MedlinePlus Trusted Health Information for You U.S. National Library of MedicineNational Institutes of Health
Contact Us FAQs Site Map About MedlinePlus
español Home Health Topics Drugs & Supplements Medical Encyclopedia Dictionary News Directories Other Resources

 

Medical Encyclopedia

Other encyclopedia topics:  A-Ag  Ah-Ap  Aq-Az  B-Bk  Bl-Bz  C-Cg  Ch-Co  Cp-Cz  D-Di  Dj-Dz  E-Ep  Eq-Ez  F  G  H-Hf  Hg-Hz  I-In  Io-Iz  J  K  L-Ln  Lo-Lz  M-Mf  Mg-Mz  N  O  P-Pl  Pm-Pz  Q  R  S-Sh  Si-Sp  Sq-Sz  T-Tn  To-Tz  U  V  W  X  Y  Z  0-9 

Panic disorder

Printer-friendly versionEmail this page to a friend
Contents of this page:

Alternative Names   

Panic attacks

Definition    Return to top

Panic disorder is an anxiety disorder that causes repeated, unexpected attacks of intense fear. These attacks may last from minutes to hours.

See also: Generalized anxiety disorder

Causes    Return to top

The exact cause of a panic disorder is unknown. Genetics may play a role in this disorder. Studies suggest that if one identical twin has panic disorder, 40% of the time, the other twin will also develop the condition. However, panic disorder also often occurs in family members who are not blood relatives.

Panic disorder occurs twice as often in women as in men. A person with panic disorder often lives in fear of another attack and may be afraid to be alone or to be far from medical help.

Symptoms usually begin before age 25. Although panic disorder may occur in children, it is often not diagnosed until they are older. People with this condition often have medical tests and exams for symptoms related to heart attack or other conditions before a diagnosis of panic disorder is made.

Symptoms    Return to top

With panic disorder, at least four of the following symptoms suddenly occur within 10 minutes. Attacks may be followed by at least 1 month of persistent fear of having another attack.

There are often extreme changes in behavior at home, school, work, or with family. People with the disorder often worry about the significance of their panic attacks. They may think they are "going crazy" or having a heart attack.

Exams and Tests    Return to top

A health care provider will perform a physical examination, including blood tests and a psychiatric evaluation. Underlying medical disorders must be ruled out before the diagnosis of panic disorder can be made.

Disorders related to substance abuse should also be considered, because some can mimic panic attacks. Substance abuse may result when individuals with panic attacks try to cope with fear by using alcohol or illegal drugs.

Cardiovascular, endocrine, respiratory, and neurologic disorders may be suspected, and can be present at the same time as panic disorders. Specific diagnostic tests will vary between individuals and will be based on the symptoms.

Many people with panic disorder first seek treatment in the emergency room, because the panic attack feels like a heart attack.

Treatment    Return to top

Anti-anxiety medications, antidepressants, and cognitive behavioral therapy (working with a therapist) have been successfully used to treat panic disorders. The medications act on the central nervous system to reduce anxiety and related symptoms.

A commonly-used class of anti-anxiety medications is benzodiazepines, including aprolazam (Xanax). However, this class of medications is associated with dependence and addiction. Ideally, these drugs are used only on a temporary basis.

Drugs from a class of antidepressant called SSRIs (selective serotonin reuptake inhibitors) are the most commonly used medications for panic disorder. They include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), fluvoxamine (Luvox), cetalopram (Celexa), and escitalopram (Lexapro). If these do not help, longer-term use of benzodiazepines may be considered if the person does not have a history of drug dependence and tolerance.

The monoaxmine oxidase inhibitors (MAOIs) such as phnelzine (Nardil) tranylcypramine (Parnate), and isocarboxazid (Marplan) are only used when all the other drugs don't work. MAOIs are the most effective medications for panic disorder, but they have serious side effects and interactions with other drugs and foods. They should only be prescribed by a psychiatrist who is experienced in their use.

Behavioral therapies should be used together with drug therapy. These include cognitive-behavioral therapy, exposure, relaxation techniques, pleasant mental imagery, and cognitive restructuring (learning to recognize and replace panic-inducing thoughts). Behavioral treatment appears to have long-lasting benefits.

Regular exercise, adequate sleep, and regularly scheduled meals may help reduce the frequency of the attacks. Caffeine and other stimulants should be reduced or eliminated.

Outlook (Prognosis)    Return to top

The disorder may be long-lasting and difficult to treat. Although some people with this disorder may not be cured with treatment, most can expect rapid improvement with drug and behavioral therapies.

Possible Complications    Return to top

Possible complications of this condition include avoiding situations or places that might bring on an attack, and an increased likelihood for other anxiety and mood disorders.

Dependence on anti-anxiety medications is a possible complication of treatment. Dependence involves needing a medication to be able to function and to avoid withdrawal symptoms. It is not the same as addiction, which involves the uncontrolled use of a substance despite negative results. Dependence and addiction often occur together, but dependence itself is not always a problem.

When to Contact a Medical Professional    Return to top

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

Prevention    Return to top

Avoid stimulants such as caffeine and cocaine and avoid alcohol use if you are prone to panic attacks. These substances may induce or worsen the symptoms.

References    Return to top

Bandelow B, Seidler-Brandler U, Becker A, Wedekind D, Ruther E. Meta-analysis of randomized controlled comparisons of psychopharmacological and psychological treatment of anxiety disorders. World J Biol Psychiatry. 2007;8(3):175-87.

Bandelow B, Zohar J, Hollander E, Kasper S, Moller HJ. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the pharmacological treatment of anxiety, obsessive-compulsive and posttraumatic stress disorders. World J Biol Psychiatry. 2002;3(4):171-199.

Fava GA, Rafanelli C, Grandi S, et. al. Long-term outcome of panic disorder with agoraphobia treated by exposure. Pyschol Med. 2001;31(5):891-8.

Katon WJ. Clinical Practice. Panic disorder. N Engl J Med. 2006;354(22):2360-7.

Smoller JW, Pollack MH, Wassertheil-Smoller S, et al. Panic attacks and risk of incident cardiovascular events among postmenopausal women in the Women's Health Initiative Observational Study. Arch Gen Psychiatry. 2007;64(10):1153-60.

Update Date: 5/19/2008

Updated by: Timothy A. Rogge, MD, private practice in Psychiatry, Kirkland, WA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M. Logo

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 1997-2008, A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.