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Panic Disorder
Overview

Panic disorder is one of the most common mental disorders in the United States. Anxiety and panic can be miserable. If you suffer from anxiety, you may feel very alone. Actually, there are around 40 million adults in the United States that suffer from some type of panic disorder. There are several different causes and the condition is very manageable with proper treatment and support. This article explains more about panic disorder and some helpful lifestyle tips to help.

What is Panic Disorder?

Panic disorder is when you feel fear and terror that cannot be controlled for no apparent reason. You may be reading a book, watching a quiet TV program, or driving in your car. They can happen anywhere at any time and have a tendency to reoccur. This results in persistent fear of “panic attacks,” so people that suffer from them may change the things they do to try and avoid them.
Living in fear of panic attacks can severely affect the quality of life in the sufferer. If you have them at the grocery store, you may have someone else do your shopping. If you have them while driving, you may limit your driving. Some avoid social situations and people with severe cases may even avoid leaving the house altogether. It can disable some people and they are unable to attend work or school.
There are a few different “types” of panic disorders and they vary by severity and how often they occur:
Generalized Anxiety Disorder – GAD. This is ongoing anxiety for most of the day every day. Some people even experience anxiety at night in their sleep. Nothing seems to trigger the anxiety, it is just there.
Panic Disorder. These are anxiety attacks that come on severe and sudden. It may happen just a few times a day or repeatedly in cycles. Periods in between attacks may be calm and you may feel just fine until the next attack hit. Panic attacks usually have triggers like; getting in the car, going certain places, or situations.
Social Anxiety Disorder. This anxiety comes on in large crowds of people, in shopping areas, concerts, or even small gatherings.
The condition can last for weeks, to months, to even years if left untreated. Many people don’t recognize the symptoms of panic disorder and suffer in silence.

Panic Disorder Symptoms

The symptoms of panic disorder are pretty straightforward, but some people may have more than just the common symptoms. Here is a comprehensive list of panic disorder symptoms:

Intense fear
Sweating
Feeling cold
Feeling smothered
Trouble breathing
Feeling faint
Nausea
Feeling disconnected
Feeling like you want to curl up into a ball
Trouble concentrating. Feeling like your brain is shutting down
Feelings of doom
Trouble hearing. Plugged ears.
Excessive yawning
Headaches
Irregular heartbeats – Palpitations

Feeling like you need to run or get somewhere quickly
Hot flashes
Choking sensations
Fast heart rate
Chest Pain
Numbness in hands and feet
Feeling disoriented
Fear of dying
Chest pressure
Burning sensations
Focus is only on the symptoms
Passing gas
Blurred vision
Frequent urination or bowel movements
Dry mouth

You may feel like the symptoms will last forever or that you may die from the attack. Actually, a panic attack usually doesn’t last for more than 10 minutes and true panic attacks are in no way life-threatening. The attacks usually come on suddenly in a spike fashion and then go away slowly. Some people will feel very tired after the attack or continue to be “on edge” for hours.
Panic attacks can mimic the symptoms of other disorders and some people feel like they are having a heart attack, stroke, or other life-threatening condition. This is why it is very important that the first time you experience these symptoms, especially with chest pain and pressure, that you get emergency medical help right away. If you are given the “all clear” that you’re physically okay, make an appointment with your doctor as soon as possible for a full physical examination.

Panic Disorder Causes

There can be many different causes of panic disorder that are unrelated to any illness or condition. Some of the causes include:

Family History of Anxiety
Reaction to normal secretion of adrenaline in the body
Stress
Emotional or physical trauma – PTSD
Environment

Conditions That Have Anxiety as a Symptom

Sometimes, anxiety and panic disorder can actually be a symptom of certain conditions or illness. This is why it is important to see a doctor for a full physical evaluation. Anxiety can be a symptom of:

Hyperthyroidism
Adrenal Gland Tumor – Pheochromocytomas
Estrogen Imbalance in women
Lyme Disease
Strep Infection
Vitamin B12 Deficiency
Head Trauma
Wilson’s Disease – Copper Metabolism Disorder
Electrolyte Disturbance – Potassium, Magnesium, Calcium
Street Drug and Alcohol Use

How is Panic Disorder Diagnosed?

When you see your regular doctor, they will take a health history, medications, and family history. The doctor will do a physical examination and order tests to check your physical health and check for other conditions that can cause anxiety and panic disorder. These tests may include:
Thyroid testing
EKG
Testing on your Adrenal glands – CT scan to check for tumors, 24 hour urine for catecholamine’s (the chemicals in your body that can make you anxious).
Female Hormone levels – Estrogen, Progesterone
Lyme disease testing
Electrolytes – Magnesium, Potassium, Calcium
Vitamin B12 levels

And other testing your doctor may think is needed. If your physical health checks out okay, your doctor may evaluate you for panic disorder. The diagnosis of true panic disorder is based on the following criteria:
1. Your panic attacks are unrelated to your health, substance abuse, or other mental health condition.
2. You have frequent panic attacks that are unexpected and cannot be explained
3. At least one panic attack is followed by one month or longer of worry about panic attacks, feeling like you are losing control, or you develop avoidant behaviors.
The doctor may still choose to treat you for an anxiety disorder even if you are not diagnosed with one. Even infrequent panic attacks can develop into a full blown debilitating panic disorder.

