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http://www.anxietypanic.com/signs.html
PANIC DISORDER
The purpose of this material is to explain Panic Disorder. It may help you to decide if you have this disorder. If there is reason to
suspect Panic Disorder, the brochure suggests a reasonable approach to take so that a proper diagnosis can be made and, if
necessary, treatment begun. This is intended for educational information only. Treatment for appendicitis is not a 'do it yourself'
project. Neither is treatment for OCD. If you believe, after reading this, that you might have OCD, you should see your physician
who can either diagnose and treat you, or refer you to a specialist.
A Case History
Ann was watching television after a typical workday. She suddenly developed a peculiar and very strong feeling of
being lightheaded and a smothering sensation as if there were no oxygen in the air she was breathing. Then a surge of
pounding rapid heartbeat began. It came on so quickly and was so severe that she became panicked that she might be
dying of a heart attack! Then she felt very shaky, sweaty, and unsteady. This whole experience reached peak intensity
within 60 seconds. This was the eighth such attack this month.
PANIC
"Panic" was hardly the word to describe how terrified she was feeling. It went beyond any feeling of fear that she had
ever experienced. Although she had gone to the emergency room several times, nothing seemed to be found by the
doctors to explain why she kept having the attacks.
She frantically searched for her car keys so that she could get to the hospital immediately. She thought desperately, "What's
wrong with me?"
What it feels like.
The main symptom of a Panic Disorder is the panic attack itself. Panic Disorder is a medical disorder characterized by
severe and sudden episodes.
It is important to mention that sudden episodes of the symptoms listed above caused by another reasonable cause are not panic
attacks. Two such reasonable causes would be (1) a certain medical ailment that might mimic a panic attack, or (2) a life
threatening experience immediately preceding the attack. If these reasonable causes are found not be the cause of the problem
then there is the possibility of a Panic Disorder.
Panic attacks reach maximum intensity within a minute or two once they begin. They diminish slowly over the next 30 minutes or
the next several hours. It is common for the first attack to cause a person to go to an emergency medical facility. Subsequent
attacks occur several times a month and are often as severe as the initial attack.
About three fourths of Panic Disorder patients are women. Panic Disorder begins most often when people are 20-30 years old. It
begins less often in teenagers or persons in their forties. It is uncommon for the disorder to appear in the elderly for the first
time.
It is important to note that although a few experts say it is more common in persons who experienced a separation experience as
a child, many of experts feel that Panic Disorder afflicts emotionally healthy people. Persons with Panic Disorder are no more likely
than the average American to have suffered from emotional problems at the time the disorder begins.
Afraid of Something.
Persons experiencing repetitive, severe panic attacks may simply have panic attacks and that is all. Other persons
may begin to experience a progression of bothersome or distressing panic attack "side effects". This progression
commonly occurs as follows:
1
A few weeks or months prior to the first panic attack there are sometimes minor symptoms such as rapid heart beat.
2
The first major panic attack occurs. The person often seeks emergency medical evaluation at this time. The initial
examination is commonly normal.
3
Continued panic attacks cause the person to seek further medical evaluations which may be inconclusive. Many panic
attack sufferers go for months or years before receiving the proper diagnosis and by that time may have seen over a
dozen physicians, psychologists and counselors. This appearance of "doctor shopping" may cause others to regard the
sufferer as a hypochondriac.
4
An individual with Panic Disorder may begin to avoid a certain activity because it occurs to them that it would be
especially embarrassing or dangerous to have an attack while engaged in that activity. A typical sufferer of Panic
Disorder might think, "It's bad enough to have an attack at all, but it would be dangerous to have one on Interstate 75
because I would be preoccupied with the attack and would not be a safe driver. I might wreck my car, injuring myself
or someone else!" This avoidance behavior may appear to be a fear of driving when it is really a fear of having a panic
attack while driving.
5
Tendencies to avoid circumstances in everyday life may increase and extend to more activities. This extensive
avoidance behavior is referred to as agoraphobia.
