Panic Disorder




The panic disorder occurs when you have repeated (recurring) and unexpected panic attacks, without an obvious trigger.

All people can experience feelings of anxiety and fear at certain times in their life. It is a natural response to stressful or dangerous situations (Video). However, in individuals with panic disorder, feelings of anxiety, stress, and terror occur frequently, suddenly and spontaneously. In addition, persistent worry about having other panic attacks and the possible consequences (for example, fear of losing control, having a heart attack, etc.) appears.


Anxiety is a condition of excessive worry, intense apprehension. It can range from mild to severe and can include feelings of intense fear or dread.

There are several ways that anxiety can manifest itself and they include:

  • phobia, excessive or unreasonable fear of an object, a place, a situation, an animal
  • generalized anxiety disorder (GAD), excessive and constant anxiety and worry about various situations
  • post-traumatic stress disorder, a condition that leads to continually reliving a traumatic event that occurred in the past and is accompanied by marked disturbances of anxiety or excitability (for example, difficulty sleeping, irritability, hypervigilance, motor restlessness)

Panic attacks

A panic attack occurs when one feels suddenly, for no reason, in the throes of a very intense fear associated, often, with the fear of being about to die. Physical discomfort occurs during a panic attack, such as:

  • nausea or abdominal discomfort
  • sweating
  • tremors
  • palpitations, tachycardia
  • feeling of lack of air or suffocation

The number of panic attacks depends on the severity of the disease. Some people may have one or two every month; others, several a week.

They can be very scary and intense, but they are not dangerous. They cause no physical harm, and are unlikely to require hospitalization.

As with many mental health problems, the exact cause of panic disorder is also unclear. However, it is thought to be linked to a combination of physical and psychological factors.

Several diseases cause disorders (symptoms) similar to those of anxiety. For example:

  • mitral valve prolapse
  • postural orthostatic tachycardia syndrome (POT Syndrome), disorders that occur when passing from lying down to standing and include an abnormal and persistent increase in the number of heartbeats of approximately 30 per minute
  • anemia
  • paroxysmal atrial tachycardia, rapid and regular heartbeats that start and end abruptly
  • thyrotoxicosis, situation where large amounts of thyroid hormones are released into the bloodstream causing rapid heartbeat, sweating, tremors and anxiety
  • diabetes poorly controlled
  • adrenal tumors, growths that develop on the two triangular glands that are part of the kidneys (adrenal glands)
  • carcinoid syndrome, set of disorders (symptoms) caused by certain carcinoid tumors which can develop in the cells of the glands that produce and secrete hormones (endocrine system)
  • Zollinger-Ellison syndrome, a condition that causes an overproduction of insulin and a decrease in the concentration of sugar in the blood (hypoglycemia)

Panic disorder is considered established (diagnosed) when repeated (recurring) and unexpected attacks occur followed by a period of time, of at least one month, in which there is continued concern that they may recur and have serious consequences (for example, fear of having a heart attack or going crazy).

The treatment, which mainly consists of psychological therapy and the use of drugs, aims to reduce the number of attacks and to alleviate the severity of the ailments (symptoms).

For a full recovery it is important to seek medical help as soon as possible. The therapy, in fact, is much more effective if started as soon as the disorders present themselves (early). If left untreated, it can become debilitating, lead to social isolation and increase the risk of developing other mental health problems such as agoraphobia or other phobias.

Worldwide, around 3% of adults suffer from panic disorder in their lifetime.



The disorders (symptoms) caused by a panic attack can be very frightening and distressing and occur suddenly and for no apparent reason.

In addition to an overwhelming sense of anxiety, a panic attack can be accompanied by a variety of other annoyances, including:

  • palpitations, tachycardia
  • sweating
  • tremors
  • hot flashes
  • chills
  • shortness of breath, shortness of breath
  • feeling of suffocation
  • chest pain
  • nausea
  • feelings of skidding, of instability
  • feeling faint
  • numbness or tingling
  • abdominal pain
  • fear of dying
  • fear of losing control or to go crazy
  • feeling that things around are unreal or to be detached from oneself

The physical complaints (symptoms) of a panic attack are unpleasant and can also be accompanied by extreme fear or terror. Because of this, people begin to fear the next attack. Sometimes, they can be so intense that they feel like they are having a heart attack. However, even if a rapid heart rate and shortness of breath do appear, It is important to know that they are not the signs of a heart attack.Although frightening, panic attacks do not cause physical harm.