Panic Disorder Treatment

Panic disorder usually benefits well from a combination of treatments. You may need medication in the beginning to help bring the anxiety under control. This combined with behavioral techniques to control the anxiety can help relieve the panic attacks. If you only have mild panic disorder, you may only need some therapy and behavioral techniques. Treatments include:
Therapy. A trained counselor or psychologist can help you talk out your feelings. They can also teach you “Cognitive Behavioral Therapy” techniques to help you control the attacks. These help you overcome the actual “fear of fear.” Therapy can takes months to be effective, but lasts for long-term.
Medication. There are several different medications that can help reduce panic attacks and possible underlying symptoms of depression. These include:
Benzodiazepines. These help short-term to stop acute panic attacks. They are usually only used during the period antidepressants take to start working, from 4 to 6 weeks. They are used as little as possible due to side-effects and risk of dependence.
Selective Serotonin Reuptake Inhibitors – SSRI’s. These work to block the reuptake of serotonin in the brain and nervous system cells. This helps to balance the chemicals that make you feel better and calmer.
Selective Norepinephrine Reuptake Inhibitors – SNRI’s These work to block the reuptake of norepinephrine in the brain and nervous system cells. They are more potent than SSRI’s, but tend to work well for anxiety.
Your doctor may actually try a combination of medications to make them more effective. They do have side-effects including; low libido (sex drive), dry mouth, weight gain, and drowsiness. Make sure you check to see how the medicine is working before driving or working with heavy machinery.

Natural Remedies for Anxiety

While they are not a cure, some herbal remedies may help the symptoms of panic disorder. Always make sure you talk to your doctor about using any herbal supplements. Some can interact with other antidepressants and be dangerous. Let your doctor know if you are already taking anything over-the-counter for anxiety. A few herbal remedies some have used are:
Inositol. Studies are finding that this B vitamin may be helpful in reducing anxiety
Aromatherapy. Lavender oils, etc. May cause skin allergy and increased blood pressure.
Chamomile Tea. Generally safe unless you are allergic.
St. John’s Wort. Never use this if you are on prescription antidepressants.
Passionflower.
Kava. Do not use if you have liver disease
Valerian.

Tips for Coping with Anxiety

The following lifestyle tips can help reduce your anxiety levels and increase your ability to get through panic attacks:
Breathe. Deep and slow breathing can help you relax and stop the “fight-or-flight” reaction. Try breathing in slowly while counting to five, hold your breath while counting to five, and then slowly count to five while you exhale. Repeat until the anxiety subsides.
Exercise. Exercise can help you “burn-off” the chemicals in your body that cause anxiety and release calming endorphins that relax you. Exercising daily can help reduce the attacks and help you sleep better at night.
Get on a Good Sleep Routine. Make sure you set a regular bedtime and get on a good pre-sleep routine. Take a relaxing bath, do your deep breathing exercises and turn off all electronic. Take some time to journal things that cause you to worry before you go to bed and once you shut your journal, try not to think about them anymore.
Make Friends with Your Anxiety. That’s right, confront it and say “hello.” When you feel the overwhelming feeling coming on, stop yourself wherever you are. Say, “hello again anxiety how are you today?” Ask it questions like, “what can I do for you today?” Tell it that you are not afraid of it. The more you face the anxiety, the less the fear will become.
Avoid Withdrawing from Connections. You need support from others. Stay in touch with those close to you. Talk to someone when you need to. If you have fear of leaving your house, try to get out just a little each day. Sit in your yard, listen to the sounds of nature, invite people over, and maintain connections.
Ditch Caffeine. Caffeine can ramp up anxiety levels and keep you feeling on edge. Try switching to decaf coffee and tea. Make sure you’re getting enough fluids in the form of water, herbal teas, and juices.

Complications and Prognosis for Anxiety

Say this, “I will not die from anxiety.” If it continues, say it again. And again. And again. If your doctor has cleared you from any medical cause, the thoughts of dying are the anxiety. Don’t give in to those thoughts. You can expect to live a normal lifespan if you get your anxiety under control. There can be health complications of constant anxiety including:
Increased risk of heart disease
Increased risk of gastrointestinal conditions
Depression
Risk of substance abuse
Thoughts of hurting yourself
If you do have thoughts of hurting yourself, call someone right away or get to your nearest emergency room. There are crisis helplines in your local telephone book and understanding people that can help you.

Bibliography

Anxiety and Depression Association of America. (2014, September). Facts and Statistics. Retrieved from Anxiety and Depression Association of America: https://www.adaa.org/about-adaa/press-room/facts-statistics
Jack Gorman, M. (2013, February). Panic Disorder. Retrieved from National Alliance on Mental Illness: https://www2.nami.org/Content/NavigationMenu/Inform_Yourself/About_Mental_Illness/By_Illness/Panic_Disorder.htm
Margarita Tartakovsky, M. (2015, September 3). 15 Small Steps You Can Take Today to Improve Anxiety Symptoms. Retrieved from PsychCentral: https://psychcentral.com/lib/15-small-steps-you-can-take-today-to-improve-anxiety-symptoms/
Mayo Clinic. (2015, May 19). Panic Disorder: Tests and Diagnosis. Retrieved from Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/panic-attacks/basics/tests-diagnosis/con-20020825
Patricia Hentz, E. C.-B. (2008, March 18). Separating anxiety from physical illness. Retrieved from Clinical Advisor: https://www.clinicaladvisor.com/features/separating-anxiety-from-physical-illness/article/117767/
U.S. Department of Health and Human Services. (2013). Panic Disorder: When Fear Overwhelms; NIH Publication No. TR 10-4679 . Retrieved from National Institute of Health: https://www.nimh.nih.gov/health/publications/panic-disorder-when-fear-overwhelms/index.shtml
University of Maryland Medical Center. (2013, March 11). Anxiety Disorders. Retrieved from Umm.edu: https://umm.edu/health/medical/reports/articles/anxiety-disorders

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