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Anxiety and panic disorder treatment


Panic attacks and panic disorder - Diagnosis and treatment

Diagnosis

Your primary care provider will determine if you have panic attacks, panic disorder or another condition, such as heart or thyroid problems, with symptoms that resemble panic attacks.

To help pinpoint a diagnosis, you may have:

  • A complete physical exam
  • Blood tests to check your thyroid and other possible conditions and tests on your heart, such as an electrocardiogram (ECG or EKG)
  • A psychological evaluation to talk about your symptoms, fears or concerns, stressful situations, relationship problems, situations you may be avoiding, and family history

You may fill out a psychological self-assessment or questionnaire. You also may be asked about alcohol or other substance use.

Criteria for diagnosis of panic disorder

Not everyone who has panic attacks has panic disorder. For a diagnosis of panic disorder, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, lists these points:

  • You have frequent, unexpected panic attacks.
  • At least one of your attacks has been followed by one month or more of ongoing worry about having another attack; continued fear of the consequences of an attack, such as losing control, having a heart attack or "going crazy"; or significant changes in your behavior, such as avoiding situations that you think may trigger a panic attack.
  • Your panic attacks aren't caused by drugs or other substance use, a medical condition, or another mental health condition, such as social phobia or obsessive-compulsive disorder.

If you have panic attacks but not a diagnosed panic disorder, you can still benefit from treatment. If panic attacks aren't treated, they can get worse and develop into panic disorder or phobias.

More Information

  • Electrocardiogram (ECG or EKG)

Treatment

Treatment can help reduce the intensity and frequency of your panic attacks and improve your function in daily life. The main treatment options are psychotherapy and medications. One or both types of treatment may be recommended, depending on your preference, your history, the severity of your panic disorder and whether you have access to therapists who have special training in treating panic disorders.

Psychotherapy

Psychotherapy, also called talk therapy, is considered an effective first choice treatment for panic attacks and panic disorder. Psychotherapy can help you understand panic attacks and panic disorder and learn how to cope with them.

A form of psychotherapy called cognitive behavioral therapy can help you learn, through your own experience, that panic symptoms are not dangerous. Your therapist will help you gradually re-create the symptoms of a panic attack in a safe, repetitive manner. Once the physical sensations of panic no longer feel threatening, the attacks begin to resolve. Successful treatment can also help you overcome fears of situations that you've avoided because of panic attacks.

Seeing results from treatment can take time and effort. You may start to see panic attack symptoms reduce within several weeks, and often symptoms decrease significantly or go away within several months. You may schedule occasional maintenance visits to help ensure that your panic attacks remain under control or to treat recurrences.

Medications

Medications can help reduce symptoms associated with panic attacks as well as depression if that's an issue for you. Several types of medication have been shown to be effective in managing symptoms of panic attacks, including:

  • Selective serotonin reuptake inhibitors (SSRIs). Generally safe with a low risk of serious side effects, SSRI antidepressants are typically recommended as the first choice of medications to treat panic attacks. SSRIs approved by the Food and Drug Administration (FDA) for the treatment of panic disorder include fluoxetine (Prozac), paroxetine (Paxil, Pexeva) and sertraline (Zoloft).
  • Serotonin and norepinephrine reuptake inhibitors (SNRIs). These medications are another class of antidepressants. The SNRI venlafaxine (Effexor XR) is FDA approved for the treatment of panic disorder.
  • Benzodiazepines. These sedatives are central nervous system depressants. Benzodiazepines approved by the FDA for the treatment of panic disorder include alprazolam (Xanax) and clonazepam (Klonopin). Benzodiazepines are generally used only on a short-term basis because they can be habit-forming, causing mental or physical dependence. These medications are not a good choice if you've had problems with alcohol or drug use. They can also interact with other drugs, causing dangerous side effects.

If one medication doesn't work well for you, your doctor may recommend switching to another or combining certain medications to boost effectiveness. Keep in mind that it can take several weeks after first starting a medication to notice an improvement in symptoms.

All medications have a risk of side effects, and some may not be recommended in certain situations, such as pregnancy. Talk with your doctor about possible side effects and risks.

