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Panic Disorder

Panic disorder is defined as recurring panic attacks over the course of at least a month, as well as worry about the possibility of future attacks which lead to a change of behaviour.

  1. Common condition in primary care
  2. Often experienced in conjunction with another condition
  3. Treated with both cognitive behavioural therapy (CBT) and antidepressants

A panic attack is a potentially frightening experience that many people can have at certain points in their lives. However, living with a panic disorder may be challenging, and you may wish to speak to a doctor through our video consultation service about how you can control symptoms and what permanent treatment options are available.

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Description

What is panic disorder?

Panic disorder is a condition characterised by recurrent panic attacks. The disorder may develop as a consequence of a particular event that induces panic, but attacks can also be unpredictable. 

The condition consists of worrying about the possibility of future attacks, and changes of behaviour to try and cope with them. There are often physical symptoms that manifest during panic attacks, such as heart palpitations and pain in the chest. Someone having a panic attack can often perceive these symptoms as an indication that they are ‘going crazy’ or ‘about to die’.

Panic disorder is a common condition, and in the US the lifetime prevalence is estimated to be between 2-5%. It is also thought that around a quarter of chest complaints warranting admission to A&E result from a panic attack.

Who gets panic disorder?

Panic disorder is most likely to develop during peoples’ early 20s, and it’s more than twice as likely to affect women than men. Symptoms of panic attacks during adolescence put that person at an increased risk of developing an anxiety-related disorder later in life. Agoraphobia is the condition that has the highest prevalence of co-existence with panic disorder. 

There are also varying symptoms depending on ethnicity, according to one study in America. White people are thought to present predominantly cardiac and respiratory symptoms, whereas African-Americans report symptoms of numbing in the extremities, and more prominent thoughts about mortality.

There are several risk factors for developing panic disorder. You are five times more likely to develop the condition if a first-degree relative has it. Although panic attacks are random, it is possible that previous trauma rooted in a significant life event can elicit panic if something in the environment triggers it. 

What causes panic disorder?

Panic attacks stem from the brain sending impulses around the body, which produces hormones such as adrenaline. This is called the ‘fight or flight response’, where the central nervous system stimulates the adrenal glands, resulting in the release of adrenaline, noradrenaline and other chemicals. This leads to symptoms such as hyperventilation, heart palpitations and dizziness. It can become a ‘vicious circle’ -  the more severe the symptoms, the greater the amount of fear that develops, which can often lead to a loss of consciousness.

An attempt to stop a panic attack by avoiding a situation which may trigger the anxiety will provide short-term relief, but also increase the likelihood of developing more severe episodes in future.

If you have had a panic attack and are worried about it happening again, you can contact one of our UK doctors, who can diagnose whether you have a panic disorder. Having arranged a consultation with them at a time that suits you, they will be able to offer you the possibility of treatment in the form of CBT and SSRIs.

Page last reviewed:  12/06/2020
Diagnosis and treatment

How does someone know they have a panic disorder?

A few key symptoms may indicate that you’re suffering from panic disorder. If you have experienced sudden, intense anxiety attacks and fear which you had no control over whatsoever in the past two weeks, are worried about them happening again, and have tried to avoid situations that have caused this anxiety to occur, it’s possible that you have the condition.

However, this should not be sufficient for a diagnosis; you will need to see a doctor in order to get a clinical perspective.

How is panic disorder diagnosed?

A diagnosis for panic disorder can be made based on the symptoms that a patient describes feeling when a panic attack occurs. There are three characteristics that can help to diagnose panic disorder:

  • Recurrent, unexpected, panic attacks that peak in severity after a few minutes.
  • The fear during the panic attacks revolves around the misconception that what is happening will have damaging physical and mental consequences.
  • Refraining from putting yourself in a position that might lead to a panic episode. 

Furthermore, for a diagnosis of panic disorder, the person must have experienced a panic attack followed by a period of worry about a recurrence. The attacks may occur very sporadically over several months, or there may be several episodes in a short space of time.

A doctor will look out for certain behavioural patterns while the person is describing the symptoms of their panic attacks, as someone is more likely to become anxious and agitated while doing so. There may also be a dependency on something to distract them, such as smoking.

Does panic disorder require treatment?

There is no specific treatment for a panic attack. However, there is treatment for panic disorder, to reduce the frequency at which episodes occur and lower their intensity. Treatment can also help to stop the reliance on safety cues, and improve general functional capacity.

Like many other mental conditions, communication is vital for treatment. It is important to understand that fear arises from the mind misinterpreting the body’s sensations, which creates a vicious circle. The anxiety felt during panic attacks can’t be removed, but it may be effectively managed.

What treatments are there for panic disorder?

A doctor will want to establish some basic measures to be taken before starting treatment. It might help the person affected to speak to a family member or someone close to them to increase their understanding of what to do during an attack. A doctor will suggest stopping the consumption of possible anxiety-inducing substances such as alcohol or caffeine.

The implementation of CBT may be the next step. This treatment can be used to focus on recognition of the factors that trigger the panic attacks, and what behaviours can be adjusted to help cope with symptoms. Session are usually 1-2 hours each week for no more than four months. Shorter term treatment which is more intense may be more helpful for some people. 

Additionally, antidepressants can be prescribed for panic disorder. Selective serotonin reuptake inhibitors (SSRIs), such as Citalopram, are the first-line option and are usually prescribed over a 12 week period. The SSRI that is chosen depends on what the side effects are, and its efficacy for the individual. 

Another example of an SSRI is Duciltia, which is a branded version of Duloxetine. It can be used for a number of mental health conditions outside of panic disorder. 

Page last reviewed:  12/06/2020
Questions and Answers

What should I do if I think I might have a panic disorder?

If you have had panic attacks that resemble panic disorder, you should contact your local GP. If you have had a panic attack in the last month, and have consistently worried about it since and thought about ways in which you can prevent it from happening again, you may have panic disorder. 

Your GP will be able to help you formulate a treatment plan and recommend self-help guides that allow you to learn about the principles of CBT and other psychotherapies.

Does panic disorder treatment have side effects?

The only physical side effects from panic disorder treatment stem from the SSRIs that a doctor may prescribe to you following CBT treatment. They can often impact on your sex drive and make you feel lethargic.

It's also possible that if a high intensity form of CBT is chosen, it can have a detrimental effect if the person struggles to talk about their behaviour.

Can I consult a doctor about panic disorder online?

You can consult with a doctor about panic disorder online by using our video consultation service.

Our UK doctors are available for you to speak to at a convenient time for you, and will be able to help diagnose your symptoms and recommend treatment. They can also refer you to a specialist if you are going to start CBT.

Page last reviewed:  12/06/2020

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