Anxiety Disorders

Panic Disorder

Panic disorder is characterized by recurrent, unexpected panic attacks — sudden episodes of intense fear that peak within minutes. People with panic disorder live in fear of the next attack and may change their behavior to avoid situations where attacks have occurred. It often co-occurs with agoraphobia.

Symptoms

Sudden episodes of intense fear or discomfort

Heart palpitations or racing heart

Sweating, trembling, or shaking

Shortness of breath or feeling of choking

Chest pain or discomfort

Nausea or abdominal distress

Dizziness or lightheadedness

Chills or hot flashes

Numbness or tingling sensations

Feeling of unreality (derealization) or being detached (depersonalization)

Fear of losing control or going crazy

Fear of dying

Persistent worry about future attacks

Avoidance of places where attacks occurred

Causes

Genetic predisposition
Overactive fight-or-flight response
Brain chemistry imbalances (norepinephrine, serotonin, GABA)
Major life transitions or stressful events
History of childhood abuse or trauma
Caffeine and stimulant use
Medical conditions (mitral valve prolapse, thyroid disorders)

Diagnosis

Diagnosis requires recurrent unexpected panic attacks with at least 1 month of persistent concern about additional attacks or significant behavioral changes. Must rule out medical conditions (cardiac, thyroid, respiratory) and substance-induced panic. ECG and blood tests help exclude physical causes.

Treatment Options

SSRIs: Sertraline, Paroxetine, Escitalopram (first-line)

SNRIs: Venlafaxine

Benzodiazepines for acute attacks: Alprazolam, Clonazepam (short-term)

Cognitive Behavioral Therapy with exposure (gold standard)

Interoceptive exposure (deliberately inducing panic-like sensations)

Breathing retraining and relaxation techniques

Lifestyle changes: reduce caffeine, regular exercise, adequate sleep

When to Seek Help

Seek help if you've had recurring panic attacks, if you live in fear of the next attack, if you're avoiding places or situations due to panic, or if panic symptoms are interfering with your daily life.

Your Action Plan

1.Step 1: KNOW THIS: A panic attack CANNOT kill you. It CANNOT cause a heart attack. It WILL pass within 10-30 minutes. Your body physically cannot sustain the response longer than this

2.Step 2: Get proper diagnosis — rule out medical causes once, then trust the diagnosis

3.Step 3: Start CBT with interoceptive exposure — this is the MOST effective treatment

4.Step 4: During an attack: slow breathing (4 in, 7 hold, 8 out), focus on a single external object, remind yourself 'this is panic, not danger, it will pass'

5.Step 5: Stop safety behaviors: carrying medication 'just in case', avoiding places, needing someone with you — these MAINTAIN the disorder

6.Step 6: Deliberately practice interoceptive exposure: breathe through a straw, spin, run in place — prove to your brain that body sensations are not dangerous

7.Step 7: Consider SSRI medication if attacks are frequent — takes 4-6 weeks but very effective

8.Step 8: Reduce caffeine (significant trigger), maintain regular sleep, and exercise regularly (reduces baseline arousal)

9.Step 9: Join a panic disorder support group — others understand what you're experiencing