Panic Disorder
Disease Details
Family Health Simplified
- Description
- Panic disorder is a mental health condition characterized by recurrent, unexpected panic attacks and persistent concern about having more attacks.
- Type
- Panic disorder is a type of anxiety disorder. Its genetic transmission is typically complex and multifactorial, meaning it involves the interaction of multiple genes and environmental factors, rather than being transmitted through a clear Mendelian inheritance pattern.
- Signs And Symptoms
-
Individuals with panic disorder usually have a series of intense episodes of extreme anxiety during panic attacks. These attacks typically last about ten minutes, and can be as short-lived as 1–5 minutes, but can last twenty minutes to more than an hour, or until helpful intervention is made. Panic attacks can last up to an hour, and the intensity and symptoms of panic may vary.In some cases, the attack may continue at unabated high intensity or seem to be increasing in severity. Managing panic disorder can be a challenge, but there are several strategies that can help individuals manage their symptoms and improve their social life. Common symptoms of panic disorder attack include rapid heartbeat, perspiration, dizziness, dyspnea, trembling, uncontrollable fear such as: the fear of losing control and going crazy, the fear of dying and hyperventilation. Other symptoms are a sensation of choking, paralysis, chest pain, nausea, numbness or tingling, chills or hot flashes, vision problems, faintness, crying and some sense of altered reality. In addition, the person usually has thoughts of impending doom. Individuals experiencing an episode have often a strong wish of escaping from the situation that provoked the attack. The anxiety of panic disorder is particularly severe and noticeably episodic compared to that from generalized anxiety disorder. Panic attacks may be provoked by exposure to certain stimuli (e.g., seeing a mouse) or settings (e.g., the dentist's office). Nocturnal panic attacks are common in people with panic disorder. Other attacks may appear unprovoked. Some individuals deal with these events on a regular basis, sometimes daily or weekly.
Limited symptom attacks are similar to panic attacks but have fewer symptoms. Most people with Parkinson's disease experience both panic attacks and limited symptom attacks. - Prognosis
-
Panic disorder prognosis:
The prognosis for panic disorder can vary widely among individuals. With appropriate treatment, which may include therapy, medication, or a combination of both, many people experience significant improvement or complete remission of symptoms. Early intervention often leads to better outcomes. However, some individuals may have recurrent symptoms or require long-term management. Lifestyle changes, stress reduction, and ongoing support can also play crucial roles in improving the prognosis. - Onset
- Panic disorder can onset in late adolescence to early adulthood, typically between ages 20 and 30, but it can start at any age.
- Prevalence
- Panic disorder affects approximately 2-3% of adults in the United States each year.
- Epidemiology
-
Panic disorder typically begins during early adulthood; roughly half of all people who have panic disorder develop the condition between the ages of 17 and 24, especially those subjected to traumatic experiences. However, some studies suggest that the majority of young people affected for the first time are between the ages of 25 and 30. Women are twice as likely as men to develop panic disorder and it occurs far more frequently in people of above average intelligence.
Panic disorder can continue for months or years, depending on how and when treatment is sought. If left untreated, it may worsen to the point where one's life is seriously affected by panic attacks and by attempts to avoid or conceal the condition. In fact, many people have had problems with personal relationships, education and employment while struggling to cope with panic disorder. Some people with panic disorder may conceal their condition because of the stigma of mental illness. In some individuals, symptoms may occur frequently for a period of months or years, then many years may pass with little or no symptoms. In some cases, the symptoms persist at the same level indefinitely. There is also some evidence that many individuals (especially those who develop symptoms at an early age) may experience a complete cessation of symptoms later in life (e.g., over age 50).In 2000, the World Health Organization found prevalence and incidence rates for panic disorder to be very similar across the globe. Age-standardized prevalence per 100,000 ranged from 309 in Africa to 330 in East Asia for men and from 613 in Africa to 649 in North America, Oceania, and Europe for women. - Intractability
- Panic disorder is generally not considered intractable. Many individuals with panic disorder can achieve significant improvement or even complete remission with appropriate treatment. Common treatments include cognitive-behavioral therapy (CBT), medications such as selective serotonin reuptake inhibitors (SSRIs), and lifestyle modifications. However, the effectiveness of treatment can vary, and some individuals may experience recurrent symptoms or require long-term management.