Places, activities or circumstances frequently avoided by persons with Panic Disorder include the following:
Shopping malls
>Department stores
Restaurants
Church
Meetings
Classes
Driving
Being alone
Airplanes
Elevators
6
After months or years of continuous panic attacks and the restricted lifestyle caused by the typical avoidance
behavior, the sufferer of Panic Disorder may become demoralized and psychologically or physically depressed.
Some sufferers turn to alcohol in an attempt to self medicate or to diminish the symptoms of the disorder. This greatly
complicates the individual's life and ability to seek appropriate treatment.
Tragically, one out of every five untreated sufferers attempts to end his or her life, never realizing that there was hope and
treatment available.
Is There Damage?
A person will not die from a panic attack. But, Panic Disorder does indeed cause damage. It is difficult to estimate the
misery and loss of overall productivity that this disorder causes.
There is personal pain and humiliation and a restricted lifestyle. There are missed days of work due to panic attacks. There may
be unemployment due to partial or complete disability. There is increased risk of alcoholism and suicide.
Add the unhappiness the disorder causes in the loved ones of panic disorder and the consequential loss of their productivity. You
come to realize that the total magnitude of the damage that the disorder causes nationally is staggering. And we haven't even
touched on the tremendous cost that the waste of misdiagnosis and unnecessary or inappropriate medical care adds to the
damage estimate. Drug and alcohol abuse are the number one public concern of Americans. However, Anxiety Disorders affect
more Americans than the combined toll of drug and alcohol abuse. And yet Anxiety Disorders are not even in the top fifty of
Americans' public concerns The federal government has developed a plan to deal with this problem.
CAUSES & TREATMENT
What causes Panic Disorder?
Twenty years ago Panic Disorder was poorly understood even by most experts. It was called Anxiety Neurosis and was
thought by some to stem from "deeply rooted" psychological conflicts and subconscious upsetting impulses of a
sexual nature.
Now we regard Panic Disorder as more of a physical problem with a metabolic core. It is not an emotional problem,
although after suffering from it, emotionally healthy persons may develop depression or other problems. There are
different theories about where in the nervous system the problem exists.
>There is considerable evidence pointing toward an abnormality in the function of the locus ceruleus and its associated nerve
pathways. The locus ceruleus is a tiny nerve center in the brainstem(the part of the brain that controls heartbeat, breathing and
other vital functions).
Few experts still cling to the notion that this is not a physical disorder. Scientific evidence clearly favors there being a physical
cause of this disorder. It is regarded as a physical disorder much like Diabetes or Pneumonia.
There is hope and help
Is there hope for persons with Panic Disorder? Yes. Panic disorder is very treatable. And nearly everyone responds
well to proper treatment. Treatment consists of several steps:
A
First a person must be educated about this disorder. Simply learning some of the things mentioned in this brochure will
improve matters somewhat by giving hope where there perhaps was despair. Understanding and knowledge gives
confidence and a positive expectation so important to the success of any medical treatment.
B
Next, it is necessary to find a medication which can eliminate the panic attacks completely, if at all possible.
Psychiatrists experienced in treating Panic Disorder have had success using any one of three kinds of medicines:
1
Certain Antidepressants. Tofranil (imipramine) and Paxil (paroxetine) are examples of old and new antidepressants
that are useful in treating Panic Disorder.
Though approved by the FDA for treating depression, most antidepressants will block panic attacks. Physical dependence does
not occur on such medicine.
Successful treatment requires full strength dosage and it usually takes four to eight weeks for the medicine to begin to block the
panic attacks. Perhaps half of persons trying this type of medicine are made initially worse to some degree. Certain properties of
the medicines tend to trigger more than the usual number of attacks in the first couple of weeks or so. But this discomfort may
have to be considered a short term investment in return for a long term gain of recovery. As a rule, the less expensive
antidepressants (Tofranil) have more bothersome side effects than the newer more expensive ones (Paxil) .
Here are some examples of antidepressants known by clinicians to be helpful for panic disorder:
Paxil (paroxetine)
Prozac (fluoxetine)
Zoloft (sertraline)
Sinequan (doxepin)
Tofranil (imipramine)
2
High Potency Benzodiazepine Tranquilizers. Some examples are Xanax (alprazolam), Ativan (lorazepam) and Klonopin
(clonazepam). Xanax (alprazolam) is the most thoroughly studied of this group. Xanax (alprazolam) was already used
for a decade to treat Panic Disorder when it was approved for use in Panic Disorder by the FDA in 1990. These
medicines are quite effective and usually have few side effects at proper doses. They block panic attacks almost
immediately in the first day or two of treatment.