People who have been suffering from it for some time usually learn to recognize this "feeling of having a heart attack" and become more aware of ways to control it.

Most panic attacks last from five to 20 minutes, although there are reports of some attacks lasting up to one "hour. In these cases, it is likely that a second attack has occurred soon after the first or that the anxiety levels.

Recurring panic attacks

People with panic disorder have attacks that recur over time (recurring). In some, they occur once or twice a month; in others, several times a week. Because they can be very unpredictable, people who suffer from them can develop a constant state of anxiety as they wait for the next episode.


During an attack the disturbances (symptoms) can be so intense and out of control as to cause a feeling of detachment from the current situation, from one's body and from the surrounding environment. it's spectators only.
This phenomenon is known as depersonalization but it does not provide any relief and does not make the panic attack any less scary. On the contrary, it often makes the experience more disorienting.



The exact cause of panic disorder is not entirely clear but is believed to be a combination of physical and psychological factors which include:

Traumatic life experiences

A trauma such as, for example, a bereavement can sometimes trigger a panic attack that can appear immediately after the event or manifest itself unexpectedly after some time.


Having a close, 1st-degree family member with panic disorder increases your risk of being affected.


Neurotransmitters are chemicals that occur naturally in the brain. An imbalance of these is believed to increase the risk of developing panic disorder.

Increased sensitivity to carbon dioxide

Some experts speculate that panic disorder is linked to an increased sensitivity to carbon dioxide and that breathing air with high levels of this substance could trigger an attack. Breathing techniques, in this case, could help relieve, or stop, the attacks.

Catastrophic thinking

According to another theory, people suffering from panic attacks tend to focus on mild physical ailments (symptoms) and interpret them catastrophically as signs of a serious illness. panic attack.



Everyone who has panic disorder sooner or later experiences panic attacks. However, not all people who have had panic attacks also suffer from panic disorder because these episodes can also be classified into other types of disorders.


Some people have panic attacks in response to specific situations. For example, they may have an excessive or unreasonable fear of enclosed spaces (claustrophobia) and have a panic attack when they are in such a situation.

While most individuals with phobias experience panic attacks only when faced with the situation, or object, that triggers fear in them, episodes caused by panic disorder occur without warning and for no obvious reason.

In fact, panic disorder is considered established (diagnosed) only in the presence of recurrent and unexpected attacks followed by a period, of at least one month, in which there is the constant worry of having others or the fear of their consequences (for example, losing control, having a heart attack, fear of going crazy).

Talk to your doctor

Typically, the family doctor asks the person suffering from panic attacks to describe the disorders they are experiencing, how often they occur, and the situations in which they occur. While it can sometimes be difficult to talk to someone else about your emotions and life, try not to feel embarrassed. The doctor needs to understand well the disorders that have appeared in order to recommend a possible specialist study and the most appropriate treatment.

He may also prescribe tests to check that there are no diseases, such as an overactive thyroid (hyperthyroidism), possible causes of ailments similar to panic attacks. After ruling them out, your doctor may suggest that you see a mental health specialist to confirm that you have panic disorder.



Psychological and drug therapy are the two types of treatment for panic disorder. Depending on the individual circumstances, it may be necessary to use only one or both of them (read the Hoax).

If psychological therapy is prescribed, it will likely be cognitive behavioral therapy (CBT) (read the hoax). If this does not work, the use of a drug may be recommended. Before prescribing any type of treatment, the doctor will discuss the available alternatives with the person, explaining the benefits and any risks, or side effects, of each.

No therapy works the same for everyone and it may be necessary to try a number of them before finding the most suitable one. Recommended treatment will depend on your general level of health, the severity of the problem and your personal preferences.

Since it is important to understand what the treatment consists of and what it involves, it is advisable to ask the doctor to explain all aspects in a clear and detailed way.

