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PANIC DISORDER |
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MARIA DEL PILAR YAG�E, R.N.
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PANIC DISORDER
"All of a sudden, I felt a tremendous wave of fear
As described above, the symptoms of a panic attack appear
suddenly,
without any apparent cause. They may include
A panic attack typically lasts for several minutes and is one of
the
most distressing conditions that a person can experience. Most
who
have one attack will have others. When someone has repeated
attacks,
or feels severe anxiety about having another attack, he or she is
said
to have panic disorder.
Panic disorder is a serious health problem in this country. At
least
1.6 percent of adult Americans, or 3 million people, will have
panic
disorder at some time in their lives. The disorder is strikingly
different from other types of anxiety in that panic attacks are
so
sudden, appear to be unprovoked, and are often disabling.
Once someone has had a panic attack--for example while driving,
shopping in a crowded store, or riding in an elevator--he or she
may
develop irrational fears, called phobias, about these situations
and
begin to avoid them. Eventually, the pattern of avoidance and
level
of anxiety about another attack may reach the point where the
individual with panic disorder may be unable to drive or even
step out
of the house. At this stage, the person is said to have panic
disorder with agoraphobia. Thus panic disorder can have as
serious an
impact on a person's daily life as other major illnesses--unless
the
individual receives effective treatment.
Yes, panic disorder is real and potentially disabling, but it can
be
controlled with specific treatments. Because of the disturbing
symptoms that accompany panic disorder, it may be mistaken for
heart
disease or some other life-threatening medical illness. People
frequently go to hospital emergency rooms when they are having a
panic
attack, and extensive medical tests may be performed to rule out
these
other conditions.
Others often try to reassure the person who is having a panic
attack
that he or she is not in great danger. Expressions such as
"nothing
serious," "all in your head," or "nothing to worry about" may
give
the incorrect impression that there is no real problem and that
treatment is not possible or necessary.
Thanks to research, there are a variety of treatments available,
including several effective medications, and also specific forms
of
psychotherapy. Often, a combination of psychotherapy and
medications
produces good results. Some improvement may be noticed in a
fairly
short period of time--about 6 to 8 weeks. Thus appropriate
treatment
of panic disorder can prevent panic attacks or at least
substantially
reduce their severity and frequency--bringing significant relief
to 70
to 90 percent of people with panic disorder.
In addition, people with panic disorder may need treatment for
other
emotional problems. Depression has often been associated with
panic
disorder, as have alcohol and drug abuse. Recent research also
suggests that suicide attempts are more frequent in people with
panic
disorder. Fortunately, these problems associated with panic
disorder
can be overcome effectively, just like panic disorder itself.
Tragically, many people with panic disorder do not seek or
receive
treatment.
Panic disorder tends to continue for months or years. It
typically
begins in young adulthood, but the symptoms may arise earlier or
later
in life. If left untreated, it may worsen to the point where the
person's life is seriously affected by panic attacks and by
attempts
to avoid or conceal them. In fact, many people have had problems
with
friends and family or lost jobs while struggling to cope with
panic
disorder. It does not usually go away unless the person receives
treatments designed specifically to help people with panic
disorder.
So, if you or someone you know has symptoms like those described
in
this brochure, it is important to see a health care professional
for a
correct diagnosis and proper treatment.
According to one theory of panic disorder, the body's normal
"alarm
system" tends to be triggered unnecessarily. Scientists don't
know
exactly why this happens. Panic disorder has been found to run
in
families, and this may mean that inheritance (genes) plays a
strong
role in determining who will get it. However, many people who
have no
family history of the disorder develop it. Often the first
attacks
are triggered by physical illnesses, a major life stress, or
certain
medications.
NIMH supports research with animals and humans to learn more
about the
causes of panic disorder and to find better ways of controlling
it.
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TREATMENT FOR PANIC DISORDER
This brochure is for people who want to find out whether they or someone they know may have
panic disorder and how it can be treated most effectively. It may be helpful to refer to this
pamphlet when consulting with a health care professional.
Also in this brochure, three people with panic disorder comment on how treatment has helped
them regain their lives.