Several dosage increases over a period of several weeks are customary. Ultimately no further increases are required.
Public concern about such medicines being dangerously addictive is unduly exaggerated in the case of persons with Panic
Disorder.
Scientific evidence shows surprisingly low rates of abuse of this and other medicines in persons with Panic Disorder. Physical
dependence does develop with such medicines at larger dosages. The person who chooses such medicine for this disorder should
accept the fact that they may require higher doses and may therefore be physically dependent on the medicine. They must not
abruptly cease taking their medicine. Doing so would result in withdrawal symptoms. One does not abruptly stop such medicine.
When it comes time to go off medicine it is decreased gradually by tiny reductions every one to three weeks). More information
about this benzodiazepine kind of medication is linked (click benzodiazepine).
3
Nardil (phenelzine). This unique medicine, though more effective than any other medicine for this disorder, is rather
complicated to use. It may be best to reserve it for cases where simpler medications have failed or cannot be used for
some reason. Nardil is a safe medicine when used by an experienced physician in a patient who complies with the
necessary diet and medication restrictions. Unsafe elevations of blood pressure for several hours can occur if one does
not adhere to these restrictions while taking Nardil.
More information about Nardil, a MAOI medication, is linked to Dr. Ivan Goldbergís PsyCom.Net website for depression.
http://www.psycom.net/depression.central.html.
C
Once the panic attacks have been successfully blocked completely for about three months Panic Disorder patients
usually get back to normal life without any additional assistance. However, many do not automatically overcome their
tendencies to avoid the situations that they have been evading. Success in such patients is achieved by organizing a
systematic approach of doing the very things that have been avoided. They begin going into the least difficult of
avoided places first. This exposure to the feared situations is practiced repeatedly until they are reasonably
comfortable. Then they proceed to the next more difficult avoided activity.
This highly successful approach is a common sense method based on the old adage "If you fall off the horse, get right back on."
This cognitive behavior therapy approach may be helpful in resolving such fears. The person discovers that they can indeed
perform the avoided activities and the medication prevents the attacks from occurring. Confidence is restored and normal life
resumes with security, peace of mind and a sense that one is in control once again.
Some professionals believe that Panic Disorder can be treated solely with talk therapy such as cognitive behavioral therapy or
expensive cassette tapes. This area is controversial. The National Anxiety Foundation urges professionals and patients to employ
the combination of both methods (medication and cognitive-behavioral therapy) until convincing research clarifies, once and for
all, this controversy.
Seeking help.
What kind of doctor should I see to get help?
The first step should be to have a medical evaluation to determine the proper diagnosis. Your family physician is the
good place to start. Tell him or her what has been happening to you and that you wonder if you might have Panic
Disorder. Show the doctor this brochure. After the evaluation perhaps the doctor will tell you that you do have Panic
Disorder. Then what? You may wish to see a psychiatrist.
Psychiatrists are physicians (MD's). A psychiatrist who is experienced in treating Panic Disorder is the most qualified
single professional to deal with the problem. There is a national shortage of psychiatrists. There may not be one in
your area, or your HMO may not allow you to be seen by one of their psychiatrists. In these instances, seeing your
regular doctor for medication to stop the attacks and consulting a psychologist, if necessary, for behavior therapy is
second best. Psychologists are not physicians (instead of M.D., they may have other abbreviations after their name
such as Ph.D. or Ed.D. or Psy.D.). If a psychologist isn't available for behavior therapy, a social worker who is familiar
with this therapy might be helpful.
The prognosis.
Remember, Panic Disorder is a serious but highly treatable medical illness. Almost everyone responds well to
treatment and can return to normal functioning in weeks or months.
All materials at this site not otherwise credited are Copyright
1997-2002 Anxiety/Panic Attack Resource Site. All rights reserved. Use of any material contained herein is subject to stated
terms or written permission.
