Causes and symptoms

Scientists are not sure what causes panic disorder, but they suspect the tendency to develop the condition can be inherited. Some experts think that people with panic disorder may have a hypersensitive nervous system that unnecessarily responds to nonexistent threats. Research suggests that people with panic disorder may not be able to make proper use of their body's normal stress-reducing chemicals.

People with panic disorder usually have their first panic attack in their 20s. Four or more of the following symptoms during panic attacks would indicate panic disorder if no medical, drug-related, neurologic, or other psychiatric disorder is found:

• pounding, skipping or palpitating heartbeat
• shortness of breath or the sensation of smothering
• dizziness or lightheadedness
• nausea or stomach problems
• chest pains or pressure
• choking sensation or a "lump in the throat"
• chills or hot flashes
• sweating
• fear of dying
• feelings of unreality or being detached
• tingling or numbness
• shaking and trembling
• fear of losing control or going crazy

A panic attack is often accompanied by the urge to escape, together with a feeling of certainty that death is imminent. Others are convinced they are about to have a heart attack, suffocate, lose control, or "go crazy." Once people experience a panic attack, they tend to worry so much about having another attack that they avoid the place or situation associated with the original episode.

Diagnosis

Because its physical symptoms are easily confused with other conditions, panic disorder often goes undiagnosed. A thorough physical examination is needed to rule out a medical condition. Because the physical symptoms are so pronounced and frightening, panic attacks can be mistaken for a heart problem. Some people experiencing a panic attack go to an emergency room and endure batteries of tests until a diagnosis is made.

Once a medical condition is ruled out, a mental health professional is the best person to diagnose panic attack and panic disorder, taking into account not just the actual episodes, but how the patient feels about the attacks, and how they affect everyday life.

Most health insurance policies include some limited amount of mental health coverage, although few completely cover outpatient mental health care.

Treatment

Most patients with panic disorder respond best to a combination of cognitive-behavioral therapy and medication. Cognitive-behavioral therapy usually runs from 12-15 sessions. It teaches patients:

• how to identify and alter thought patterns so as not to misconstrue bodily sensations, events, or situations as catastrophic
• how to prepare for the situations and physical symptoms that trigger a panic attack
• how to identify and change unrealistic self-talk (such as "I'm going to die!") that can worsen a panic attack.
• how to calm down and learn breathing exercises to counteract the physical symptoms of panic
• how to gradually confront the frightening situation step by step until it becomes less terrifying
• how to "desensitize" themselves to their own physical sensations, such as rapid heart rate

At the same time, many people find that medications can help reduce or prevent panic attacks by changing the way certain chemicals interact in the brain. People with panic disorder usually notice whether or not the drug is effective within two months, but most people take medication for at least six months to a year.

Several kinds of drugs can reduce or prevent panic attacks, including:

• selective serotonin reuptake inhibitor (SSRI) antipressants like paroxetine (Paxil) or fluoxetine (Prozac), are approved specifically for the treatment of panic
• tricyclic antidepressants such as clomipramine (Anafranil)
• benzodiazepines such as alprazolam (Xanax) and clonazepam (Klonopin)

Finally, patients can make certain lifestyle changes to help keep panic at bay, such as eliminating caffeine and alcohol, cocaine, amphetamines, and marijuana.

Alternative treatment

One approach used in several medical centers focuses on teaching patients how to accept their fear instead of dreading it. In this method, the therapist repeatedly stimulates a person's body sensations (such as a pounding heartbeat) that can trigger fear. Eventually, the patient gets used to these sensations and learns not to be afraid of them. Patients who respond report almost complete absence of panic attacks.

A variety of other atlernative therapies may be helpful in treating panic attacks. Neurolinguistic programming and hypnotherapy can be beneificial, since these techniques can help bring an awareness of the root cause of the attacks to the conscious mind. Herbal remedies, including lemon balm (Melissa officinalis ), oat straw (Avena sativa) , passionflower (Passiflora incarnata ), and skullcap (Scutellaria lateriflora ), may help significantly by strengthening the nervous system. Homeopathic medicine, nutritional supplementation (especially with B vitamins, magnesium, and antioxidant vitamins), creative visualization, guided imagery, and relaxation techniques may help some people experiencing panic attacks. Hydrotherapies, especially hot epsom salt baths or baths with essential oil of lavender (Lavandula officinalis ), can help patients relax.

Prognosis

While there may be occasional periods of improvement, the episodes of panic rarely disappear on their own. Fortunately, panic disorder responds very well to treatment; panic attacks decrease in up to 90% of people after 6-8 weeks of a combination of cognitive-behavioral therapy and medication.

Unfortunately, many people with panic disorder never get the help they need. If untreated, panic disorder can last for years and may become so severe that a normal life is impossible. Many people who struggle with untreated panic disorder and try to hide their symptoms end up losing their friends, family, and jobs.

Prevention

There is no way to prevent the initial onset of panic attacks. Antidepressant drugs or benzodiazepines can prevent future panic attacks, especially when combined with cognitive-behavioral therapy. There is some suggestion that avoiding stimulants (including caffeine, alcohol, or over-the-counter cold medicines) may help prevent attacks as well.

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