loader

Panic disorder

Addbanner

Panic disorder



Introduction 

Panic disorder is where you have recurring and regular panic attacks, often for no apparent reason.

Everyone experiences feelings of anxiety and panic at certain times during their lifetime. It's a natural response to stressful or dangerous situations.

However, for someone with panic disorder, feelings of anxiety, stress and panic occur regularly and at any time.

Anxiety

Anxiety is a feeling of unease. It can range from mild to severe and can include feelings of worry and fear.
 
There are several conditions that can cause severe anxiety including


phobias – an extreme or irrational fear of an object, place, situation, feeling or animal

generalised anxiety disorder (GAD) – a long-term condition that causes excessive anxiety and worry relating to a variety of situations

post-traumatic stress disorder – a condition with psychological and physical symptoms caused by distressing or frightening events


Panic attacks

A panic attack occurs when your body experiences a rush of intense psychological (mental) and physical symptoms.

You may experience an overwhelming sense of fear, apprehension and anxiety. As well as these feelings, you may also have physical symptoms such as:


nausea

sweating

trembling

a sensation that your heart is beating irregularly (palpitations)


The number of panic attacks you have will depend on how severe your condition is. Some people may have one or two attacks each month, while others may have several attacks a week.

Panic attacks can be very frightening and intense, but they're not dangerous. An attack won't cause you any physical harm, and it's unlikely that you'll be admitted to hospital if you've had a panic attack.

What causes panic disorder?

As with many mental health conditions, the exact cause of panic disorder isn't fully understood.

However, it's thought the condition is probably linked to a combination of physical and psychological factors.

It’s important to be aware that some physical conditions and disorders can have similar symptoms to those of anxiety. For example:


mitral valve prolapse

postural orthostatic tachycardic syndrome (POTS)

anaemia

paroxysmal atrial tachycardia – episodes of rapid and regular heartbeats that begin and end abruptly

thyrotoxicosis – where large amounts of thyroid hormones are released into the bloodstream, causing rapid heartbeat, sweating,tremor and anxiety

poorly controlled diabetes

adrenal tumours – growths that develop on the adrenal glands (two triangular-shaped glands that form part of the kidneys)

carcinoid syndrome – a set of symptoms caused by some carcinoid tumours that can develop in the cells of the endocrine system (glands that produce and secrete hormones)

Zollinger-Ellison syndrome – causes overproduction of insulin and low blood sugar (hypoglycaemia)


Diagnosing panic disorder

See your GP if you have symptoms of anxiety or panic disorder (see above).

You may be diagnosed with panic disorder if you experience recurrent and unexpected panic attacks followed by at least one month of continuous worry or concern about having further attacks..

Treating panic disorder

The aim of treating panic disorder is to reduce the number of panic attacks you have and ease the severity of your symptoms.

Psychological therapy and medication are the two main types of treatment for panic disorder.

Read more about treating panic disorder and things you can do to help yourself during a panic attack.

Having panic disorder may affect your ability to drive. It's your legal obligation to inform the Driver and Vehicle Licensing Agency (DVLA)about a medical condition that could have an impact on your driving ability.

GOV.UK has further information and advice about driving with a disability or health condition.

Complications of panic disorder

Panic disorder is treatable, but to make a full recovery it's important that you seek medical help as soon as possible. Treatment for panic disorder is much more effective if it's given at an early stage.

Left untreated, panic disorder can become a very debilitating and isolating illness. It can also increase your risk of developing other mental health conditions, such as agoraphobia or other phobias.

Agoraphobia is a fear of being in situations where escape might be difficult, or help wouldn't be available if things go wrong.

Symptoms of panic disorder 

The symptoms of a panic attack can be very frightening and distressing.

Symptoms tend to occur suddenly, without warning and often for no apparent reason.