More Information

  • Cognitive behavioral therapy
  • Psychotherapy

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Lifestyle and home remedies

While panic attacks and panic disorder benefit from professional treatment, these self-care steps can help you manage symptoms:

  • Stick to your treatment plan. Facing your fears can be difficult, but treatment can help you feel like you're not a hostage in your own home.
  • Join a support group. Joining a group for people with panic attacks or anxiety disorders can connect you with others facing the same problems.
  • Avoid caffeine, alcohol, smoking and recreational drugs. All of these can trigger or worsen panic attacks.
  • Practice stress management and relaxation techniques. For example, yoga, deep breathing and progressive muscle relaxation — tensing one muscle at a time, and then completely releasing the tension until every muscle in the body is relaxed — also may be helpful.
  • Get physically active. Aerobic activity may have a calming effect on your mood.
  • Get sufficient sleep. Get enough sleep so that you don't feel drowsy during the day.

Alternative medicine

Some dietary supplements have been studied as a treatment for panic disorder, but more research is needed to understand the risks and benefits. Herbal products and dietary supplements aren't monitored by the Food and Drug Administration (FDA) the same way medications are. You can't always be certain of what you're getting and whether it's safe.

Before trying herbal remedies or dietary supplements, talk to your doctor. Some of these products can interfere with prescription medications or cause dangerous interactions.

Preparing for your appointment

If you've had signs or symptoms of a panic attack, make an appointment with your primary care provider. After an initial evaluation, he or she may refer you to a mental health professional for treatment.

What you can do

Before your appointment, make a list of:

  • Your symptoms, including when they first occurred and how often you've had them
  • Key personal information, including traumatic events in your past and any stressful major events that occurred before your first panic attack
  • Medical information, including other physical or mental health conditions that you have
  • Medications, vitamins, herbal products and other supplements, and the dosages
  • Questions to ask your doctor

Ask a trusted family member or friend to go with you to your appointment, if possible, to lend support and help you remember information.

Questions to ask your primary care provider at your first appointment

  • What do you believe is causing my symptoms?
  • Is it possible that an underlying medical problem is causing my symptoms?
  • Do I need any diagnostic tests?
  • Should I see a mental health professional?
  • Is there anything I can do now to help manage my symptoms?

Questions to ask if you're referred to a mental health professional

  • Do I have panic attacks or panic disorder?
  • What treatment approach do you recommend?
  • If you're recommending therapy, how often will I need it and for how long?
  • Would group therapy be helpful in my case?
  • If you're recommending medications, are there any possible side effects?
  • For how long will I need to take medication?
  • How will you monitor whether my treatment is working?
  • What can I do now to reduce the risk of my panic attacks recurring?
  • Are there any self-care steps I can take to help manage my condition?
  • Are there any brochures or other printed material that I can have?
  • What websites do you recommend?

Don't hesitate to ask any other questions.

What to expect from your doctor

Your primary care provider or mental health professional may ask:

  • What are your symptoms, and when did they first occur?
  • How often do your attacks occur, and how long do they last?
  • Does anything in particular seem to trigger an attack?
  • How often do you experience fear of another attack?
  • Do you avoid locations or experiences that seem to trigger an attack?
  • How do your symptoms affect your life, such as school, work and personal relationships?
  • Did you experience major stress or a traumatic event shortly before your first panic attack?
  • Have you ever experienced major trauma, such as physical or sexual abuse or military battle?
  • How would you describe your childhood, including your relationship with your parents?
  • Have you or any of your close relatives been diagnosed with a mental health problem, including panic attacks or panic disorder?
  • Have you been diagnosed with any medical conditions?
  • Do you use caffeine, alcohol or recreational drugs? How often?
  • Do you exercise or do other types of regular physical activity?

Your primary care provider or mental health professional will ask additional questions based on your responses, symptoms and needs. Preparing and anticipating questions will help you make the most of your appointment time.

