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Panic disorder is defined as recurring panic attacks or episodes of intense fear accompanied by an array of physical symptoms that strike often and without warning, even during sleep. Mercifully, panic attacks tend to be brief, usually lasting a few minutes, although in rare instances, they can persist for an hour or more. For reasons as yet unclear, panic disorder is twice as common in women as in men and afflicts 3 million to 6 million Americans. The disorder usually begins in young adulthood but can strike at any age.
Symptoms
According to American Psychiatric Association's official diagnostic manual, DSM-IV, a panic attack includes four or more of the following symptoms:
- Pounding heart or palpitations
- Sweating
- Trembling or shaking
- Sensations of shortness of breath or smothering
- Feeling of choking
- Chest pain or discomfort
- Nausea or abdominal distress
- Feeling dizzy, lightheaded or faint
- Feelings out of touch with reality
- Fear of losing control or going crazy
- Fear of dying
- Numbness or tingling sensations
- Chills or hot flushes
An isolated panic attack is probably nothing to worry about. But recurring episodes can cause considerable disability and should be investigated by a psychiatrist or another physician skilled at identifying and helping people with anxiety disorders. Without treatment, people with panic disorder may develop a fear of supermarkets, public transportation, parties, restaurants or other places or situations in which they have experienced previous panic attacks.
In about one-third of cases, these irrational fears progress to agoraphobia, or the fear of being in a place or situation from which escape might be difficult or embarrassing. Some agoraphobics are afraid to leave home or other familiar surroundings. In many cases, early diagnosis and treatment can alleviate panic symptoms before agoraphobia has a chance to develop.
Treatments
According to research, at least 70 percent of people with panic disorder can be helped by cognitive-behavioral psychotherapy, medications or a combination of both. Among those who respond to treatment, significant improvement is usually seen within six to eight weeks.
Cognitive-behavioral psychotherapy operates under the theory that panic attacks are basically a learned response to something the patient is afraid of. Therapy sessions focus on helping the patient "unlearn" those physical reactions. The therapist may suggest certain relaxation techniques, such as slow, controlled breathing, to refocus attention when panic begins to rise. The therapist might also offer a reality check by pointing out, for example, that a slightly elevated heart rate cannot cause a heart attack. Aside from the therapeutic exercises, talking things out during therapy sessions can be extremely beneficial to patients as they combat panic disorder.
Like cognitive-behavioral psychotherapy, medications such as benzodiazepines, monoamine oxidase inhibitors, selective serotonin reuptake inhibitors and tricyclic antidepressants have been shown to reduce the frequency and severity of panic attacks.
 Children, teens and adults being treated with antidepressants, particularly people being treated for depression, should be watched closely for worsening of depression and for increased suicidal thinking or behavior. Close watching may be especially important early in treatment or when the dose is changed - either increased or decreased. Bring up your concerns immediately with your doctor.
Paxil may increase the risk for birth defects, particularly heart defects, when women take it during the first three months of pregnancy, according to a 2005 advisory from the Food and Drug Administration (FDA). The FDA is waiting for the results of recent studies to better understand the higher risk. Discuss with your doctor about the health risks of Paxil if you plan to become pregnant or are in the first three months of pregnancy. You may want to consider taking a different antidepressant. Do not stop taking the drug without first talking to your doctor.
This article was reviewed and updated June 2007.
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