The Medical Minute: Panic disorders -- a common anxiety disorder

By Ravi Singareddy

Did you know that nearly 2.4 million Americans suffer from panic disorders, according to the National Institute of Mental Health? 

In fact, more than 20 percent of adult Americans will have at least one panic attack in their lifetime and up to 4 percent of adults suffer from panic disorders. Panic disorders are two to three times more common in women than men. 

Panic disorders are a common anxiety disorder with devastating socioeconomic consequences, such as poor quality of life, increased absenteeism from work or school, job loss, financial dependence and excessive health-care utilization. Individuals with panic disorders initially have unprovoked (out of the blue), intense episodes of fear and anxiety known as panic attacks.

Symptoms of panic attacks may include overwhelming anxiety or nervousness with difficulty breathing, trembling and shaking, sweating, pounding heartbeat, chest pain (tightness or discomfort), dizziness, tingling in fingers or toes, hot flashes or sudden chills. During these attacks, most report extreme terror with a fear of going crazy or a sensation like the walls are closing in or they are going to die. Panic attacks can occur in any situation, but often occur in seemingly harmless situations or even during sleep. 

The first time a person has a panic attack, he or she may not recall a specific trigger or cue. If it becomes recurring, he or she may notice where it happens — in the elevator, driving in the car, or going into a crowded place. As a result, most of the individuals with recurrent panic attacks start avoiding specific situations such as going to crowded places, driving or taking elevators. This common complication is known as agoraphobia.

Furthermore, when individuals start having recurrent panic attacks, they have constant and ongoing apprehension, anxiety or concerns about having another panic attack. This may affect individuals’ work, school, social and/or family life and may lead to substantial impairment. When an individual has recurring panic attacks affecting day-to-day life, he or she is diagnosed with panic disorders. Individuals with panic disorders are unable to participate fully in activities that most people take for granted, with some having considerably restricted lifestyles. 

Panic disorders are frequently misdiagnosed. Individuals with frequent panic attacks or panic disorders primarily present with complaints of fearful physical symptoms such as cardiac or heart-related symptoms (pounding heartbeat, chest pain or shortness of breath), gastrointestinal complaints (nausea, belly pain or diarrhea), neurological symptoms (headache, dizziness or lightheadedness) and pulmonary or breathing-related symptoms (smothering sensation, shortness of breath). As a result, they are often misdiagnosed and in fact may see 10 or more physicians and spend more than a decade visiting various health care facilities — such as emergency rooms, cardiology clinics, gastroenterology clinics or primary care clinics — before they are correctly diagnosed. 

Of all anxiety disorders, panic disorders are the most treatable. In most cases, individuals with panic disorder can be successfully treated with certain medications or a type of talk-therapy (psychotherapy) known as cognitive behavioral therapy. Common medications to treat panic disorders include antidepressants such as selective serotonin reuptake inhibitors (also known as SSRIs) and other anxiety medications. Anxiety patients are typically more sensitive to these medications and will tolerate them better if started at a very low dose and gradually increasing the dose, however, they often require higher than typical dosages of these medications. Cognitive behavioral therapy helps change thinking patterns that lead to fear and anxiety. A combination of medication and cognitive behavioral therapy is probably the best treatment; however, there are very few therapists who are trained to provide this kind of therapy.   

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Ravi Singareddy is an assistant professor of psychiatry and sleep research at Penn State Milton S. Hershey Medical Center.