Psychological therapy

Cognitive Behavioral Therapy (CBT)
This therapy has shown long-term benefits and is recommended for the treatment of panic disorder. Usually, it is recommended because scientific evidence is available on its effectiveness. It consists of regular meetings with an experienced therapist who discusses and explores, with the person suffering from panic disorder, the reactions and thoughts that have arisen during an attack.

Once you have identified all the negative and erroneous processes and beliefs, work to replace them with others that are more realistic and immersed in everyday life. The therapist can also indicate what to do to better cope with any future panic attacks. For example, it can teach you breathing techniques you can use to help keep calm.

The British National Institute for Health and Clinical Excellence (NICE) recommends a total of 7-14 hours of CBT to be done weekly and to be completed within a four month period. Treatment usually involves sessions of 1- 2 hours a week.
NICE also suggests that in certain situations a shorter but more intense CBT program (with more frequent sessions) or reinforced with informational and self-help material may be equally effective.

Self-help groups
Self-help groups are able to provide useful information and advice, and most importantly, support on how to cope and manage panic disorder. They are also a good way to meet other people who have had similar experiences and to discuss and support each other.

Panic attacks can sometimes be frightening and cause isolation. Knowing that other people experience the same emotions, therefore, can be important.

Self-help groups consist of meetings where you can talk to others about your problems and difficulties. Individuals can also provide and receive support and advice over the phone or in writing.

Pharmacological therapy

Antidepressants are mostly used to treat depression, but they can also be used to treat a number of other psychological conditions.

Antidepressant treatment (therapy) can take two to four weeks before it starts to show its effects. It is, therefore, important to continue taking them even if you feel they are not working. You should never stop taking them unless your doctor specifically advises them to do so.
The selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants are the two types of antidepressants often recommended for the treatment of panic disorder.

When you start taking a new type of medication, you should see your doctor to discuss any problems that may arise and allow him to assess which treatment is most effective and tolerated.

Selective Serotonin Reuptake Inhibitors (SSRIs)
Serotonin reuptake inhibitors (SSRIs) are a type of antidepressant that works by increasing the level of a chemical, called serotonin, in the brain. They are the most commonly prescribed type of antidepressant for the treatment of panic disorder. Usually, it starts with a low dose which is gradually increased as the body gets used to the drug.

The most common side effects of SSRIs include:

  • nausea
  • headache
  • loss of appetite
  • sweating
  • feeling of agitation
  • insomnia (sleep disorders)
  • intestinal pain
  • decreased sexual desire

When you start taking SSRIs, feelings of anxiety and panic may get worse. In most cases, this is a temporary phenomenon and the symptoms (symptoms) subsequently tend to improve within a few days. If they get worse and no signs of improvement appear, you need to talk to your doctor.

Once you have started taking an SSRI, it is recommended that you get checked by your doctor after two, four, six and twelve weeks so that he can check your progress and see if you are responding well to therapy. Not everyone has the same results with antidepressant medications, therefore, it is important that progress is closely followed (monitored) over time.

If the doctor deems it necessary, during therapy he may ask for regular blood tests or blood pressure checks. If there is no sign of improvement after twelve weeks of treatment, she may prescribe an alternative SSRI to see if it has any positive effects.

The duration of treatment varies depending on how well you respond to the treatment. Even if panic disorder is believed to have been successfully treated, it is likely that you will need to continue taking the drug for several more months. If therapy is stopped before this time, the risk of relapse may increase. Also, some people may need to take SSRIs for longer than the usual six to twelve month period.

When the doctor, in agreement with the patient, deems it appropriate to discontinue treatment with SSRIs, the discontinuation should be gradual by slowly reducing the dosage. You should not stop taking SSRI drugs on your own initiative but you should always follow the doctor's instructions how and when to do this to prevent withdrawal symptoms (symptoms) such as:

  • dizziness
  • numbness and tingling
  • nausea and vomit
  • headache
  • anxiety
  • sweating
  • insomnia (sleep disorders)

These disturbances can also occur when the dose is reduced. They are usually mild in nature but could occur severely if the drug is stopped suddenly and not gradually. For some people, this means having to take long-term SSRIs. In others, the risk of relapse can be reduced through the use of CBT.