By Mayo Clinic Staff

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NIMH » Panic Disorder: When Fear Overwhelms

Do you sometimes have sudden attacks of anxiety and overwhelming fear that last for several minutes? Maybe your heart pounds, you sweat, and you feel like you can’t breathe or think clearly. Do these attacks occur at unpredictable times with no apparent trigger, causing you to worry about the possibility of having another one at any time?

An untreated panic disorder can affect your quality of life and lead to difficulties at work or school. The good news is panic disorder is treatable. Learn more about the symptoms of panic disorder and how to find help.

What is panic disorder?

People with panic disorder have frequent and unexpected panic attacks. These attacks are characterized by a sudden wave of fear or discomfort or a sense of losing control even when there is no clear danger or trigger. Not everyone who experiences a panic attack will develop panic disorder.

Panic attacks often include physical symptoms that might feel like a heart attack, such as trembling, tingling, or rapid heart rate. Panic attacks can occur at any time. Many people with panic disorder worry about the possibility of having another attack and may significantly change their life to avoid having another attack. Panic attacks can occur as frequently as several times a day or as rarely as a few times a year.

Panic disorder often begins in the late teens or early adulthood. Women are more likely than men to develop panic disorder.

What are the signs and symptoms of panic disorder?

People with panic disorder may have:

  • Sudden and repeated panic attacks of overwhelming anxiety and fear
  • A feeling of being out of control, or a fear of death or impending doom during a panic attack
  • An intense worry about when the next panic attack will happen
  • A fear or avoidance of places where panic attacks have occurred in the past
  • Physical symptoms during a panic attack, such as:
    • Pounding or racing heart
    • Sweating
    • Chills
    • Trembling
    • Difficulty breathing
    • Weakness or dizziness
    • Tingly or numb hands
    • Chest pain
    • Stomach pain or nausea

What causes panic disorder?

Panic disorder sometimes runs in families, but no one knows for sure why some family members have it while others don’t. Researchers have found that several parts of the brain and certain biological processes may play a crucial role in fear and anxiety. Some researchers think panic attacks are like “false alarms” where our body’s typical survival instincts are active either too often, too strongly, or some combination of the two. For example, someone with panic disorder might feel their heart pounding and assume they’re having a heart attack. This may lead to a vicious cycle, causing a person to experience panic attacks seemingly out of the blue, the central feature of panic disorder. Researchers are studying how the brain and body interact in people with panic disorder to create more specialized treatments. In addition, researchers are looking at the ways stress and environmental factors play a role in the disorder.

How is panic disorder treated?

If you’re experiencing symptoms of panic disorder, talk to a health care provider. After discussing your history, a health care provider may conduct a physical exam to ensure that an unrelated physical problem is not causing your symptoms. A health care provider may refer you to a mental health professional, such as a psychiatrist, psychologist, or clinical social worker. The first step to effective treatment is to get a diagnosis, usually from a mental health professional.

Panic disorder is generally treated with psychotherapy (sometimes called “talk therapy”), medication, or both. Speak with a health care provider about the best treatment for you.

Psychotherapy

Cognitive behavioral therapy (CBT), a research-supported type of psychotherapy, is commonly used to treat panic disorder. CBT teaches you different ways of thinking, behaving, and reacting to the feelings that happen during or before a panic attack. The attacks can become less frequent once you learn to react differently to the physical sensations of anxiety and fear during a panic attack.

Exposure therapy is a common CBT method that focuses on confronting the fears and beliefs associated with panic disorder to help you engage in activities you have been avoiding. Exposure therapy is sometimes used along with relaxation exercises.

For more information on psychotherapy, visit the National Institute of Mental Health (NIMH) psychotherapies webpage.

Medication

Health care providers may prescribe medication to treat panic disorder. Different types of medication can be effective, including:

  • Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs)
  • Beta-blockers
  • Anti-anxiety medications, such as benzodiazepines

SSRI and SNRI antidepressants are commonly used to treat depression, but they also can help treat the symptoms of panic disorder. They may take several weeks to start working. These medications also may cause side effects, such as headaches, nausea, or difficulty sleeping. These side effects are usually not severe, especially if the dose starts off low and is increased slowly over time. Talk to your health care provider about any side effects that you may experience.