PANIC DISORDER
The purpose of this material is to explain Panic Disorder. It may help you to decide if you have this disorder. If there is reason to
suspect Panic Disorder, the brochure suggests a reasonable approach to take so that a proper diagnosis can be made and, if
necessary, treatment begun. This is intended for educational information only. Treatment for appendicitis is not a 'do it yourself'
project. Neither is treatment for OCD. If you believe, after reading this, that you might have OCD, you should see your physician
who can either diagnose and treat you, or refer you to a specialist.
A Case History
Ann was watching television after a typical workday. She suddenly developed a peculiar and very strong feeling of
being lightheaded and a smothering sensation as if there were no oxygen in the air she was breathing. Then a surge of
pounding rapid heartbeat began. It came on so quickly and was so severe that she became panicked that she might be
dying of a heart attack! Then she felt very shaky, sweaty, and unsteady. This whole experience reached peak intensity
within 60 seconds. This was the eighth such attack this month.
PANIC
"Panic" was hardly the word to describe how terrified she was feeling. It went beyond any feeling of fear that she had
ever experienced. Although she had gone to the emergency room several times, nothing seemed to be found by the
doctors to explain why she kept having the attacks.
She frantically searched for her car keys so that she could get to the hospital immediately. She thought desperately, "What's
wrong with me?"
What it feels like.
The main symptom of a Panic Disorder is the panic attack itself. Panic Disorder is a medical disorder characterized by
severe and sudden episodes.
It is important to mention that sudden episodes of the symptoms listed above caused by another reasonable cause are not panic
attacks. Two such reasonable causes would be (1) a certain medical ailment that might mimic a panic attack, or (2) a life
threatening experience immediately preceding the attack. If these reasonable causes are found not be the cause of the problem
then there is the possibility of a Panic Disorder.
Panic attacks reach maximum intensity within a minute or two once they begin. They diminish slowly over the next 30 minutes or
the next several hours. It is common for the first attack to cause a person to go to an emergency medical facility. Subsequent
attacks occur several times a month and are often as severe as the initial attack.
About three fourths of Panic Disorder patients are women. Panic Disorder begins most often when people are 20-30 years old. It
begins less often in teenagers or persons in their forties. It is uncommon for the disorder to appear in the elderly for the first
time.
It is important to note that although a few experts say it is more common in persons who experienced a separation experience as
a child, many of experts feel that Panic Disorder afflicts emotionally healthy people. Persons with Panic Disorder are no more likely
than the average American to have suffered from emotional problems at the time the disorder begins.
Afraid of Something.
Persons experiencing repetitive, severe panic attacks may simply have panic attacks and that is all. Other persons
may begin to experience a progression of bothersome or distressing panic attack "side effects". This progression
commonly occurs as follows:
1
A few weeks or months prior to the first panic attack there are sometimes minor symptoms such as rapid heart beat.
2
The first major panic attack occurs. The person often seeks emergency medical evaluation at this time. The initial
examination is commonly normal.
3
Continued panic attacks cause the person to seek further medical evaluations which may be inconclusive. Many panic
attack sufferers go for months or years before receiving the proper diagnosis and by that time may have seen over a
dozen physicians, psychologists and counselors. This appearance of "doctor shopping" may cause others to regard the
sufferer as a hypochondriac.
4
An individual with Panic Disorder may begin to avoid a certain activity because it occurs to them that it would be
especially embarrassing or dangerous to have an attack while engaged in that activity. A typical sufferer of Panic
Disorder might think, "It's bad enough to have an attack at all, but it would be dangerous to have one on Interstate 75
because I would be preoccupied with the attack and would not be a safe driver. I might wreck my car, injuring myself
or someone else!" This avoidance behavior may appear to be a fear of driving when it is really a fear of having a panic
attack while driving.
5
Tendencies to avoid circumstances in everyday life may increase and extend to more activities. This extensive
avoidance behavior is referred to as agoraphobia.
