Treatment for Panic Disorder

When a person experiences recurring and chronic episodes of panic attacks, it is often a sign that they may be suffering from panic disorder. A panic attack is characterized as an onset of intense fear or anxiety that lasts for several minutes when there is no actual threat. Physical responses such as rapid heart rate, sweating, difficulty breathing, and trouble concentrating on anything other than the fear and anxiety usually accompany episodes. Causes of panic disorder are unknown and, if left untreated, living with panic disorder can interfere with work, school, social interaction, relationships and other life experiences.

Panic disorder is a type of anxiety disorder that affects about 6 million American adults. Anxiety disorders are a group of mental health conditions in which people have an extreme reaction that is disproportionate to an actual or perceived threat.

To be diagnosed with panic disorder, a person must meet the requirements of the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5). The DSM-5 requires someone suffer from frequent, unexplained panic attacks and that at least one of the episodes has been followed by a one-month period in which the person worried about having more panic attacks, worried about the ramifications of having a panic attack—like having a heart attack, losing control or sanity—and changed their behavior to avoid situations that might trigger a panic attack. Additionally, panic attacks must not be caused directly by a medical condition, other mental health issues, or drug and/or alcohol use.

Not everyone who has experienced one or more panic attacks is living with panic disorder. Nevertheless, treatment can be effective to manage episodes, so they do not increase and cause other medical or mental health issues, phobias, substance abuse, or develop into a diagnosable panic disorder.

Signs and Symptoms of Panic Disorder


Panic attacks come on suddenly and can occur whether the person is calm or under stress. The symptoms usually peak within about 10 to 20 minutes, but the resulting anxiety can last for hours after the panic attack has subsided. Common symptoms of panic attack include:

  • Sweating
  • Shortness of breath or trouble breathing
  • A choking sensation
  • Rapid pulse or heart palpitations
  • Chest pain or discomfort
  • Dizziness or feeling faint
  • Feeling of impending doom, of losing control, or fear of dying
  • Feeling detached from reality or self
  • Numbness or tingling
  • Shaking or trembling
  • Hot flashes or chills
  • Nausea or abdominal distress

For the episode to be considered panic disorder, a person must experience at least four of these symptoms during the episode.

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Causes of Panic Disorder


Medical professionals do not know what causes panic disorder, but sex, genetics, stress, trauma, and environmental factors all play a role. Some studies have shown a 43 percent heredity factor in first degree relatives that also suffered from panic disorder.

Panic disorder usually appears during late teenage years or in early adulthood. However, it can develop later in life. Women are twice as likely as men to suffer from panic disorder. Some risk factors for developing panic disorder include recent trauma or significant stressors, like death of someone close, financial problems, predisposition to anxiety, other anxiety disorder or phobias, serious medical problems and alcohol and substance abuse.

Recent studies have indicated an abnormality in the part of the brain that controls the fear response, may also lead to panic attacks and be one of the causes of panic disorder.

Dysfunction in the amygdala, thalamus, hypothalamus, and brain stem areas of the brain show a possible connection to panic disorders. Studies suggest the amygdala in particular plays a critical role in panic disorder. Since the amygdala controls the fear response, any disruption or imbalance in its function can lead to exaggerated fear responses, increased anxiety, and/or excessive worry, all symptoms of panic attacks. Neuroimaging studies that show structural, chemical,l and functioning alterations in the amygdala regions of the brain tend to support its crucial role in panic disorder.

Treating dysfunction in the brain could be beneficial in managing panic disorder; however, more studies are needed to further understand the amygdala’s role in panic disorder.

 

Treatment for Panic Disorder


Left untreated, panic attacks tend to get worse and can interfere with the ability to function in life. It is extremely difficult to manage panic disorder on one’s own, thus getting treatment is usually a better option. People living with panic disorder should seek medical attention as soon as possible, because panic attacks can also mimic other major medical issues, like heart or breathing problems, which should be ruled out. When other issues are ruled out and panic disorder is diagnosed, treatment is often the next step. The main types of methods used to treat panic disorder are psychotherapy, medication, or a combination of the two.