Beta-blockers can help control some of the physical symptoms of panic disorder, such as rapid heart rate, sweating, and tremors. Although health care providers do not commonly prescribe beta-blockers for panic disorder, the medication may be helpful in certain situations that precede a panic attack.

Benzodiazepines, which are anti-anxiety sedative medications, can be very effective in rapidly decreasing panic attack symptoms. However, some people build up a tolerance to these medications and need higher and higher doses to get the same effect. Some people even become dependent on them. Therefore, a health care provider may prescribe them only for brief periods of time if you need them.

Both psychotherapy and medication can take some time to work. Many people try more than one medication before finding the best one for them. A health care provider can work with you to find the best medication, dose, and duration of treatment for you. A healthy lifestyle also can help combat panic disorder. Make sure to get enough sleep and exercise, eat a healthy diet, and turn to family and friends who you trust for support. To learn more ways to take care of your mental health, visit NIMH’s Caring for Your Mental Health webpage.

For more information about medications used to treat panic disorder, visit NIMH’s Mental Health Medications webpage. Visit the U.S. Food and Drug Administration (FDA) website for the latest warnings, patient medication guides, and information on newly approved medications.

How can I support myself and others with panic disorder?

Educate Yourself

A good way to help yourself or a loved one who may be struggling with panic attacks or panic disorder is to seek information. Research the warning signs, learn about treatment options, and keep up to date with current research.

Communicate

If you are experiencing panic disorder symptoms, have an honest conversation about how you’re feeling with someone you trust. If you think that a friend or family member may be struggling with panic disorder, set aside a time to talk with them to express your concern and reassure them of your support.

Know When to Seek Help

If your anxiety, or the anxiety of a loved one, starts to cause problems in everyday life—such as at school, at work, or with friends and family—it’s time to seek professional help. Talk to a health care provider about your mental health.

Are there clinical trials studying panic disorder?

NIMH supports a wide range of research, including clinical trials that look at new ways to prevent, detect, or treat diseases and conditions—including panic disorder. Although individuals may benefit from being part of a clinical trial, participants should be aware that the primary purpose of a clinical trial is to gain new scientific knowledge so that others may be better helped in the future.

Researchers at NIMH and around the country conduct clinical trials with patients and healthy volunteers. Talk to a health care provider about clinical trials, their benefits and risks, and whether one is right for you. For more information, visit NIMH's clinical trials webpage.

Finding Help

Behavioral Health Treatment Services Locator

This online resource, provided by the Substance Abuse and Mental Health Services Administration (SAMHSA), helps you locate mental health treatment facilities and programs. Find a facility in your state by searching SAMHSA’s online Behavioral Health Treatment Services Locator. For additional resources, visit NIMH's Help for Mental Illnesses webpage.

Talking to a Health Care Provider About Your Mental Health

Communicating well with a health care provider can improve your care and help you both make good choices about your health. Find tips to help prepare for and get the most out of your visit at Taking Control of Your Mental Health: Tips for Talking With Your Health Care Provider. For additional resources, including questions to ask a provider, visit the Agency for Healthcare Research and Quality website.

If you or someone you know is in immediate distress or is thinking about hurting themselves, call the National Suicide Prevention Lifeline toll-free at 1-800-273-TALK (8255). You also can text the Crisis Text Line (HELLO to 741741) or use the Lifeline Chat on the National Suicide Prevention Lifeline website.

Reprints

This publication is in the public domain and may be reproduced or copied without permission from NIMH. We encourage you to reproduce and use NIMH publications in your efforts to improve public health. If you do use our materials, we request that you cite the National Institute of Mental Health. To learn more about using NIMH publications, please contact the NIMH Information Resource Center at 1-866‑615‑6464, email [email protected], or refer to NIMH’s reprint guidelines.

For More Information

MedlinePlus (National Library of Medicine) (en español)

ClinicalTrials.gov (en español)

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
National Institutes of Health
NIH Publication No. 22-MH-8077 
Revised 2022

Treatment of Anxiety and Panic Disorders at the EMC Clinic of Psychiatry and Psychotherapy in Moscow

Anxiety disorders is a group of disorders in which irrational uncontrollable fear and a persistent feeling of anxiety become the predominant symptoms, which can occur in situations that do not really pose a current danger .