If unwanted effects (side effects) occur that do not reduce over time, it is necessary to contact the attending physician.

Tricyclic antidepressants
If SSRIs are not suitable, or if your symptoms (symptoms) do not improve after a twelve-week course of treatment, your doctor may prescribe a different type of antidepressant.

Tricyclic antidepressants work in a similar way to SSRIs. They regulate the levels of certain neurotransmitters such as norepinephrine, resulting in a positive effect on feelings and mood and are not addictive. Imipramine and clomipramine are two tricyclic antidepressants often prescribed to treat panic disorder. SSRIs are usually prescribed before tricyclic antidepressants because they have fewer side effects.

Common side effects of tricyclic antidepressants are:

  • constipation
  • difficulty urinating
  • blurred vision
  • dry mouth
  • decreased sexual desire
  • weight gain
  • tachycardia
  • drowsiness
  • dizziness
  • memory difficulties

Such ailments should subside after 7-14 days of treatment as the body begins to get used to the drug. However, should they arise, it is always advisable to consult your doctor.

Pregabalin is another drug often used in panic disorder. It is an anticonvulsant also used to treat a disease that causes repeated seizures (epilepsy). However, its usefulness has also been recognized in anxiety therapy. Undesirable effects (side effects) of pregabalin can include:

  • drowsiness
  • dizziness
  • increased appetite and weight gain
  • blurred vision
  • headache
  • dry mouth
  • nausea
  • fatigue, tiredness

Pregabalin is less likely to cause nausea or decreased sex drive than SSRIs.

Clonazepam is another drug often used to treat epilepsy which is also sometimes prescribed for panic disorder. It can cause a wide variety of unwanted effects (side effects) including:

  • strong lack of energy (lethargy)
  • abnormal eye movements (nystagmus)
  • confusion
  • difficulty concentrating and sexual dysfunctions

Specialist consultation

The psychiatrist and clinical psychologist can evaluate the patient's condition by asking him if he has followed the treatments and if they have been effective and by gathering information about his life and the support he can rely on from family and friends.

The specialist will be able to devise a treatment plan that will aim to effectively treat the ailments.

The type of mental health specialist to refer to (read the hoax) will depend on the individual situation:

  • the psychiatrist, is a qualified physician specializing in mental health; is one of the few mental health specialists who can prescribe drugs
  • the clinical psychologist is trained in the study of behavior and underlying mental processes; it helps to find ways to effectively manage anxiety and panic attacks


There are several self-help techniques that you can use on your own to help reduce the symptoms of panic disorder. They include:

Stay where you are
If possible, during a panic attack you should stay where you are. The attack can last up to an hour, so if you are driving you should pull over the car or motor vehicle, taking them out of the flow of traffic and, if possible, park them where it is allowed to do so.

If you are having a panic attack, it can be helpful to remind yourself that the terrifying thoughts and feelings will sooner or later pass and that what is being perceived is not real. It is also advisable to try to focus on something concrete, clearly visible and non-threatening such as, for example, the clock face with the hands that mark the passing of time or a product displayed in a supermarket.

Slow and deep breathing
When the panic attack is in progress, try to breathe slowly and deeply for a count of three during each inhalation and exhalation. Panic and anxiety, in fact, can worsen if you breathe too quickly.

Challenge your fear
During a panic attack, one should try to identify one's fear and challenge it by constantly reminding oneself that it is unrealistic and will soon pass.

Creative visualization
Many things can go through the mind during a panic attack, for example, some people think about catastrophes and death. Instead of focusing on negative thoughts, it is advisable to shift your attention to positive and relaxing images. Think of a place or situation that makes you feel calm, relaxed and at ease. Once identified, focus on it. distract yourself and help alleviate any complaints (symptoms).

Thinking positively can be difficult, especially if you haven't been used to it for a long time. Creative visualization is a technique that takes practice but, over time and gradually, it can bring about positive changes in the way you think about yourself and others.

Don't fight a panic attack
Fighting a panic attack can often make the situation worse. Trying to resist the attack and failing can increase the sense of anxiety, frustration and panic.