Chuck, 51, Copy Editor, Indiana (photo omitted):
Laura, 42, Travel Agent, California (photos omitted):
Lisa, 9, Laura's Daughter:
Tammy, 34. Administrative Assistant, New York (photo omitted):
Do you experience sudden episodes of intense and overwhelming fear that seem to come on for
no apparent reason?
During these episodes, do you also experience several of the following:
During these episodes, do you have the urge to flee, or the feeling that you need to escape?
During these episodes, do you think something terrible might happen--that you might die, have a
heart attack, suffocate, lose control, or embarrass yourself?
Do you worry a lot about these episodes or fear that they will happen again? And does this fear
cause you to avoid places or situations that you think might have triggered the attack?
If you answered yes to most of these questions, chances are you are suffering from panic disorder.
If so, you are not alone.
Panic disorder is very different from everyday anxiety. More than 3 million American adults have,
or will have, panic disorder. Most frequently, it starts in young adulthood. Usually, it does not
go away by itself. But with proper treatment, people with panic disorder can be helped.
Repeated episodes of fear--commonly called panic attacks--that are typical of panic disorder can
be devastating. The panic attacks, or avoidance of them, can completely take control of your life.
You do not have to live this way. You need to know that panic disorder is treatable . In fact,
proper treatment reduces or completely prevents panic attacks in 70 to 90 percent of people.
Many people feel substantial relief in just weeks or months.
Unfortunately, some people are reluctant to pursue treatment. Perhaps they think their condition
is not serious. Perhaps they feel embarrassed. They may blame themselves or have trouble asking
for help. Perhaps they dislike the idea of medication or therapy. Or, maybe they have sought help
but are frustrated because their condition was not diagnosed or treated effectively.
Do not let these or any other reasons stop you from getting proper treatment. If you have panic
disorder, you should get whatever help is necessary to overcome it, just as you would for any
serious medical illness.
Do not be discouraged if some people say, "It's nothing to worry about," "It's just stress," "It's all
in your head," or "Snap out of it." While they often mean well, the fact is that most people who
do not have panic disorder do not understand that it is REAL and, therefore, tend to doubt its
seriousness.
Most importantly, do not try to numb the effects of panic attacks with alcohol or other drugs.
This will only make the problem worse.
Since panic disorder can mimic a variety of medical conditions, such as heart problems and
digestive complaints, the first thing you should do is have a full medical evaluation.
Although it is important for you and your doctor to concentrate on your physical symptoms, you
should not overlook other aspects of your attacks. You may want to re-read the questions at the
beginning of this pamphlet and tell your doctor anything you notice about how your attacks make
you feel and when they usually occur.
Information on both the physical and emotional aspects of the attacks can be very useful to the
doctor in making a diagnosis. For example, the doctor will want to know if your attacks, or fear
of having attacks, keep you from carrying out any of your normal activities.
Many people with panic disorder also suffer from depression--feelings of intense sadness, even
hopelessness. Depression is accompanied by an impaired ability to think, concentrate, and enjoy
the normal pleasures of life. Be sure to make your doctor aware of these symptoms as well. If
you have been drinking or using drugs to try to control your symptoms, let your doctor know
about that too.
Once you have been properly diagnosed, your doctor--perhaps in consultation with a mental
health specialist--can help you determine which treatment is best for you.
Treatment for panic disorder can consist of taking a medication to adjust the chemicals in your
body--just as you might take medicine to correct a thyroid imbalance.
Or treatment might involve working with a psychotherapist to gain more control over your
anxieties--just as some people work with specialists to learn techniques to control migraine
headaches or lower their blood pressure.
Research shows that both kinds of treatment can be very effective. For many patients, the
combination of medication and psychotherapy appears to be more effective than either treatment
alone. Early treatment can help keep panic disorder from progressing.
Cognitive-behavioral therapy (CBT) teaches you to anticipate and prepare yourself for the
situations and bodily sensations that may trigger panic attacks. CBT usually includes the
following elements:
CBT generally requires at least 8 to 12 weeks. Some people may need a longer time in treatment
to learn the skills and put them into practice. Most panic disorder patients are successful in
controlling or preventing their panic attacks after completing treatment with CBT.