- Disease Severity
- Panic disorder is an anxiety disorder characterized by recurrent and unexpected panic attacks—sudden periods of intense fear or discomfort accompanied by symptoms such as palpitations, sweating, trembling, shortness of breath, and feelings of impending doom. The severity can vary widely among individuals, ranging from mild and manageable symptoms to severe episodes that can significantly impair daily functioning and quality of life.
- Healthcare Professionals
- Disease Ontology ID - DOID:594
- Pathophysiology
-
Panic disorder is primarily characterized by recurring and unexpected panic attacks, which are sudden periods of intense fear or discomfort. The pathophysiology of panic disorder involves a combination of genetic, neurobiological, and environmental factors.
1. **Neurobiological Factors**: Dysregulation of neurotransmitters such as serotonin, norepinephrine, and gamma-aminobutyric acid (GABA) is implicated. The brain regions, particularly the amygdala, hippocampus, and prefrontal cortex, play crucial roles in the fear and anxiety responses associated with panic attacks.
2. **Genetic Factors**: There is evidence to suggest a hereditary component, as the disorder tends to run in families. Specific genetic variations may increase susceptibility.
3. **Environmental Factors**: Stressful life events, trauma, and significant changes can act as triggers or exacerbators of the disorder.
Overall, panic disorder is driven by a complex interplay of these factors, leading to the characteristic symptoms and behaviors associated with the condition. - Carrier Status
- Panic disorder is a type of anxiety disorder characterized by repeated and unexpected panic attacks. It is not considered a genetic disorder with "carrier status," but genetic factors can contribute to an individual's susceptibility. Other factors like stressful life events, a history of childhood abuse, and certain changes in brain function also play roles in the development of panic disorder.
- Mechanism
- The neuroanatomy of panic disorder largely overlaps with that of most anxiety disorders. Neuropsychological, neurosurgical, and neuroimaging studies implicate the insula, amygdala, hippocampus, anterior cingulate cortex (ACC), lateral prefrontal cortex, and periaqueductal grey. During acute panic attacks, viewing emotionally charged words, and rest, most studies find elevated blood flow or metabolism. However, the observation of amygdala hyperactivity is not entirely consistent, especially in studies that evoke panic attacks chemically. Hippocampus hyperactivity has been observed during rest and viewing emotionally charged pictures, which has been hypothesized to be related to memory retrieval bias towards anxious memories. Insula hyperactivity during the onset of and over the course of acute panic episodes is thought to be related to abnormal introceptive processes; the perception that bodily sensations are "wrong" is a transdiagnostic finding (i.e. found across multiple anxiety disorders), and may be related to insula dysfunction. Rodent and human studies heavily implicate the periaqueductal grey in generating fear responses, and abnormalities related to the structure and metabolism in the PAG have been reported in panic disorder. The frontal cortex is implicated in panic disorder by multiple lines of evidence. Damage to the dorsal ACC has been reported to lead to panic disorder. Elevated ventral ACC and dorsolateral prefrontal cortex during symptom provocation and viewing emotional stimuli have also been reported, although findings are not consistent.Researchers studying some individuals with panic disorder propose they may have a chemical imbalance within the limbic system and one of its regulatory chemicals GABA-A. The reduced production of GABA-A sends false information to the amygdala which regulates the body's "fight or flight" response mechanism and, in return, produces the physiological symptoms that lead to the disorder. Clonazepam, an anticonvulsant benzodiazepine with a long half-life, has been successful in keeping the condition under control.Recently, researchers have begun to identify mediators and moderators of aspects of panic disorder. One such mediator is the partial pressure of carbon dioxide, which mediates the relationship between panic disorder patients receiving breathing training and anxiety sensitivity; thus, breathing training affects the partial pressure of carbon dioxide in a patient's arterial blood, which in turn lowers anxiety sensitivity. Another mediator is hypochondriacal concerns, which mediate the relationship between anxiety sensitivity and panic symptomatology; thus, anxiety sensitivity affects hypochondriacal concerns which, in turn, affect panic symptomatology.Perceived threat control has been identified as a moderator within panic disorder, moderating the relationship between anxiety sensitivity and agoraphobia; thus, the level of perceived threat control dictates the degree to which anxiety sensitivity results in agoraphobia. Another recently identified moderator of panic disorder is genetic variations in the gene coding for galanin; these genetic variations moderate the relationship between females with panic disorder and the level of severity of panic disorder symptomatology.