It is best to reassure yourself by remembering that although it may seem embarrassing and the ailments (symptoms) may be difficult to deal with, the attack is not life-threatening and will soon pass.

If you have panic disorder, you may feel constantly worried and fearful waiting for another episode to occur. Learning to relax can help relieve your distress and more effectively cope with panic attacks when they do occur. .

Some people choose some complementary therapies, such as massage and aromatherapy, to try to relax. Even activities such as yoga and pilates they can be useful. In addition, to alleviate the ailments (symptoms), it is possible to practice slow breathing and relaxation techniques to use them in the event of a panic attack.

Physical activity
Practicing regular physical activity, especially aerobic exercise, can help reduce stress and eliminate or release tension. It can also stimulate the brain to release serotonin which helps improve mood.

Unless otherwise instructed by the treating physician, it is recommended that adults aged 19-64 do at least 150 minutes (2 hours 30 minutes) of moderate-intensity aerobic activity, such as cycling or brisk walking, each week. In addition, strength training of all major muscle groups (legs, hips, back, abdomen, chest, shoulders and arms) should also be performed two or more days a week.

If you have not exercised for a long time, or you have never exercised before, before starting a new physical activity program it is advisable to visit your doctor who, based on the state of health detected, can indicate the the type and intensity of physical activity to practice and the one to avoid.

Too high or too low blood sugar levels can contribute to the manifestation of the disorders (symptoms) that characterize a panic attack. Therefore, it is necessary to maintain a healthy and balanced diet, to eat regularly and not to abuse sugary foods and drinks. In addition, caffeine, alcohol, and smoking should be avoided, as they can help trigger attacks.



Panic disorder is a treatable disease and it is very important to contact a mental health specialist as soon as possible to start treatment in order to be cured.

If left undiagnosed (diagnosed) and untreated, panic disorder can become a debilitating and isolating disease. It can also increase the risk of developing other psychological problems.

Agoraphobia and other phobias
Agoraphobia is the fear of being in situations (open or closed places) from which it is difficult to escape, get away quickly or receive help. Many people with agoraphobia avoid daily activities such as, for example, taking a bus or going to a shopping center. They fear that if a panic attack occurs, they will find themselves in an embarrassing situation and have difficulty getting help if they need it. They may also be worried that they are in places, such as a moving train, from which it is possible to escape if a panic attack occurs.In some cases they may also have difficulty leaving the house, especially if not accompanied by a family member or friend.

People with panic disorder can also develop other fears and phobias that can often seem irrational. For example, experiencing "excessive anxiety in the presence of a particular animal, object or action" that promotes attacks.

Panic disorder is more common in teenagers than in children.

Attacks can be particularly debilitating in children and young people and, if severe, can affect their development and learning ability. Fear of having a panic attack can cause you to stop going to school, have social relationships, and cause difficulty concentrating on schoolwork.

To ascertain (diagnose) panic disorder in children, it is necessary to collect detailed information on their state of health, present and past (anamnesis), and carry out a complete examination to exclude any other physical causes that may present with the same disorders (symptoms). Investigations may also be needed to ascertain whether other anxiety disorders are causing panic attacks.

Panic attacks in children are often dramatic events and can manifest themselves with screaming, crying, and increased breathing rate (hyperventilation).

If the child shows the signs and symptoms of panic disorder for an extended period of time, the family doctor may refer you to a specialist for further evaluation and treatment.

The specialist may recommend psychotherapy for the child, such as cognitive-behavioral therapy (CBT).

Drugs and alcohol abuse
Studies have shown that situations that cause intense anxiety, such as panic disorder, can also increase the risk of developing alcohol or drug problems.

Also, the side effects, or withdrawal symptoms, of some medications and the effects of drugs can increase anxiety symptoms. Since smoking and caffeine can also make them worse, you should try to quit smoking. ) and limit the amount of caffeine in the diet.

In-depth link

In-depth link

Association Free from Panic and Anxiety (ALPA)

Italian League against Anxiety Disorders, Agoraphobia and Panic Attacks (LIDAP) Onlus

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