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Definition, Symptoms, Causes & Treatment

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Definition, Symptoms, Causes & Treatment

Postby Butterfly Faerie » Sat Aug 26, 2006 6:54 pm

Definition

Panic disorderis characterized by un-expected and repeated episodes of intense fear accompanied by physical symptoms that may include chest pain, heart palpitations, shortness of breath, dizziness or abdominal distress. These sensations often mimic symptoms of a heart attack or other life-threatening medical conditions. As a result, the diagnosis of panic disorder is frequently not made until extensive and costly medical procedures fail to provide a correct diagnosis or relief.

Many people with panic disorder develop intense anxiety between episodes. It is not unusual for a person with panic disorder to develop phobias about places or situations where panic attacks have occurred, such as in supermarkets or other everyday situations. As the frequency of panic attacks increases, the person often begins to avoid situations where they fear another attack may occur or where help would not be immediately available. This avoidance may eventually develop into agoraphobia, an inability to go beyond known and safe surroundings because of intense fear and anxiety.

Fortunately, through research supported by the National Institute of Mental Health (NIMH) and by industry, effective treatments have been developed to help people with panic disorder.

About 1.7% of the adult U.S. population ages 18 to 54 - approximately 2.4 million Americans - has panic disorder in a given year. Women are twice as likely as men to develop panic disorder. Panic disorder typically strikes in young adulthood. Roughly half of all people who have panic disorder develop the condition before age 25.


Symptoms
To make a formal diagnosis of panic disorder, a person must experience either four panic attacks within a four-week period, or one or more attacks followed by at least a month of persistent fear of having another attack. During one of those attacks a minimum of four of these symptoms reach a peak within 10 minutes.

Palpations, pounding heart, or accelerated heart rate
Sweating
Trembling or shaking
Sensations of shortness of breath or smothering
Feeling of choking
Chest pain or discomfort
Nausea or abdominal distress
Feeling dizzy, unsteady, lightheaded, or faint
Feeling detached from oneself or feelings of unreality
Fear of losing control or of going crazy
Fear of dying
Numbness or tingling sensation
Chills or hot flashes


Causes
Heredity, other biological factors, stressful life events, and thinking in a way that exaggerates relatively normal bodily reactions are all believed to play a role in the onset of panic disorder. The exact cause or causes of panic disorder are unknown and are the subject of intense scientific investigation.

Studies in animals and humans have focused on pinpointing the specific brain areas and circuits involved in anxiety and fear, which underlie anxiety disorders such as panic disorder. Fear, an emotion that evolved to deal with danger, causes an automatic, rapid protective response that occurs without the need for conscious thought. It has been found that the body's fear response is coordinated by a small structure deep inside the brain, called the amygdala. Although relatively small, the amygdala is a very complicated structure, and recent research suggests that anxiety disorders may be associated with abnormal activity in the amygdala.


Treatment
Treatment for panic disorder includes medications and a type of psychotherapy known as cognitive-behavioral therapy, which teaches people how to view panic attacks differently and demonstrates ways to reduce anxiety. Appropriate treatment by an experienced professional can reduce or prevent panic attacks in 70% to 90% of people with panic disorder. Most patients show significant progress after a few weeks of therapy. Relapses may occur, but they can often be effectively treated just like the initial episode.

Antidepressants

A number of medications that were originally approved for treatment of depression have been found to be effective for panic disorder. If your doctor prescribes an antidepressant, you will need to take it for several weeks before symptoms start to fade. So it is important not to get discouraged and stop taking these medications before they've had a chance to work.

Some of the newest antidepressants are called selective serotonin reuptake inhibitors, or SSRIs. These medications act in the brain on a chemical messenger called serotonin. SSRIs tend to have fewer side effects than older antidepressants. People do sometimes report feeling slightly nauseated or jittery when they first start taking SSRIs, but that usually disappears with time. Some people also experience sexual dysfunction when taking some of these medications. An adjustment in dosage or a switch to another SSRI will usually correct bothersome problems. It is important to discuss side effects with your doctor so that he or she will know when there is a need for a change in medication.

Fluoxetine, sertraline, fluvoxamine, paroxetine, and citalopram are among the SSRIs commonly prescribed for panic disorder. SSRIs are often used to treat people who have panic disorder in combination with OCD, social phobia, or depression. These medications are started at a low dose and gradually increased until they reach a therapeutic level.

Similarly, antidepressant medications called tricyclics are started at low doses and gradually increased. Tricyclics have been around longer than SSRIs and have been more widely studied for treating panic disorders. They are as effective as the SSRIs, but many physicians and patients prefer the newer drugs because the tricyclics sometimes cause dizziness, drowsiness, dry mouth, and weight gain. When these problems persist or are bothersome, a change in dosage or a switch in medications may be needed.

