Panic disorder is a condition where you have recurring panic attacks. Many people with panic disorder also develop agoraphobia. This means you avoid many places, and may not even go out from your home, due to fear of having a panic attack in a public place. Treatment with antidepressant medicines and/or cognitive behavioural therapy works well in over half of cases.
This leaflet is part of our series on anxiety and phobias
A panic attack is a severe attack of anxiety and fear which occurs suddenly, often without warning, and for no apparent reason. In addition to the anxiety, various other symptoms may also occur during a panic attack. These include one or more of the following:
The physical symptoms that occur with panic attacks do not mean there is a physical problem with the heart, chest, etc. The symptoms mainly occur because of an overdrive of nervous impulses from the brain to various parts of the body during a panic attack.
During a panic attack you tend to over-breathe (hyperventilate). If you over-breathe you blow out too much carbon dioxide which changes the acidity in the blood. This can then cause more symptoms such as confusion and cramps, and make palpitations, dizziness, and pins and needles worse. This can make the attack seem even more frightening, and make you over-breathe even more, and so on. A panic attack usually lasts 5-10 minutes, but sometimes they come in waves for up to two hours.
See separate leaflet called Panic Attack for more details.
At least 1 in 10 people have occasional panic attacks. If you have panic disorder it means that you have recurring panic attacks. The frequency of attacks can vary. About 1 in 50 people have panic disorder.
If you have panic disorder, you also have ongoing worry about having further attacks and/or worry about the symptoms that you get during attacks. For example, you may worry that the palpitations or chest pains that you get with panic attacks are due to a serious heart problem. Some people worry that they may die during a panic attack.
Panic attacks usually occur for no apparent reason. The cause is not clear. Slight abnormalities in the balance of some brain chemicals (neurotransmitters) may play a role. This is probably why medicines used for treatment work well. Anyone can have a panic attack, but they also tend to run in some families. Stressful life events such as bereavement may sometimes trigger a panic attack.
Some people with panic disorder worry about having a panic attack in a public place where it is difficult to get out of, or where help may not be available, or where it can be embarrassing. This may cause you to develop agoraphobia. About 1 in 3 people with panic disorder also develop agoraphobia.
If you have agoraphobia you have a number of fears of various places and situations. So, for example, you may be afraid to:
You may also develop other irrational fears. For example, you may think that exercise or certain foods cause the panic attacks. Because of this you may fear (develop a phobia) for certain foods, or avoid exercise, etc.
To ease a panic attack, or to prevent one from getting worse, breathe as slowly and as deeply as you can. Really focus on your breathing. Learning and using relaxation techniques may also help.
No treatment is needed if you have just an occasional panic attack. It may help if you understand about panic attacks. This may reassure you that any physical symptoms you get during a panic attack are not due to a physical disease. It may help to know how to deal with a panic attack.
Treatment can help if you have recurring attacks (panic disorder). The main aim of treatment is to reduce the number and severity of panic attacks.
An antidepressant medicine is the usual treatment. These usually work well to prevent panic attacks in more than half of cases. (These medicines are often used to treat depression, but have been found to work well for panic disorder too, even if you are not depressed.) They work by interfering with brain chemicals (neurotransmitters) such as serotonin which may be involved in causing symptoms of panic.
Note: after first starting an antidepressant, in some people some anxiety symptoms become worse for a few days before they start to improve.
If it works, it is usual to take an antidepressant for panic disorder for at least a year. At the end of a course of treatment, you should not stop an antidepressant suddenly, but you should reduce the dose gradually under the supervision of a doctor. In about half of people who are successfully treated, there is a return of panic attacks when treatment is stopped. An option then is to take an antidepressant long-term. The attacks are less likely to return once you stop antidepressants if you have had a cognitive behavioural course (see below).
This is a type of specialist talking treatment. It is probably the most effective treatment. Studies show that it works well for over half of people with panic disorder (and agoraphobia).
If you have CBT and it works, the long-term outlook may be better than with treatment with antidepressants. However, CBT may not be available in every area, and does not suit everyone.
A combination of CBT and antidepressants may work better than either treatment alone.