- Treatment
- Panic disorder is a serious health problem that in many cases can be successfully treated, although there is no known cure. Identification of treatments that engender as full a response as possible, and can minimize relapse, is imperative. Cognitive behavioral therapy and positive self-talk specific for panic are the treatments of choice for panic disorder. Several studies show that 85 to 90 percent of panic disorder patients treated with CBT recover completely from their panic attacks within 12 weeks. When cognitive behavioral therapy is not an option, pharmacotherapy can be used. SSRIs are considered a first-line pharmacotherapeutic option.
- Compassionate Use Treatment
-
Compassionate use treatment generally refers to the use of investigational drugs outside of clinical trials for patients with serious or life-threatening conditions who have no other treatment options. For panic disorder, compassionate use might involve the administration of experimental psychotropic drugs that are still in clinical testing phases but show promise in managing anxiety symptoms.
Off-label treatments for panic disorder typically involve the use of medications that are approved for other conditions but have been found effective in treating panic disorder. Examples include certain antidepressants (like tricyclic antidepressants or SSRIs not initially approved for panic disorder), beta-blockers (primarily used for cardiovascular conditions), and anticonvulsants.
Experimental treatments for panic disorder might involve new pharmacological interventions such as novel anxiolytics being tested in clinical trials, advancements in neuromodulation techniques like transcranial magnetic stimulation (TMS), or innovative psychotherapeutic approaches incorporating technology, such as virtual reality exposure therapy. - Lifestyle Recommendations
-
For panic disorder, several lifestyle recommendations may help manage symptoms:
1. **Regular Exercise**: Engaging in physical activities can help reduce anxiety and improve mood.
2. **Healthy Diet**: Eating a balanced diet with plenty of fruits, vegetables, and whole grains supports overall mental health.
3. **Adequate Sleep**: Ensuring you get enough sleep each night is crucial for managing stress and anxiety levels.
4. **Stress Management**: Incorporating relaxation techniques such as yoga, meditation, deep-breathing exercises, or mindfulness can help reduce stress and prevent panic attacks.
5. **Limit Stimulants**: Reducing intake of caffeine and nicotine can help decrease anxiety symptoms.
6. **Stay Connected**: Maintaining social connections with friends and family can provide emotional support and alleviate feelings of isolation.
7. **Avoid Alcohol and Drugs**: These substances can increase anxiety and exacerbate panic disorder symptoms.
8. **Regular Routine**: Establishing and maintaining a regular daily routine can provide a sense of stability and control.
These measures, combined with professional treatment such as cognitive-behavioral therapy (CBT) or medication if prescribed, can significantly improve the quality of life for individuals with panic disorder. - Medication
-
Appropriate medications are effective for panic disorder. Selective serotonin reuptake inhibitors are first line treatments rather than benzodiazapines due to concerns with the latter regarding tolerance, dependence and abuse. Although there is little evidence that pharmacological interventions can directly alter phobias, few studies have been performed, and medication treatment of panic makes phobia treatment far easier (an example in Europe where only 8% of patients receive appropriate treatment).Medications can include:
Antidepressants (SSRIs, MAOIs, tricyclic antidepressants and norepinephrine reuptake inhibitors): The most common SSRIs used while treating panic disorder include Prozac, Luvox, Zoloft, Paxil, Effexor, and Serzone with Prozac. These have been reported as the most effective in preventing panic attacks. The most researched and support tricyclic antidepressants are Tofranil and Anafranil. Other tricyclic antidepressants used for treatment include Pamelor, Norpramin, and Elavil. While these are potentially helpful in treating panic disorder, research has not been as conclusive when compared to the two previously mentioned medications. MAO inhibitors are considered to be the most successful in blocking panic attacks. Phenelzine and Tofranil, two of the most commonly used of anti-panic MAOI medications, have been found to be the best with both being equally effective in treatment.
