Panic Disorder (101)

The Facts (3, 6)

Panic disorder is a type of anxiety disorder. People with this condition may become anxious to the extent that their feelings interfere with daily life. While most people have experienced a panic attack brought on by particular events or situations, the attacks in panic disorder often develop suddenly and for no apparent reason.

Panic disorder affects about 4% of Canadians, and is twice as common in women as in men. The disorder can appear at any age, but it most commonly appears in young adults.

The risk of developing a panic disorder is increased if there is a family history of panic attacks or disorders, a history of abuse, the experience of a traumatic event, the experience of high levels of stress, and the need to adapt to significant changes in your life.

Causes (6)

The exact cause of panic disorder is not entirely understood. However, researchers believe that panic disorder may be due to chemical imbalances in the brain. Panic disorder also tends to run in families, so there is likely a strong genetic connection. Excessive stress and trauma may also be linked to the development of panic disorder.

Certain medical conditions, such as an overactive thyroid (i.e., hyperthyroidism) and certain heart problems, can have the same symptoms as panic attacks. If you are having panic attacks, you should also be examined for other medical conditions.

Things that may trigger a panic attack include:

• drinking large amounts of alcohol
• drinking excessive amounts of caffeine (e.g., coffee, tea, colas)
• taking stimulants or cocaine
• taking or suddenly stopping taking certain prescription medications

Symptoms and Complications (6)

Panic attacks occur with the sudden appearance or occurrence of at least 4 of the following symptoms:

• chest pain or discomfort
• choking
• dizziness, or feeling faint or unsteady
• fear of dying
• fear of losing control
• feelings of choking
• feelings of not being part of your environment
• flushing or chills
• nausea, stomach ache, or diarrhea
• numbness or tingling
• racing heart
• sweating
• trembling or shaking
• trouble breathing

Panic attacks do not usually last longer than 10 minutes. However, since the symptoms affect the lungs, heart, and other important organs, a person might worry that they are having a serious medical problem that requires emergency medical treatment. However, the panic attack is usually over by the time the doctor sees the person who has had the attack.

Since panic attacks are unpredictable, a person often worries about having another attack. If a person starts to avoid the places where they had previous panic attacks, they may develop a condition called agoraphobia. This type of anxiety disorder causes a person to avoid many places (including places with many people) and may lead them to become housebound.

Making the Diagnosis

Your doctor will diagnose panic disorder based on symptoms, family history, and a physical examination. Your doctor will also rule out any other medical causes before making the diagnosis.

In order to be diagnosed with panic disorder, people must have recurrent and unexpected panic attacks plus at least 1 of the following symptoms for 1 month or more:

• constantly fearing that they will have more attacks
• changing behavior due to the panic attacks (e.g., avoiding situations that may provoke an attack)

Treatment and Prevention (5,6)

The treatment of panic disorder usually involves a combination of medications and behavioural or cognitive therapy. The goals of treatment are to reduce the number and frequency of panic attacks and improve your quality of life.
The most commonly used medications for treating panic disorder include:

• selective serotonin re-uptake inhibitors (SSRIs) such as paroxetine*
• serotonin norepinephrine re-uptake inhibitors (SNRIs) such as venlafaxine
• tricyclic antidepressants (TCAs) such as imipramine
• monoamine oxidase inhibitors (MAOIs) such as phenelzine
• anti-anxiety medications, including benzodiazepines such as lorazepam

Your doctor may also recommend behavioural therapy such as exposure or relaxation therapy to help reduce fear and anxiety. In exposure therapy, you are slowly exposed to the same situation that triggers panic attacks until fear and anxiety are reduced to a tolerable level or are eliminated. In relaxation therapy, you are provided with techniques to help you relax in situations that have previously caused panic attacks.

Cognitive therapy (psychotherapy) may also be recommended. Cognitive therapy attempts to change your thought patterns by helping you analyze your reactions to panic attack triggers.

*All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol®). The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For information on a given medication, check our Drug Information database. For more information on brand names, speak with your doctor or pharmacist.

[references]

• Berkow R, Beer MH, Fletcher AJ (Eds). The Merck Manual of Medical Information: Home Edition. N.J: Merck Research Laboratories. 1997:432-434.
• Komaroff AL. (Ed). Harvard Medical School Family Health Guide. New York: Simon and Schuster, Inc., 1999:738-742.
• 3. Panic attacks and panic disorders. Mayo Clinic. http://www.mayoclinic.com/health/panic-attacks/DS00338/METHOD=print, accessed 23 April 2009.
• Katon, W. and Ciechanowski, P. Panic disorder: Epidemiology, pathogenesis, clinical manifestations, course, assessment and diagnosis. Retrieved from the UpToDate database on February 5, 2015
• Roy-Byrne, P.P. Pharmacotherapy for panic disorder. Retrieved from the UpToDate database on February 5, 2015
• Statistics Canada. Section B: Anxiety Disorders. Retrieved from http://www.statcan.gc.ca/pub/82-619-m/2012004/sections/sectionb-eng.htm on February 5, 2015
• Roy-Byrne PP. Pharmacotherapy for panic disorder with or without agoraphobia in adults. UpToDate. Last updated Jan 20, 2020. Accessed 20200123.
• Panic Attacks and Panic Disorder. The Merck Manual for Consumers [Online]. Last reviewed April 2020. Accessed Nov 3, 2023. Available at https://www.merckmanuals.com/en-ca/home/mental-health-disorders/anxiety-and-stress-related-disorders/panic-attacks-and-panic-disorder