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Your Guide to Anxiety and Panic Disorders

Anxiety and panic disorders are not the same as the normal level of anxiety all of us feel at some time or another. These disorders are much more disturbing and much more overwhelming, to the point where the person may feel they are unable to function. It is estimated that nearly 40 million Americans over the age of 18 years suffer from some form of anxiety and panic disorder every year.(1, 2)

Anxiety and panic disorders happen when you start experiencing recurring and unexpected panic attacks, and you start living your life with a constant fear of having these panic attacks. A good example of what a panic attack feels like is when you feel a sudden and overwhelming dread or fear that has no known cause. You are likely to experience physical symptoms as well, such as breathing difficulties, excessive sweating, and a racing heart. While most people have a panic attack only once or twice in their lifetime, others experience these attacks much more frequently and many times without any apparent cause.

Your Guide to Anxiety and Panic Disorders

A person is diagnosed with anxiety or panic disorder when they go through at least one month of continuous dread or fear about having recurring panic attacks. However, even though it may feel very overwhelming and scary, the symptoms of anxiety and panic disorders can be managed and brought under control with treatment. Here is a complete guide to anxiety and panic disorders.

Understanding the Symptoms of Panic and Anxiety Attacks

According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), a panic or anxiety attack is defined as a sudden and intense feeling of overwhelming fear or immense discomfort that reaches a peak in just a few minutes.(3, 4)

Panic attacks can produce feelings of intense fear that starts suddenly and usually with no warning. A typical attack can last for anywhere between 5 to 20 minutes, but in extreme cases, the symptoms may continue for over an hour. The exact experience varies for everyone, and the symptoms may also vary from person to person.(5)

Some of the common symptoms people experience with anxiety and panic attacks include:

In some cases, an anxiety attack might be triggered by a specific event or some type of external stimuli. Or, it is also possible that you experience the symptoms of an anxiety attack for no apparent reason. Usually, the symptoms of such an attack are never proportionate to the level of actual danger that you might be in or that is there around you.(6, 7)

Due to their unpredictable nature, panic attacks have a major impact on your day-to-day life. Some people even experience panic attacks at work, at home, or in public when they are out with friends. Your doctor will typically diagnose you with an anxiety or panic disorder if you experience four or more panic attacks or you are living in fear of having an attack after having had the first one. The basic criteria for being diagnosed with panic/anxiety disorder is that you should experience these panic attacks unexpectedly.(8, 9, 10)

Causes of Anxiety and Panic Disorders

The causes of panic disorder are entirely understood, and research is still ongoing on this subject. Here are some of the possibilities that are believed to be responsible for developing panic and anxiety disorder.

  • Genetics: According to research, your genes are the ones that make you more susceptible to developing an anxiety disorder. A study from 2020 found that panic disorder may have a genetic connection. Researchers discovered 40 genes that are believed to be connected to panic disorder. Most of these genes were found to be connected to the system of neurotransmitters in the body, which are responsible for managing the communication process between the nerve cells. The research team said that these biomarkers could prove to be useful in diagnosing panic disorder.(11)
  • Life Changes: Anxiety and panic disorders are typically associated with major life changes and stressful events such as arguing with your spouse, going through a divorce, leaving home for college, starting a new job, getting married, death of a loved one, moving, having a child, etc. Sometimes, even when these life changes are positive, they can still create new stressors and challenges, triggering a panic attack. This is why it is so important that you take care of your physical and mental health during periods of change in your life. Having the support of loved ones can help a great deal in keeping such attacks at bay.
  • Anxiety: If you have a tendency to be anxious, having panic attacks and anxiety disorder is much more likely. In the DSM-5, panic attacks are listed under anxiety disorders. Both panic and anxiety disorders are known to be long-term conditions. Anxiety can show up as being nervous, worried, or overwhelmed. While it is normal for a person to feel anxious sometimes, but people who feel anxious all the time should consider consulting a doctor.

Treatment Options for Anxiety and Panic Disorders

Treatment for anxiety and panic disorders revolves around eliminating or at least reducing the symptoms. This can be approached through lifestyle changes, therapy, and medication if required.