Anxiety is a normal adaptive response of the body to changing conditions or threatening events. However, fears can be a serious problem for a person if the level of anxiety reaches pathological proportions. This imposes restrictions on the normal functioning of the patient, which significantly reduces his quality of life. Also, the long-term existence of an anxiety disorder dramatically increases the risk of other mental disorders, such as depressive disorder (by about 15 times) and pathological addictions (by about 20 times).

Major anxiety disorders include the following disorders:

Panic disorder - the main symptoms of the disease include recurring attacks of irrational anxiety (panic), not limited to a specific situation or any specific circumstances.

Dominant symptoms : sudden onset tachycardia (rapid heartbeat), sweating, tremors, dry mouth, chest pain, difficulty breathing, feeling of suffocation and nausea, as well as dizziness and a feeling of unreality of what is happening.

Agoraphobia is a group of anxiety disorders that includes a number of phobias, which include a painful fear of open spaces and public places. Patients experience uncontrollable anxiety when they are in a crowd, refuse to visit shops and other crowded places, limit their exits from the house unaccompanied, and have difficulty using public transport on their own. Agoraphobia is one of the most maladaptive types of phobic disorders.

Dominant symptoms : when immersed in a frightening situation, patients experience a sharp increase in anxiety, increased heart rate and breathing, sweating and dizziness appear, in some cases a panic attack develops. As a rule, such patients try in every possible way to avoid those situations that cause them a panic attack, which contributes to the consolidation of an anxiety disorder, changes their usual lifestyle and interferes with normal life.

Generalized anxiety disorder - manifested by a constant feeling of anxiety, tension and persistent anxiety about a variety of life events, the likelihood of which is extremely small. In this case, anxiety is not limited to any specific external circumstances, so it is often difficult for the patient to outline the circle of situations that trigger panic.

Dominant symptoms : the most typical complaints are a feeling of constant nervousness, trembling, muscle tension, sweating, tachycardia, dizziness, discomfort in the epigastric region. Often the patient experiences fear for his loved ones, suffers from gloomy forebodings. For a diagnosis of generalized anxiety disorder, the symptoms described must have been present for at least 6 months.

Social phobia - this anxiety disorder is based on the fear of being seen by others, as well as being in an awkward position, being ridiculed or humiliated, which leads to the formation of a reaction to avoid such situations. Often this disorder is combined with low self-esteem and fear of criticism. Fears can manifest themselves when eating in a public place, the need to maintain a conversation during a casual meeting with friends in the presence of strangers, visiting public places and group activities.

Dominant symptoms : hand tremor, nausea (fear of vomiting may be present), urge to urinate or defecate (or fear of such an urge), flushing of the face. Sometimes the patient takes one of these side manifestations of anxiety for the underlying disease. Avoidance of frightening situations causes significant psycho-emotional stress, since the person himself realizes that his reaction is excessive and has no reasonable grounds.

Specific phobias are fears limited to narrowly specific situations, such as, for example, being in close proximity to animals of a certain biological species, being in the dark, at height, in a confined space. Specific phobias also include fear of air travel, fears of eating certain foods, visiting a doctor, medical procedures, and the sight of blood. When confronted with fearful stimuli or when thoughts about them arise, the person "triggers" anxiety and the symptoms described above are observed.

Benefits of treatment at EMC
  • Thorough diagnosis of the patient's mental state, identification of risk factors.
  • Designing an individual treatment program, including pharmacotherapy, cognitive behavioral therapy, if necessary, TMS.
  • The Clinic for Psychiatry and Psychotherapy constantly organizes trainings that teach relaxation skills and coping with anxiety symptoms.

Panic attacks and anxiety disorders

Sometimes a panic attack or unreasonable anxiety visits a person only once, and then does not recur. It happens that the problem manifests itself several times, and also disappears on its own. However, if you regularly encounter such disorders, you should not wait until they go away on their own, because this may not happen.