CBT requires a motivated patient and a specially trained therapist. Make sure any therapist
you work with has proper training and experience in this method of panic disorder treatment.
Indeed, in some parts of the country, you may find limited access to professionals trained and
experienced in CBT.
Several types of medication that alter the ways chemicals interact in the brain can reduce or
prevent panic attacks and decrease anxiety. Two major categories of medication that have been
shown to be safe and effective in the treatment of panic disorder are antidepressants and
benzodiazepines.
Each medication works differently. Some work quickly and others more gradually. All of them
have to be taken on a regular basis. Usually, treatment with medication lasts at least 6 months to
a year. But within 8 weeks, you and your doctor should be able to assess whether it's effectively
blocking the panic attacks. More details on medications can be found in the brochure
"Understanding Panic Disorder." To get a copy, see the back of this pamphlet.
Clinical experience suggests that for many patients with panic disorder, a combination of CBT and
medication may be the best treatment. The National Institute of Mental Health (NIMH) is
conducting a large study to confirm this and to help determine the kinds of patients most likely to
need combined therapy.
Various types of health professionals may have the training and experience needed to treat panic
disorder. Sometimes panic disorder patients are treated by two health care professionals--one
who prescribes and monitors medication and another who provides CBT.
Each professional will use the treatments with which he or she is most familiar and successful. It
is vital to choose a professional who is trained and experienced in the treatment methods
described earlier; it is equally important to choose someone with whom you feel comfortable.
Many people begin looking for treatment by visiting their family doctor or a local clinic or health
maintenance organization. Other places to seek help include your local health department or
community mental health clinic. If there is a university near you, you may wish to ask about
participating in a panic disorder study. Many universities have ongoing treatment research
programs in their psychology or psychiatry departments that may provide care at less expense.
From the beginning, it is important to be a full participant in your treatment. Be active and
assertive. Ask questions. Maintain open communication with your treatment professional and let
him or her know your concerns.
Every patient responds differently, but it is important to know that none of the treatments for
panic disorder works instantly. So, you must stick with a particular treatment for at least 8 weeks
to see if it works. If you do not see significant improvement within that time, you and your
treatment professional can adjust your treatment plan. It may take a bit of trial and error before
you find what works best for you. Be patient and be sure to communicate with your treatment
professional. Of course, if at any time you feel uncomfortable with the professional you have
chosen or don't think your treatment is going well, you should feel free to consider seeking a
second opinion or even changing providers.
If your treatment involves medication, talk with your doctor about how often and in what manner
your dosage will be monitored. No matter what medication you are taking, your doctor is likely
to start you on a low dose and gradually increase it to the full dose. You should know that every
medication has side effects, but they usually become tolerated or diminish with time. If side
effects become a problem, the doctor may advise you to stop taking the medication and to wait a
week or so before trying another medication. When your treatment is near an end, your doctor
will taper the dosage gradually.
Patient-run support groups can be a rich source of information for people with panic disorder.
These groups typically involve 5 to 10 people who meet weekly to talk about their experiences,
encourage each other, and share tips on coping strategies and local treatment resources.
Sometimes, family members are invited to attend.
The NIMH Referral List can help you find a support group in your area. If there are no groups
near you, you may want to form your own. Some of the sources listed can aid you in doing this.
NIMH also has a Resource List that provides some self-help information about panic disorder,
including books, articles, and videotapes.
Another way to get help is to enlist the support of friends and family members. You may want to
share this booklet and other materials with them so they can better understand panic disorder and
its treatment.
Panic disorder is far too serious--and far too treatable--to delay getting help. Recognizing the
situation is the first step to recovery.
Now take the next step. If you think you may have panic disorder, act now. See your health
professional for a diagnosis and then follow the suggestions in this booklet for making your
treatment successful. Educate yourself about your condition. The more you know about panic
attacks and panic disorder, the better you will understand your role in treatment.
Remember, Panic Disorder Is Very Treatable. You Can Get Better.
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