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Approximately six million Americans have panic disorder, with women outnumbering men by approximately 2:1. The illness, which is a type of anxiety disorder, is characterized by intermittent attacks of overwhelming fear. Although the exact cause of panic disorder is unknown, the illness tends to run in families. Panic disorder can often be controlled with treatment, especially if instituted early in the course of the illness.
ONSET
Most people with panic disorder experience their first attack in their late teens or early twenties, although attacks can begin at any age. The cause of the first attack is poorly understood, but extremely stressful situations may be a contributing factor.
ATTACK SYMPTOMS
Panic attacks are traumatic, frightening experiences. Fortunately, an attack is not life-threatening and typically lasts for only a few minutes. Common symptoms include sweating, chest pain, faintness or unsteadiness, a pounding heartbeat, shortness of breath, a choking sensation, trembling, chills or hot flashes, a sensation of disconnectedness and fear of dying, losing control or impending doom. Many people who experience a panic attack mistake the symptoms for a heart attack. After a panic attack passes, people typically feel normal.
DISEASE PROGRESSION
Panic attacks commonly cause anticipatory anxiety, which means you become anxious about going places or involving yourself in situations wherein you have previously experienced an attack. This anxiety may cause you to progressively restrict your activities, disrupting your ability to work and function normally. In the extreme, avoidant behavior may lead to agoraphobia, the fear of being in a situation or location that is difficult to escape. When panic disorder progresses to agoraphobia, many people refuse to leave their homes.
TREATMENT
Treatment for panic disorder may include medication, cognitive-behavioral therapy or both. Several types medications may be effective in reducing the frequency of panic attacks, including selective serotonin reuptake inhibitors, or SSRIs; serotonin and norepinephrine reuptake inhibitors, or SNRIs; tricyclic antidepressants; benzodiazpines; and monoamine oxidase inhibitors, or MAOIs. In most cases, the medication must be taken for several weeks before becoming effective.
Cognitive-behavioral therapy involves breathing and relaxation training, and gradually learning to face fear-provoking situations without becoming excessively anxious, a process known as desensitization. With breathing training, you learn to breathe in a conscious and gentle way to avoid hyperventilating. Relaxation training teaches you techniques to counteract reflexive responses to perceived danger. Desensitization involves application of breathing and relaxation techniques as you are gradually exposed to places or situations you fear. The goal of desensitization is to allow you to face situations you once avoided without triggering a panic attack or excessive anxiety. With successful cognitive-behavioral therapy, you may no longer need medication to control panic disorder. However, you should not stop taking your medication without your doctor's approval. Stopping your medication prematurely may cause a relapse.