Places, activities or circumstances frequently avoided by persons with Panic Disorder include the following:
Shopping malls
>Department stores
Restaurants
Church
Meetings
Classes
Driving
Being alone
Airplanes
Elevators
6
After months or years of continuous panic attacks and the restricted lifestyle caused by the typical avoidance
behavior, the sufferer of Panic Disorder may become demoralized and psychologically or physically depressed.
Some sufferers turn to alcohol in an attempt to self medicate or to diminish the symptoms of the disorder. This greatly
complicates the individual's life and ability to seek appropriate treatment.
Tragically, one out of every five untreated sufferers attempts to end his or her life, never realizing that there was hope and
treatment available.
Is There Damage?
A person will not die from a panic attack. But, Panic Disorder does indeed cause damage. It is difficult to estimate the
misery and loss of overall productivity that this disorder causes.
There is personal pain and humiliation and a restricted lifestyle. There are missed days of work due to panic attacks. There may
be unemployment due to partial or complete disability. There is increased risk of alcoholism and suicide.
Add the unhappiness the disorder causes in the loved ones of panic disorder and the consequential loss of their productivity. You
come to realize that the total magnitude of the damage that the disorder causes nationally is staggering. And we haven't even
touched on the tremendous cost that the waste of misdiagnosis and unnecessary or inappropriate medical care adds to the
damage estimate. Drug and alcohol abuse are the number one public concern of Americans. However, Anxiety Disorders affect
more Americans than the combined toll of drug and alcohol abuse. And yet Anxiety Disorders are not even in the top fifty of
Americans' public concerns The federal government has developed a plan to deal with this problem.
CAUSES & TREATMENT
What causes Panic Disorder?
Twenty years ago Panic Disorder was poorly understood even by most experts. It was called Anxiety Neurosis and was
thought by some to stem from "deeply rooted" psychological conflicts and subconscious upsetting impulses of a
sexual nature.
Now we regard Panic Disorder as more of a physical problem with a metabolic core. It is not an emotional problem,
although after suffering from it, emotionally healthy persons may develop depression or other problems. There are
different theories about where in the nervous system the problem exists.
>There is considerable evidence pointing toward an abnormality in the function of the locus ceruleus and its associated nerve
pathways. The locus ceruleus is a tiny nerve center in the brainstem(the part of the brain that controls heartbeat, breathing and
other vital functions).
Few experts still cling to the notion that this is not a physical disorder. Scientific evidence clearly favors there being a physical
cause of this disorder. It is regarded as a physical disorder much like Diabetes or Pneumonia.
There is hope and help
Is there hope for persons with Panic Disorder? Yes. Panic disorder is very treatable. And nearly everyone responds
well to proper treatment. Treatment consists of several steps:
A
First a person must be educated about this disorder. Simply learning some of the things mentioned in this brochure will
improve matters somewhat by giving hope where there perhaps was despair. Understanding and knowledge gives
confidence and a positive expectation so important to the success of any medical treatment.
B
Next, it is necessary to find a medication which can eliminate the panic attacks completely, if at all possible.
Psychiatrists experienced in treating Panic Disorder have had success using any one of three kinds of medicines:
1
Certain Antidepressants. Tofranil (imipramine) and Paxil (paroxetine) are examples of old and new antidepressants
that are useful in treating Panic Disorder.
Though approved by the FDA for treating depression, most antidepressants will block panic attacks. Physical dependence does
not occur on such medicine.
Successful treatment requires full strength dosage and it usually takes four to eight weeks for the medicine to begin to block the
panic attacks. Perhaps half of persons trying this type of medicine are made initially worse to some degree. Certain properties of
the medicines tend to trigger more than the usual number of attacks in the first couple of weeks or so. But this discomfort may
have to be considered a short term investment in return for a long term gain of recovery. As a rule, the less expensive
antidepressants (Tofranil) have more bothersome side effects than the newer more expensive ones (Paxil) .
Here are some examples of antidepressants known by clinicians to be helpful for panic disorder:
Paxil (paroxetine)
Prozac (fluoxetine)
Zoloft (sertraline)
Sinequan (doxepin)
Tofranil (imipramine)
2
High Potency Benzodiazepine Tranquilizers. Some examples are Xanax (alprazolam), Ativan (lorazepam) and Klonopin
(clonazepam). Xanax (alprazolam) is the most thoroughly studied of this group. Xanax (alprazolam) was already used
for a decade to treat Panic Disorder when it was approved for use in Panic Disorder by the FDA in 1990. These
medicines are quite effective and usually have few side effects at proper doses. They block panic attacks almost
immediately in the first day or two of treatment.
