Panic attacks and panic disorder

Diagnosis

Your primary care provider will determine if you have panic attacks, panic disorder or another condition, such as heart or thyroid problems, with symptoms that resemble panic attacks.

To help pinpoint a diagnosis, you may have:

• A complete physical exam
• Blood tests to check your thyroid and other possible conditions and tests on your heart, such as an electrocardiogram (ECG or EKG)
• A psychological evaluation to talk about your symptoms, fears or concerns, stressful situations, relationship problems, situations you may be avoiding, and family history

You may fill out a psychological self-assessment or questionnaire. You also may be asked about alcohol or other substance use.

Criteria for diagnosis of panic disorder

Not everyone who has panic attacks has panic disorder. For a diagnosis of panic disorder, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, lists these points:

• You have frequent, unexpected panic attacks.
• At least one of your attacks has been followed by one month or more of ongoing worry about having another attack; continued fear of the consequences of an attack, such as losing control, having a heart attack or "going crazy"; or significant changes in your behavior, such as avoiding situations that you think may trigger a panic attack.
• Your panic attacks aren't caused by drugs or other substance use, a medical condition, or another mental health condition, such as social phobia or obsessive-compulsive disorder.

If you have panic attacks but not a diagnosed panic disorder, you can still benefit from treatment. If panic attacks aren't treated, they can get worse and develop into panic disorder or phobias.

Treatment

Treatment can help reduce the intensity and frequency of your panic attacks and improve your function in daily life. The main treatment options are psychotherapy and medications. One or both types of treatment may be recommended, depending on your preference, your history, the severity of your panic disorder and whether you have access to therapists who have special training in treating panic disorders.

Psychotherapy

Psychotherapy, also called talk therapy, is considered an effective first choice treatment for panic attacks and panic disorder. Psychotherapy can help you understand panic attacks and panic disorder and learn how to cope with them.

A form of psychotherapy called cognitive behavioral therapy can help you learn, through your own experience, that panic symptoms are not dangerous. Your therapist will help you gradually re-create the symptoms of a panic attack in a safe, repetitive manner. Once the physical sensations of panic no longer feel threatening, the attacks begin to resolve. Successful treatment can also help you overcome fears of situations that you've avoided because of panic attacks.

Seeing results from treatment can take time and effort. You may start to see panic attack symptoms reduce within several weeks, and often symptoms decrease significantly or go away within several months. You may schedule occasional maintenance visits to help ensure that your panic attacks remain under control or to treat recurrences.

Medications

Medications can help reduce symptoms associated with panic attacks as well as depression if that's an issue for you. Several types of medication have been shown to be effective in managing symptoms of panic attacks, including:

• Selective serotonin reuptake inhibitors (SSRIs). Generally safe with a low risk of serious side effects, SSRI antidepressants are typically recommended as the first choice of medications to treat panic attacks. SSRIs approved by the Food and Drug Administration (FDA) for the treatment of panic disorder include fluoxetine (Prozac), paroxetine (Paxil, Pexeva) and sertraline (Zoloft).
• Serotonin and norepinephrine reuptake inhibitors (SNRIs). These medications are another class of antidepressants. The SNRI venlafaxine (Effexor XR) is FDA approved for the treatment of panic disorder.
• Benzodiazepines. These sedatives are central nervous system depressants. Benzodiazepines approved by the FDA for the treatment of panic disorder include alprazolam (Xanax) and clonazepam (Klonopin). Benzodiazepines are generally used only on a short-term basis because they can be habit-forming, causing mental or physical dependence. These medications are not a good choice if you've had problems with alcohol or drug use. They can also interact with other drugs, causing dangerous side effects.

If one medication doesn't work well for you, your doctor may recommend switching to another or combining certain medications to boost effectiveness. Keep in mind that it can take several weeks after first starting a medication to notice an improvement in symptoms.

All medications have a risk of side effects, and some may not be recommended in certain situations, such as pregnancy. Talk with your doctor about possible side effects and risks.

Lifestyle and home remedies

While panic attacks and panic disorder benefit from professional treatment, these self-care steps can help you manage symptoms:

• Stick to your treatment plan. Facing your fears can be difficult, but treatment can help you feel like you're not a hostage in your own home.
• Join a support group. Joining a group for people with panic attacks or anxiety disorders can connect you with others facing the same problems.
• Avoid caffeine, alcohol, smoking and recreational drugs. All of these can trigger or worsen panic attacks.
• Practice stress management and relaxation techniques. For example, yoga, deep breathing and progressive muscle relaxation — tensing one muscle at a time, and then completely releasing the tension until every muscle in the body is relaxed — also may be helpful.
• Get physically active. Aerobic activity may have a calming effect on your mood.
• Get sufficient sleep. Get enough sleep so that you don't feel drowsy during the day.

Alternative medicine

Some dietary supplements have been studied as a treatment for panic disorder, but more research is needed to understand the risks and benefits. Herbal products and dietary supplements aren't monitored by the Food and Drug Administration (FDA) the same way medications are. You can't always be certain of what you're getting and whether it's safe.

Before trying herbal remedies or dietary supplements, talk to your doctor. Some of these products can interfere with prescription medications or cause dangerous interactions.

Preparing for your appointment

If you've had signs or symptoms of a panic attack, make an appointment with your primary care provider. After an initial evaluation, he or she may refer you to a mental health professional for treatment.

What you can do

Before your appointment, make a list of:

• Your symptoms, including when they first occurred and how often you've had them
• Key personal information, including traumatic events in your past and any stressful major events that occurred before your first panic attack
• Medical information, including other physical or mental health conditions that you have
• Medications, vitamins, herbal products and other supplements, and the dosages
• Questions to ask your doctor

Ask a trusted family member or friend to go with you to your appointment, if possible, to lend support and help you remember information.

Questions to ask your primary care provider at your first appointment

• What do you believe is causing my symptoms?
• Is it possible that an underlying medical problem is causing my symptoms?
• Do I need any diagnostic tests?
• Should I see a mental health professional?
• Is there anything I can do now to help manage my symptoms?

Questions to ask if you're referred to a mental health professional

• Do I have panic attacks or panic disorder?
• What treatment approach do you recommend?
• If you're recommending therapy, how often will I need it and for how long?
• Would group therapy be helpful in my case?
• If you're recommending medications, are there any possible side effects?
• For how long will I need to take medication?
• How will you monitor whether my treatment is working?
• What can I do now to reduce the risk of my panic attacks recurring?
• Are there any self-care steps I can take to help manage my condition?
• Are there any brochures or other printed material that I can have?
• What websites do you recommend?

Don't hesitate to ask any other questions.

What to expect from your doctor

Your primary care provider or mental health professional may ask:

• What are your symptoms, and when did they first occur?
• How often do your attacks occur, and how long do they last?
• Does anything in particular seem to trigger an attack?
• How often do you experience fear of another attack?
• Do you avoid locations or experiences that seem to trigger an attack?
• How do your symptoms affect your life, such as school, work and personal relationships?
• Did you experience major stress or a traumatic event shortly before your first panic attack?
• Have you ever experienced major trauma, such as physical or sexual abuse or military battle?
• How would you describe your childhood, including your relationship with your parents?
• Have you or any of your close relatives been diagnosed with a mental health problem, including panic attacks or panic disorder?
• Have you been diagnosed with any medical conditions?
• Do you use caffeine, alcohol or recreational drugs? How often?
• Do you exercise or do other types of regular physical activity?

Your primary care provider or mental health professional will ask additional questions based on your responses, symptoms and needs. Preparing and anticipating questions will help you make the most of your appointment time.