As well as overwhelming feelings of anxiety, a panic attack can also cause a variety of other symptoms, including:


a sensation that your heart is beating irregularly (palpitations)

sweating

trembling

hot flushes

chills

shortness of breath

a choking sensation

chest pain

nausea

dizziness

feeling faint

numbness or pins and needles

dry mouth

a need to go to the toilet

ringing in your ears 

a feeling of dread or a fear of dying

a churning stomach

a tingling sensation in your fingers

shivering

shaking


The physical symptoms of a panic attack are unpleasant, and they can also be accompanied by thoughts of fear and terror.

For this reason, people with panic disorder start to fear the next attack, which creates a cycle of living in ‘fear of fear’ and adds to the sense of panic.

Sometimes, the symptoms of a panic attack can be so intense they can make you feel like you're having a heart attack.

However, it's important to be aware that symptoms such as a racing heartbeat and shortness of breath won't result in you having a heart attack. Although panic attacks can often be frightening, they don't cause any physical harm. People who have had panic disorder for some time usually learn to recognise this 'heart attack sensation' and become more aware of how to control their symptoms.

Most panic attacks last for five to 20 minutes. Some attacks have been reported to have lasted up to an hour. However, it's likely that in these cases one attack occurred straight after another or high levels of anxiety were felt after the first attack.

Recurrent panic attacks

People with panic disorder have panic attacks on a recurring basis. Some people have attacks once or twice a month, while others have them several times a week.

People with panic disorder also tend to have ongoing and constant feelings of worry and anxiety. The panic attacks associated with panic disorder can be very unpredictable.

If you have panic disorder, you may also feel anxious about when your next attack will be.

Depersonalisation

During a panic attack your symptoms can be so intense and out of your control that you can feel detached from the situation, your body and your surroundings. It can almost feel as if you're an observer, making the situation seem very unreal.

This sense of detachment is known as depersonalisation. Being detached from the situation doesn't provide any relief or make a panic attack less frightening. Instead, it often makes the experience more confusing and disorientating.

Causes of panic disorder 

As with many mental health conditions, the exact cause of panic disorder isn't fully understood.

It's thought that panic disorder is probably caused by a combination of physical and psychological factors. Some of these factors are outlined below.

Traumatic life experiences

A trauma, such as bereavement, can sometimes trigger feelings of panic and anxiety. These feelings may be obvious soon after the event or they may be triggered unexpectedly years later.

Genetics

Having a close family member with panic disorder is thought to increase a person's risk of developing it. However, the precise nature of the risk isn't known.

Neurotransmitters

Neurotransmitters are chemicals that occur naturally in the brain. It's thought that an imbalance of these chemicals may increase your risk of developing conditions such as panic disorder.

Increased sensitivity to carbon dioxide

Some experts believe that panic disorder is linked to an increased sensitivity to carbon dioxide. Breathing in air with high carbon dioxide levels can bring on panic attacks, and breathing techniques can help to relieve or stop panic attacks.

Catastrophic thinking

Another theory is that people who experience panic attacks tend to focus on minor physical symptoms and interpret them in a catastrophic way. This triggers a nervous system response that causes the panic attack.

Diagnosing panic disorders 

Everyone who has panic disorder will experience panic attacks.

However, not everyone who has panic attacks is diagnosed with panic disorder.

Panic attacks

Some people have panic attacks in response to specific situations. For example, they may have a phobia (overwhelming fear) of enclosed spaces (claustrophobia) and have a panic attack when faced with an enclosed space.

While most people with phobias only experience panic attacks when faced with the thing that triggers their fear, the panic attacks of people with panic disorder usually occur without warning and for no obvious reason.

This means that panic disorder will only be diagnosed after experiencing recurrent and unexpected panic attacks, and if the attacks are followed by at least one month of continuous worry or concern about having further attacks.

Talk to your GP

Your GP will ask you to describe the symptoms you've been experiencing. They'll also ask you how often your symptoms occur and in what situations.

It's important to tell your GP about how you've been feeling and how your symptoms have affected you.