Antianxiety agents (benzodiazepines): The American Psychiatric Association states that benzodiazepines can be effective for the treatment of panic disorder and recommends that the choice of whether to use benzodiazepines, antidepressants with anti-panic properties or psychotherapy should be based on the individual patient's history and characteristics. Other experts believe that benzodiazepines are best avoided due to the risks of the development of tolerance and physical dependence. The World Federation of Societies of Biological Psychiatry, say that benzodiazepines should not be used as a first-line treatment option but are an option for treatment-resistant cases of panic disorder. Despite increasing focus on the use of antidepressants and other agents for the treatment of anxiety as recommended best practice, benzodiazepines have remained a commonly used medication for panic disorder. They reported that in their view there is insufficient evidence to recommend one treatment over another for panic disorder. The APA noted that while benzodiazepines have the advantage of a rapid onset of action, that this is offset by the risk of developing a benzodiazepine dependence. The National Institute for Clinical Excellence came to a different conclusion, they pointed out the problems of using uncontrolled clinical trials to assess the effectiveness of pharmacotherapy and based on placebo-controlled research they concluded that benzodiazepines were not effective in the long-term for panic disorder and recommended that benzodiazepines not be used for longer than 4 weeks for panic disorder. Instead NICE clinical guidelines recommend alternative pharmacotherapeutic or psychotherapeutic interventions. When compared to placebos, benzodiazepines demonstrate possible superiority in the short term but the evidence is low quality with limited applicability to clinical practice. - Repurposable Drugs
-
Repurposable drugs for panic disorder include:
1. **Clonidine** - Initially used for hypertension.
2. **Gabapentin** - Initially approved for epilepsy and neuropathic pain.
3. **Hydroxyzine** - An antihistamine that can also be used to treat anxiety.
4. **Prazosin** - Traditionally used for hypertension but also for PTSD-related nightmares. - Metabolites
-
Research on panic disorder has identified various metabolites that may be associated with the condition. Some of these include:
1. Neurotransmitters: Altered levels of neurotransmitters like serotonin, norepinephrine, and gamma-aminobutyric acid (GABA) are often noted.
2. Lactate: Elevated lactate levels have been linked with panic attacks.
3. Cortisol: Stress responses often show altered cortisol levels in individuals with panic disorder.
These biomarkers are being studied for their potential roles in the pathophysiology of panic disorder and their usefulness in diagnosis and treatment. - Nutraceuticals
-
There is limited evidence on the effectiveness of nutraceuticals for panic disorder. Some nutraceuticals that are commonly considered for mental health conditions, including panic disorder, include:
1. **Omega-3 Fatty Acids**: These have been shown to support brain health and may have a role in reducing anxiety symptoms.
2. **Magnesium**: Often thought to have a calming effect on the nervous system and may help with anxiety symptoms.
3. **L-Theanine**: An amino acid found in tea that may promote relaxation without causing drowsiness.
4. **Adaptogens**: Herbs like Ashwagandha and Rhodiola Rosea are sometimes used to help the body manage stress.
5. **B Vitamins**: Particularly B6 and B12, which are important for brain function and mood regulation.
It is essential to consult a healthcare provider before starting any nutraceuticals, as they can interact with other medications and have their own side effects. - Peptides
- Panic disorder is characterized by recurrent, unexpected panic attacks. Peptides can influence panic disorder by modulating stress response and neurotransmission. For example, corticotropin-releasing factor (CRF) peptides contribute to the stress response that can trigger panic attacks. Neuropeptide Y (NPY) is thought to have anxiolytic effects, potentially reducing anxiety and panic symptoms. Research into the roles of various peptides in panic disorder is ongoing, aiming to better understand their impact and therapeutic potential.