Can depression cause panic attacks

Panic Disorder & Depression - Bridges to Recovery

Men and women diagnosed with panic disorder are at high risk for depression, the most common co-occurring mental health condition experienced by those who suffer from anxiety disorders. The frequent comorbidity of these conditions can be explained by common risk factors, which include negative life experiences, unproductive personality traits, and unusual patterns of activity in the brain. When an individual receives a dual diagnosis for panic disorder and depression, they will require intensive, integrated treatment services to recover—but recover they can, if they are willing to put in the time and effort to overcome their complex conditions.

People who suffer from anxiety disorders frequently have a history of major depression as well. This connection holds for all types of anxiety disorder, but the association is strongest among those who’ve been diagnosed with panic disorder, or who’ve suffered symptoms consistent with such a diagnosis.

About half of all panic disorder sufferers will be diagnosed with depression either before, during, or after the onset of their panic attacks, and depression does not co-occur with any of the other anxiety disorders at such a high rate.

The relationship between panic disorder and depression is undeniable. But the explanation for the association cannot be reduced to a simple case of cause-and-effect. People who are prone to one condition tend to be prone to the other, and that is why depression has such a high predictive value for panic disorder.


Panic Disorder and Depression: Patterns of Development

Panic disorder and depression are serious mental health conditions that can each cause major life disruption. But when they occur simultaneously the symptoms of each may become even more intense and disabling, overwhelming the capacity of sufferers to cope.

There is a varying temporal pattern in the development of depression and panic disorder. Some people who suffer from both experience depression symptoms first, while others have panic attacks first and only experience the depression later.

Nevertheless, studies have revealed some tendencies. While any sequence of development is possible, a majority of sufferers will experience their initial panic symptoms before the onset of depression. These symptoms are sudden, random, and a complete surprise, and they leave the men and women who experience them mystified about what has happened.

But early panic symptoms are distinct from actual panic attacks, which must occur repeatedly before panic disorder can be diagnosed—and most people with both conditions suffer their first depressive episode before the onset of full-blown panic disorder. Initial panic symptoms may take weeks, months, or even years to blossom into disabling panic attacks, and by that time depression will usually have made its presence known.

It must be emphasized that this pattern of development is not universal. But its prevalence reveals that panic disorder and depression are closely aligned and intertwined, and the factors that predispose a person to one condition may also put them at risk for the other.

Impact of Co-occurring Panic Disorder and Depression

The symptoms of panic disorder and depression are distinct, but when both are experienced simultaneously they reinforce and amplify each other to produce more intense and troubling effects.

In comparison to those who suffer from only one of these mental health disorders, people who experience panic disorder and depression together are:

  • More likely to seek treatment from physicians or mental health care providers, based on the debilitating capacity of their symptoms
  • More likely to require hospitalization or other forms of intensive medical care
  • More likely to lose or quit their jobs (or drop out of school) because of their impaired capacity to perform
  • More likely to suffer from stress-related health issues (heart problems, respiratory conditions, high blood pressure, nervous breakdown, chronic headaches or muscle pain, etc. )
  • Far more likely to contemplate or attempt suicide

The primary symptoms of depression (loss of energy, motivation, and emotional connection to the world) and panic disorder (multiple panic attacks, usually provoked by specific types of exposures) are likely to be more devastating and overwhelming when the two conditions manifest concurrently. For recovery to occur, both disorders must be treated with equal focus and vigor.

Risk Factors for Panic Disorder and Depression

There is some variance in the risk factors for panic disorder and major depression. But there are broad commonalities that help explain the frequent co-existence of the two conditions.

The risk factors shared by these disorders include:

Exposure to childhood abuse. Physical, emotional, and sexual abuse are significant risk factors for all types of all mental health disorders. One 2012 Harvard University study found a strong correlation between childhood abuse and future incidence of depression and PTSD, which happen to be the two co-occurring disorders most frequently experienced by panic disorder sufferers.