Therapy for anxiety and panic disorders usually includes cognitive behavioral therapy (CBT). CBT is a type of therapy that teaches you to change the pattern of your thinking and actions so that you are able to better understand your anxiety and panic attacks and be able to manage the fear.(12, 13)

Medications, if needed, may include a class of drugs known as selective serotonin reuptake inhibitors (SSRIs), which are a type of antidepressant. SSRIs that are usually prescribed for anxiety and panic disorders include fluoxetine (brand name: Prozac), paroxetine (brand name: Paxil), and sertraline (brand name: Zoloft).

There are many other medications as well that may be prescribed for treating such disorders, including serotonin-norepinephrine reuptake inhibitors (SNRIs), monoamine oxidase inhibitors (MAOIs), and benzodiazepines.(14, 15, 16)

Apart from these treatments, you can also make some positive lifestyle changes to reduce and manage your symptoms. These include:

  • Get regular exercise
  • Maintain and follow a regular schedule
  • Get enough sleep
  • Avoid stimulants like caffeine, especially before bedtime
  • Eat a well-balanced and healthy diet
  • Try to reduce your stress levels

Conclusion

Anxiety and panic disorders can be long-term disorders that are challenging to treat. It is not possible to completely cure these disorders, but treatment can help manage and reduce the symptoms. Cognitive behavioral therapy, working towards reducing your stress levels, exercising regularly, and taking medication if needed are some of the potential options. If you find yourself living in fear of experiencing an attack, it is better to seek professional help for your panic and anxiety attacks.

References:

  1. Weissman, M.M. and Merikangas, K.R., 1986. The epidemiology of anxiety and panic disorders: an update. The Journal of clinical psychiatry.
  2. Bandelow, B. and Michaelis, S., 2022. Epidemiology of anxiety disorders in the 21st century. Dialogues in clinical neuroscience.
  3. Abuse, S. and Administration, M.H.S., 2016. Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health.
  4. Anon, Panic disorder. HSE.ie. Available at: https://www2.hse.ie/conditions/mental-health/panic-disorder.html [Accessed August 29, 2022].
  5. Schenberg, L.C., Bittencourt, A.S., Sudré, E.C.M. and Vargas, L.C., 2001. Modeling panic attacks. Neuroscience & Biobehavioral Reviews, 25(7-8), pp.647-659.
  6. Hayward, C., Killen, J.D., Kraemer, H.C. and Taylor, C.B., 2000. Predictors of panic attacks in adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, 39(2), pp.207-214.
  7. Sheehan, D.V., 1982. Panic attacks and phobias. New England Journal of Medicine, 307(3), pp.156-158.
  8. Li, W. and Zinbarg, R.E., 2007. Anxiety sensitivity and panic attacks: a 1-year longitudinal study. Behavior Modification, 31(2), pp.145-161.
  9. Roy-Byrne, P.P., Craske, M.G. and Stein, M.B., 2006. Panic disorder. The Lancet, 368(9540), pp.1023-1032.
  10. AGRAS, W.S., 1987. Panic attacks in the natural environment.
  11. Tretiakov, A., Malakhova, A., Naumova, E., Rudko, O. and Klimov, E., 2020. Genetic biomarkers of panic disorder: A systematic review. Genes, 11(11), p.1310.
  12. Barlow, D.H., 1997. Cognitive-behavioral therapy for panic disorder: current status. Journal of Clinical Psychiatry, 58(2), pp.32-37.
  13. Allen, L.B., White, K.S., Barlow, D.H., Shear, M.K., Gorman, J.M. and Woods, S.W., 2010. Cognitive-behavior therapy (CBT) for panic disorder: Relationship of anxiety and depression comorbidity with treatment outcome. Journal of Psychopathology and Behavioral Assessment, 32(2), pp.185-192.
  14. Quagliato, L.A., Freire, R.C. and Nardi, A.E., 2018. Risks and benefits of medications for panic disorder: a comparison of SSRIs and benzodiazepines. Expert opinion on drug safety, 17(3), pp.315-324.
  15. Nadiga, D.N., Hensley, P.L. and Uhlenhuth, E.H., 2003. Review of the long‐term effectiveness of cognitive behavioral therapy compared to medications in panic disorder. Depression and anxiety, 17(2), pp.58-64.
  16. Bruce, S.E., Vasile, R.G., Goisman, R.M., Salzman, C., Spencer, M., Machan, J.T. and Keller, M.B., 2003. Are benzodiazepines still the medication of choice for patients with panic disorder with or without agoraphobia?. American Journal of Psychiatry, 160(8), pp.1432-1438.
Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:September 23, 2022

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