ACME Center has been helping patients overcome panic attacks and anxiety disorders for over 10 years. Using an integrated approach, we find the root cause and eliminate it, returning patients to a calm and comfortable life.

What are panic attacks? Normally, these states occur due to ongoing events; this is a normal reaction of the body to the stress experienced, which allows you to instantly mobilize forces to overcome it. Fear, panic is a reaction to a sudden threat. Anxiety, in turn, is associated mainly with the expectation of a dangerous event.

But sometimes these states arise completely without reason, pursuing a person in situations where there is not a single reason for fears and worries.

This anxious disorder is expressed by the following symptoms:

  • Unreasonable fear or anxiety,
  • insomnia, the inability to relax,
  • pain in the chest,
  • nausea and vomiting
  • Breaking breathing,
  • and 900 and 900
  • Dizziness
  • Pre-syncope.

If normally these sensations occur during stress, then in an anxiety disorder they may appear suddenly, and the manifestations may be more severe.

Panic disorder is associated with the occurrence of panic attacks, psychophysical distress in the complex. In some cases, with a high intensity of the attack, a person can commit suicidal acts. Often, panic attacks are combined with other mental disorders, representing a complex disorder - depressive, post-traumatic.

Doctors - there are three types of panic attacks:

  • Spontaneous - characteristic of panic personality disorder, occurring suddenly and without reference to circumstances. A person may wake up from a panic attack that began in a dream. There is no binding to a place, circumstances, situations.
  • Situational. Panic disorder can manifest itself in some specific situations, without fear of a specific place or process. Sometimes a person experiences a panic attack just by walking in the park. Such attacks can become aggravated for periods or vice versa, subside.
  • Specific. With these attacks, a person reacts to specific situations. So, a patient with social phobia may experience panic if necessary to speak with the seller when it comes to his turn.

Anxiety syndrome is common among the population, it is typical for more than 13 percent of Russians. Panic attacks are also quite common. But these phenomena are curable, you can get rid of them. There are a number of techniques that allow you to forget about the problem forever.

Treatment of panic attacks and anxiety disorders

Panic attacks can worsen over time, leading to suicidal attempts, resulting in heart attacks and other serious consequences. Anxiety disorders are also not safe, they create a huge burden on the body, on the psyche and nervous system of a person, provoking other diseases. With these painful manifestations, as well as with any others, it is worth fighting in a timely manner, because all the possibilities for this exist today.

Doctors emphasize that complete and lasting relief is achieved by lowering the level of anxiety over a long period of time. At the same time, stabilization of the autonomic nervous system is achieved, the hypothalamus ceases to come into an excited state, adrenaline in the blood falls. A person not only parted with the symptoms of the disease, but also experiences general comfort and tranquility. His performance improves.

In order to receive a full-fledged treatment, it is necessary to consult a psychotherapist. These problems relate specifically to the sphere of the psyche, and therefore it makes no sense to isolate some part of the symptoms and refer to other specialists with it - for example, to detail only the sensations in the heart area, and contact a cardiologist.

Antipsychotics are also prescribed for severe cases of panic disorder. They are taken for a short period of time in order to suppress excessive symptoms - in this case, complete relief from the symptoms of a vegetative nature does not occur, and therefore it is necessary to use other categories of drugs. Tricyclic antidepressants may be prescribed.

Psychocorrection or hypnotic influence in panic disorder are of an auxiliary nature. These measures do not remove vegetative manifestations, but they allow you to endure the next attack more calmly, realizing that this does not threaten death. The effectiveness of the techniques is manifested only in mild forms of disorders, which often go away on their own even without it. However, activities aimed at relaxation and peace, such as meditation, spa visits or yoga, do help reduce the severity of symptoms. And therefore, psychotherapeutic techniques can also become part of the course of treatment of these pathologies.

Professional help from doctors allows you to get rid of panic attacks and groundless anxiety - do not delay contacting specialists!

Why patients choose ACME Center

Our specialists have been helping patients with panic attacks for over 10 years.
Learn more