Although it can sometimes be difficult to talk to someone else about your feelings, emotions and personal life, try not to feel anxious or embarrassed.

Your GP needs to gain a good understanding of your symptoms to make the correct diagnosis and recommend the most appropriate treatment for you.

Physical examination

Your GP may also want to carry out a physical examination to look for signs of any physical conditions that could be causing your symptoms.

For example, an overactive thyroid gland (hyperthyroidism) can sometimes cause similar symptoms to a panic attack.

By ruling out any underlying medical conditions, your GP will be able to make the correct diagnosis.

Treating panic disorder 

The main aim in treating panic disorder is to reduce the number of panic attacks and ease the severity of symptoms.

Psychological therapy and medication are the two main types of treatment for panic disorder.

Depending on your individual circumstances, you may need one of these treatment types or a combination of the two.

If you're offered psychological therapy, it will probably be in the form of cognitive behavioural therapy (CBT, see below). If this doesn't work, medication may be recommended.

Before starting any form of treatment, your GP will discuss all of the options with you, outlining the advantages of each type and making you aware of any possible risks or side effects.

No single treatment works for everyone and you may need to try a number of treatments before finding one that works for you. The treatment that's recommended will depend on your general level of health, the severity of your condition and your personal preferences.

It's important you understand what your treatment will involve. If you don't understand something your GP has told you, ask them to explain it in more detail.

Cognitive behavioural therapy

Psychological therapy has proven long-term benefits and it's recommended for treating panic disorder. It will usually take the form of cognitive behavioural therapy (CBT).

CBT is thought to be one of the most effective psychological treatments for panic disorder. It involves having regular sessions with a therapist.

The therapist may discuss with you how you react when you have a panic attack and what you think about when you're experiencing an attack.

Once you and your therapist have identified any negative thoughts and beliefs, you can work on replacing them with more realistic and balanced ones. Your therapist can also teach you ways of changing your behaviour, making it easier for you to deal with future panic attacks.

For example, they may be able to show you breathing techniques that can be used to help keep you calm during a panic attack.

The National Institute for Health and Care Excellence (NICE)recommends a total of seven to 14 hours of CBT to be completed within a four month period. Treatment will usually involve having a weekly one to two hour session.

NICE also recommends that in certain situations a shorter programme of CBT may be appropriate. This can involve a reduced number of hours of CBT with ‘homework’ being set between sessions so that you can practice what you've learnt after each session.

You should visit your GP regularly while you're having CBT so that they can assess your progress and see how you're doing.

Support groups

Support groups can provide useful information and advice about how you can effectively manage your panic disorder. They're also a good way of meeting other people who've had similar experiences of the condition.

Panic attacks can sometimes be frightening and isolating, so it can be helpful to know that other people are experiencing the same feelings and emotions as you.

Anxiety UK and Triumph Over Phobia (TOP UK) are UK-based charities that provide information and support for people with anxiety disorders.

Support groups often involve face-to-face meetings where you can talk about your problems and difficulties with others. Many can also provide support and guidance over the telephone or in writing.

Ask your GP about support groups for panic disorder near you. You can also use the services directory to find anxiety services in your area.

Antidepressants

Antidepressants are often associated with depression, but they can also be used to treat a number of other psychological conditions.

Antidepressants can take two to four weeks before becoming effective. It's therefore important to continue taking them, even if you feel they're not working. You should only ever stop taking prescribed medication if your GP specifically advises you to do so.

Selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants are two types of antidepressants that are often recommended for treating panic disorder.

When starting a new type of medication, you should be regularly assessed by your GP at two, four, six and 12 week intervals. This will allow you to discuss any issues that you have with your medication, and enables your GP to assess which treatment is most effective. It will also provide you with the opportunity to try a different type of medication if you want to.

Selective serotonin reuptake inhibitors (SSRIs)

Selective serotonin reuptake inhibitors (SSRIs) are a type of antidepressant that work by increasing the level of a chemical called serotonin in your brain.