Several dosage increases over a period of several weeks are customary. Ultimately no further increases are required.
Public concern about such medicines being dangerously addictive is unduly exaggerated in the case of persons with Panic
Disorder.
Scientific evidence shows surprisingly low rates of abuse of this and other medicines in persons with Panic Disorder. Physical
dependence does develop with such medicines at larger dosages. The person who chooses such medicine for this disorder should
accept the fact that they may require higher doses and may therefore be physically dependent on the medicine. They must not
abruptly cease taking their medicine. Doing so would result in withdrawal symptoms. One does not abruptly stop such medicine.
When it comes time to go off medicine it is decreased gradually by tiny reductions every one to three weeks). More information
about this benzodiazepine kind of medication is linked (click benzodiazepine).
3
Nardil (phenelzine). This unique medicine, though more effective than any other medicine for this disorder, is rather
complicated to use. It may be best to reserve it for cases where simpler medications have failed or cannot be used for
some reason. Nardil is a safe medicine when used by an experienced physician in a patient who complies with the
necessary diet and medication restrictions. Unsafe elevations of blood pressure for several hours can occur if one does
not adhere to these restrictions while taking Nardil.
More information about Nardil, a MAOI medication, is linked to Dr. Ivan Goldbergís PsyCom.Net website for depression.
http://www.psycom.net/depression.central.html.
C
Once the panic attacks have been successfully blocked completely for about three months Panic Disorder patients
usually get back to normal life without any additional assistance. However, many do not automatically overcome their
tendencies to avoid the situations that they have been evading. Success in such patients is achieved by organizing a
systematic approach of doing the very things that have been avoided. They begin going into the least difficult of
avoided places first. This exposure to the feared situations is practiced repeatedly until they are reasonably
comfortable. Then they proceed to the next more difficult avoided activity.
This highly successful approach is a common sense method based on the old adage "If you fall off the horse, get right back on."
This cognitive behavior therapy approach may be helpful in resolving such fears. The person discovers that they can indeed
perform the avoided activities and the medication prevents the attacks from occurring. Confidence is restored and normal life
resumes with security, peace of mind and a sense that one is in control once again.
Some professionals believe that Panic Disorder can be treated solely with talk therapy such as cognitive behavioral therapy or
expensive cassette tapes. This area is controversial. The National Anxiety Foundation urges professionals and patients to employ
the combination of both methods (medication and cognitive-behavioral therapy) until convincing research clarifies, once and for
all, this controversy.
Seeking help.
What kind of doctor should I see to get help?
The first step should be to have a medical evaluation to determine the proper diagnosis. Your family physician is the
good place to start. Tell him or her what has been happening to you and that you wonder if you might have Panic
Disorder. Show the doctor this brochure. After the evaluation perhaps the doctor will tell you that you do have Panic
Disorder. Then what? You may wish to see a psychiatrist.
Psychiatrists are physicians (MD's). A psychiatrist who is experienced in treating Panic Disorder is the most qualified
single professional to deal with the problem. There is a national shortage of psychiatrists. There may not be one in
your area, or your HMO may not allow you to be seen by one of their psychiatrists. In these instances, seeing your
regular doctor for medication to stop the attacks and consulting a psychologist, if necessary, for behavior therapy is
second best. Psychologists are not physicians (instead of M.D., they may have other abbreviations after their name
such as Ph.D. or Ed.D. or Psy.D.). If a psychologist isn't available for behavior therapy, a social worker who is familiar
with this therapy might be helpful.
The prognosis.
Remember, Panic Disorder is a serious but highly treatable medical illness. Almost everyone responds well to
treatment and can return to normal functioning in weeks or months.
All materials at this site not otherwise credited are Copyright
1997-2002 Anxiety/Panic Attack Resource Site. All rights reserved. Use of any material contained herein is subject to stated
terms or written permission.
