Oct 1, 2002 Table of Contents

Please note: This information was current at the time of publication. But medical information is always changing, and some information given here may be out of date. For regularly updated information on a variety of health topics, please visit familydoctor.org, the AAFP patient education Web site.

Information from Your Family Doctor

Panic Disorder: Panic Attacks and Agoraphobia

Am Fam Physician. 2002 Oct 1;66(7):1293-1294.

What is panic disorder?

Panic disorder is a common condition in which a person has episodes of intense fear or anxiety that occur suddenly (often without warning). These episodes—called panic attacks—can last from minutes to hours. They may occur only once in a while, or they may occur frequently. The cause, or trigger, for these attacks may not be obvious.

What happens during a panic attack?

Panic attacks are associated with physical symptoms that include the following:

  • Shaking

  • Feeling that your heart is pounding or racing

  • Sweating

  • Chest pain

  • Shortness of breath

  • Feeling that you are choking

  • Nausea

  • Cramping

  • Dizziness

  • Out-of-body feeling

  • Tingling or numb feeling in your hands

  • Chills or hot flashes

A person also may have an extreme fear of losing control, going crazy, or dying during a panic attack. It is rare for a person to have all of these symptoms at once. However, the presence of at least four symptoms strongly suggests that a person has panic disorder.

Many of the symptoms that occur during a panic attack are the same as the symptoms of diseases of the heart, lungs, intestines, or nervous system. The similarities between panic disorder and other diseases may add to the person's fear and anxiety during and after a panic attack.

Just the fear of having a panic attack is often enough to trigger the symptoms. This is the basis for a condition called agoraphobia. A person who has agoraphobia finds it difficult to leave home (or another safe area) because he or she is afraid of having a panic attack in public or not having an easy way to escape if the symptoms start.

Should I see my doctor if I'm having panic attacks?

Many people who have panic attacks don't seek medical care because of embarrassment or the fear of taking medicine. If you have panic attacks, it is important to get medical care and discuss the problem with your doctor. After you have been evaluated thoroughly, your doctor will be able to tell you if your panic attacks are related to panic disorder or are caused by another problem. Simple treatments are available to help control panic disorder.

Can medicine help people who have panic disorder?

Several medicines can make panic attacks less severe or stop them. Paroxetine (brand name: Paxil) and sertraline (brand name: Zoloft) are antidepressant medicines that have been approved by the U.S. Food and Drug Administration (FDA) to treat panic disorder. Antidepressants are highly effective in preventing anxiety and panic attacks. Often they stop the attacks completely. You don't have to be depressed for the medicines to help. Side effects are usually mild. Antidepressants will not make you lose control or change your personality. These medicines can be used for as long as necessary, even for years.

Alprazolam (brand name: Xanax) and clonazepam (brand name: Klonopin) are also medicines approved by the FDA to treat panic disorder. These medicines give relief from fear and anxiety. They should be used only for a short time (a few weeks to a few months), unless you absolutely can't function without them. Never suddenly stop taking one of these medicines. If you need to stop, these medicines should be slowly tapered off over several weeks under your doctor's supervision.

Can counseling help people who have panic disorder?

Several kinds of counseling are effective for treating panic disorder. You can ask your doctor about the different kinds that are available. Counseling does not work as fast as medicine, but it can be just as effective. The combination of counseling and medicine seems to be an effective treatment for panic disorder.

How long does treatment last?

How long treatment continues depends on you. Stopping panic attacks completely is a reasonable goal. Your doctor will design a treatment plan just for you. A treatment period of at least six to nine months is usually recommended. Some people taking medicine for panic disorder are able to stop after only a short time. Other people need to continue treatment for a long time, or even for their lifetime.

Who can I contact for more information?

Your doctor.

Anxiety Disorders Association of America

8730 Georgia Avenue, Suite 600

Silver Spring, MD 20910

Telephone: 240-485-1001

Web Address: www.adaa.org

National Institute of Mental Health

NIMH Public Inquiries

6001 Executive Blvd.

Room 8184, MSC 9663

Bethesda, MD 20892-9663

Telephone: 800-647-2642

Web Address: www.nimh.nih.gov


This handout is provided to you by your family doctor and the American Academy of Family Physicians. Other health-related information is available from the AAFP online at http://familydoctor.org.

This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.

Copyright © 2002 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv@aafp.org for copyright questions and/or permission requests.

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