They're the most commonly prescribed type of antidepressant for treating panic disorder. They're usually started at a low dose before gradually being increased as your body adjusts to the medicine.

Common side effects of SSRIs include:


nausea

headaches

low sex drive (loss of libido)

blurred vision

diarrhoea or constipation

dizziness

dry mouth

loss of appetite

sweating

feeling agitated

insomnia (sleep problems)

abdominal pain


When you first start taking SSRIs, your feelings of anxiety and panic may get slightly worse. In most cases, this is temporary and your symptoms will start to return to normal levels within a few days of taking the medicine.

Speak to your GP if you feel that your symptoms have got worse and that they're not showing signs of returning to normal levels after a few days.

After you start to take a SSRI, you should visit your GP after two, four, six, and 12 weeks so that they can check on your progress and see whether you're responding to the medicine. Not everyone responds well to antidepressant medicines, so it's important that your progress is carefully monitored.

If your GP feels it necessary, you may require regular blood tests or blood pressure checks when taking antidepressants. If after 12 weeks of taking the medication you don't show any signs of improvement, your GP may prescribe an alternative SSRI to see if it has any effect.

The length of time that you'll have to take a SSRI for will vary depending on how well you respond to the treatment. Even if you feel that your panic disorder has been successfully treated, it's likely that you'll need to keep taking the medication for at least six to 12 months.

If you stop taking your medication before this time, the risk of your symptoms recurring may be increased. Some people may have to take SSRIs for longer than the usual six to 12 month period.

When you and your GP decide that it's appropriate for you to stop taking SSRIs, you will gradually be weaned off them by slowly reducing your dosage. As with antidepressants, you should never stop taking SSRIs unless your GP specifically advises you to.

Stopping your medication straight away without being weaned off, or without seeking advice from your GP, may result in withdrawal symptoms such as:


dizziness

numbness and tingling

nausea and vomiting

headache

anxiety

sleep disturbances

sweating


These symptoms can also occur if you miss a dose of medication, or if your dose is reduced. The symptoms are usually mild, but they can be severe if the medication is stopped suddenly.

For some people, this means having to take SSRIs on a long-term basis. For others, a course of CBT can help to reduce the risk of their symptoms recurring.

Contact your GP if you experience troublesome side effects that don't ease.

Tricyclic antidepressants

If SSRIs aren't suitable, or if your symptoms don't improve after a 12 week course of SSRIs, your GP may try prescribing a different type of antidepressant.

Tricyclic antidepressants work in a similar way to SSRIs. They regulate the levels of the chemicals noradrenaline and serotonin in your brain, which has a positive effect on your feelings and mood.

Imipramine and clomipramine are two tricyclic antidepressants that are often prescribed to treat panic disorder. Tricyclic antidepressants aren't addictive.

SSRIs are usually prescribed before tricyclic antidepressants because they have fewer side effects. Common side effects of tricyclic antidepressants include:


constipation

difficulty urinating

blurred vision

dry mouth

weight gain or weight loss

drowsiness

sweating

lightheadedness

skin rash


The side effects should ease after seven to 10 days as your body starts to get used to the medication. However, see your GP if they become troublesome and don't ease.

Pregabalin

Pregabalin is another medication that’s often used to treat panic disorder. It’s an anticonvulsant that's also used to treat epilepsy (a condition that causes repeated seizures). However, it's also been found to be beneficial in treating anxiety.

Side effects of pregabalin can include:


drowsiness

dizziness

increased appetite and weight gain

blurred vision

headaches

dry mouth

vertigo – the sensation that you, or the environment around you, are moving or spinning


Pregabalin is less likely to cause nausea or a low sex drive than SSRIs.

Driving

Your driving ability may be affected if you have panic disorder.

You're legally obliged to inform the Driver and Vehicle Licensing Agency (DVLA) about a medical condition that could have an impact on your driving.

See GOV.UK for further information about driving with a disability or health condition.


Panic disorder