Monoamine oxidase inhibitors, or MAOIs, are the oldest class of antidepressant medications. The most commonly prescribed MAOI is phenelzine, which is helpful for people with panic disorder. People who take MAOIs are put on a restrictive diet because these medications can interact with some foods and beverages, including cheese and red wine, which contain a chemical called tyramine. MAOIs also interact with some other medications, including SSRIs. Interactions between MAOIs and other substances can cause dangerous elevations in blood pressure or other potentially life-threatening reactions.


Anti-Anxiety Medications

High-potency benzodiazepines relieve symptoms quickly and have few side effects, although drowsiness can be a problem. Because people can develop a tolerance to them—and would have to continue increasing the dosage to get the same effect—benzodiazepines are generally prescribed for short periods of time. One exception is panic disorder, for which they may be used for 6 months to a year. People who have had problems with drug or alcohol abuse are not usually good candidates for these medications because they may become dependent on them.

Some people experience withdrawal symptoms when they stop taking benzodiazepines, although reducing the dosage gradually can diminish those symptoms. In certain instances, the symptoms of anxiety can rebound after these medications are stopped. Potential problems with benzodiazepines have led some physicians to shy away from using them, or to use them in inadequate doses, even when they are of potential benefit to the patient. Benzodiazepines include alprazolam and lorazepam, are helpful for panic disorder.


Cognitive-Behavioral and Behavioral Therapy

Research has shown that a form of psychotherapy that is effective for several anxiety disorders, particularly panic disorder, is cognitive-behavioral therapy (CBT). A major aim of CBT and behavioral therapy is to reduce anxiety by eliminating beliefs or behaviors that help trigger panic. It has two components. The cognitive component helps people change thinking patterns that keep them from overcoming their fears. For example, a person with panic disorder might be helped to see that his or her panic attacks are not really heart attacks as previously feared; the tendency to put the worst possible interpretation on physical symptoms can be overcome.

The behavioral component of CBT seeks to change people's reactions to anxiety-provoking situations. A key element of this component is exposure, in which people confront the things they fear. The therapist helps the patient to cope with the resultant anxiety. Eventually, after this exercise has been repeated a number of times, anxiety will diminish. If you undergo CBT or behavioral therapy, exposure will be carried out only when you are ready; it will be done gradually and only with your permission. You will work with the therapist to determine how much you can handle and at what pace you can proceed.

To be effective, CBT or behavioral therapy must be directed at the person's specific anxieties and it is necessary to tailor it to the person's particular concerns. CBT and behavioral therapy have no adverse side effects other than the temporary discomfort of increased anxiety, but the therapist must be well trained in the techniques of the treatment in order for it to work as desired. During treatment, the therapist probably will assign "homework"—specific problems that the patient will need to work on between sessions.

CBT or behavioral therapy generally lasts about 12 weeks. It may be conducted in a group, provided the people in the group have sufficiently similar problems. There is some evidence that, after treatment is terminated, the beneficial effects of CBT last longer than those of medications for people with panic disorder.

Medication may be combined with psychotherapy, and for many people this is the best approach to treatment. As stated earlier, it is important to give any treatment a fair trial. And if one approach doesn't work, the odds are that another one will, so don't give up.

If you have recovered from an anxiety disorder, and at a later date it recurs, don't consider yourself a "treatment failure." Recurrences can be treated effectively, just like an initial episode. In fact, the skills you learned in dealing with the initial episode can be helpful in coping with a setback.
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Postby Oakchair » Sun Aug 27, 2006 6:41 am

Thank you sadgirl, for all of the posts like this one
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Postby Butterfly Faerie » Sun Aug 27, 2006 3:20 pm

You're welcome hon. ;)
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Re: Definition, Symptoms, Causes & Treatment

Postby saboneal » Mon Jul 26, 2010 12:10 pm

Which among the panic disorder therapies is the most effective? Is there available home remedy for this kind of disorder? Thank you Butterfly Faerie for this amazing posts..
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Re: Definition, Symptoms, Causes & Treatment

Postby Butterfly Faerie » Mon Jul 26, 2010 12:44 pm

I've done CBT, Exposure Therapy, talk therapy etc.
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Re: Definition, Symptoms, Causes & Treatment

Postby poohphilosophy » Fri May 20, 2011 6:22 am

thank you for posting this. i have been trying to understand how anxiety can affect day-to-day living and this forum has given me a lot of insight.
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Re: Definition, Symptoms, Causes & Treatment

Postby sandheart1998 » Fri Nov 18, 2016 7:13 am

I have been dealing with alot of anxiety latley with having to change meds and starting college. This post helped me alot in treating it. Though i know i will never be fully healed it makes me feel better that i am not alone in this fight...
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