Psychotherapy

Also known as talk therapy, psychotherapy can help people living with panic disorder better manage or even eliminate symptoms. Psychotherapy sessions can be individual, group, or family-oriented, and they may be short- or long-term. Short-term sessions can help with immediate issues, while long-term therapy is designed to help with complex and deep-seated issues. Generally, most people can benefit from short-term therapy to get through a crisis, but could reap greater rewards through longer-term and more intensive therapies. Longer-term, more intensive therapies are designed to focus on issues and avoidance behaviors that have developed over time and have become ingrained as a response to experiencing chronic panic attacks. The goal of therapy is to help people living with panic disorder better cope with daily living, medical illness, loss, death, trauma, and mental health conditions like depression and general anxiety.

Cognitive Behavioral Therapy (CBT)

CBT is a type of psychotherapy that helps people identify triggers and maladaptive behaviors, then change the way they think about situations and events, and subsequently change their behavior to healthier coping methods. The rationale is that by changing the way the person views a situation or event, they are better able to control anxiety and panic. This form of therapy focuses on practicing new real-world skills that create better life function. The goal is to help people learn stress management and relaxation techniques, understand stressors, recognize and replace thoughts that create panic, decrease feelings of helplessness, and thereby reduce or eliminate episodes.

Psychotherapy services can be obtained either on an inpatient or outpatient basis depending on individual need and the severity of the panic disorder.

Inpatient psychotherapy methods of treatment for panic disorder can help sufferers learn new skills in a controlled environment where the potential for unintended triggers is greatly reduced and medical professionals are nearby if a crisis occurs. Residential treatment centers offer access to mental health professionals, a variety of therapies, treatment specialties, intensive individual and group psychotherapy, peer support groups, individualized programming, and around-the-clock care by facility staff. Inpatient care can be short-term, less than three months, or long-term, but the length of the treatment program is dependent upon the need of the individual and the severity of the panic disorder.

Medication

Medication is often used together with therapy and coping strategies as a treatment for panic disorder. In fact, mental health professionals have often seen improved outcomes when psychotherapy is used in conjunction with medication. The most common options are antidepressants and anti-anxiety medications like selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and benzodiazepines, as wells as beta-blockers when appropriate.

It is important to note that when antidepressants are used to treat panic disorder, they must be taken for several weeks before symptoms begin to subside.

  • SSRI’s affect the brain through serotonin, which sends chemical messages to the brain to help reduce feelings of anxiety, among other things. The SSRI’s most commonly prescribed to treat panic disorder are citalopram (Celexa), Fluoxetine (Prozac), escitalopram (Lexapro), sertraline (Zoloft), and paroxetine (Paxil). While SSRI’s tend to have fewer side effects than other antidepressants, the main side effects include drowsiness, diarrhea, nausea, and sexual side effects, which typically diminish over time.
  • SNRI’s affect the brain through serotonin and norepinephrine, both of which affect the brain to regulate mood and anxiety. Usually, duloxetine (Cymbalta), venlafaxine (Effexor), and desvenlafaxine (Pristiq) are prescribed. Common side effects include nausea, drowsiness, headaches, sexual side effects, and increased nervousness.
  • Anti-anxiety medications ease symptoms of panic disorder more quickly than antidepressants and have fewer side effects. However, they can lead to dependence. Often, people with more severe panic disorder symptoms are prescribed benzodiazepines including alprazolam (Xanax) and lorazepam (Ativan).
  • Beta blockers are not often prescribed to treat panic disorder, but they can help alleviate symptoms, such as rapid heart rate, and may be helpful in some situations that precede panic attacks.

Though prescription medications do not cure panic disorder, they can help to lessen the symptoms and make it easier to cope.

Treating panic disorders can be highly effective if treatment is obtained early. The prognosis is especially good for people who receive a combination of therapeutic treatments and for those in residential treatment. In a supportive and therapeutic environment, those living with panic disorder can learn various coping skills, to change behavior, and to successfully manage symptoms.