Neuroticism. A 2016 joint study sponsored by UCLA and Northwestern University found a strong correlation between neurotic personality and mood and anxiety disorders. People who demonstrate the traits of neuroticism are highly sensitive to negative emotional experiences, which in their case are generated by stressful outside experiences they are unable to cope with or handle.

Negative biases that distort information processing. These biases create unhelpful and unproductive thinking patterns. Information processing biases for depression are revealed through an obsessive focus on negative feedback, a tendency to interprete ambiguous data negatively, and especially vivid memories of traumatic or self-esteem-damaging events.Information processing biases connected to anxiety make panic disorder sufferers highly sensitive and reactive to even the slightest hint of panic symptoms, cause them to interpret relatively benign situations as threatening, and leave them feeling as if they have no control over their anxiety symptoms (or, ultimately, over their lives).

Excessive activity in areas of the brain related to fear and memory. People suffering from depression and/or panic disorder demonstrate hyperactive patterns of response in two interrelated areas of the brain: the hippocampus and the amygdala. The latter is associated with emotional responses, including the intense and paralyzing fear associated with anxiety, while the former is responsible for the processing and formation of memory. Excessive activity in both areas makes anxious responses common and assures their triggers will be vividly remembered.

Suffering from other anxiety disorders besides panic disorder. Panic disorder and agoraphobia have a high rate of co-occurrence, and somewhere between 30 and 50 percent of all panic disorder sufferers will be diagnosed with co-occurring agoraphobia. There is a strong link between social anxiety disorder and panic disorder as well, which is not surprising since social anxiety is a common complicating factor in the development of agoraphobia.

Major depression is also strongly associated with social anxiety disorder. It also develops in many people who suffer from generalized anxiety disorder, which is frequently diagnosed among those who experience recurrent panic attacks.

These mutually relevant risk factors demonstrate the common roots of panic disorder and depression, which can easily manifest in the same individual without any type of cause-and-effect relationship.

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Diagnosing Panic Disorder and Depression

Diagnosing co-occurring mental or behavioral health conditions can be a significant challenge, since comorbid conditions often exhibit similar symptoms.

But this is usually not a problem when the comorbid disorders are major depression and panic disorder. Both produce distinctive symptoms that are not difficult to identify, if patients report those symptoms thoroughly and accurately. Also, mental health professionals are well aware of how common depression is among panic disorder sufferers, and vice versa, and they are certain to screen for both conditions when one or the other is suspected.

Panic disorder and depression must be diagnosed separately, based on the appearance of multiple symptoms over an extended period of time (two weeks for major depression and one month for panic disorder).

After a dual diagnosis for panic disorder and depression has been made, patients should be referred to integrated treatment programs that will address all the symptoms of both conditions at once. Neither condition should be given priority over the other, since each is a serious condition that can have significant long-term effects if left untreated.

Dual Diagnosis Treatment Programs for Panic Disorder and Depression

When multiple mental health conditions are diagnosed, treatment should begin in a residential treatment facility, where inpatient programs can be customized to meet the unique needs of every individual in recovery.

A dual diagnosis treatment program for panic disorder and depression will include daily psychotherapy sessions offered in a mixture of individual, group, and family therapy formats. Cognitive-behavioral therapy (CBT) is highly effective against the symptoms of panic disorder and is quite useful for depressed patients as well, and is likely to play a key role in any therapy regimen.

Anti-depressant medications are the preferred choice for panic disorders, which blends perfectly with the needs of those suffering from clinical depression. Other additions to a dual diagnosis recovery program may include life skills/coping skills classes designed to help sufferers deal more effectively with their symptoms when they do arise, and training in holistic healing practices that can be potent remedies for stress and anxiety management.

Separately, panic disorder and depression are both treatable and respond well to intensive interventions, and when they must be treated together the results can be just as favorable. The symptoms of panic disorder and depression can be powerful and intimidating if left unaddressed, but when sufferers get the help they need their odds of long-term recovery are excellent.

Panic Disorder and Panic Attacks

Written by Christine Richmond

In this Article

  • What Is Panic Disorder?
  • What Are Panic Disorder Symptoms?
  • What Causes Panic Disorder?
  • How Is Panic Disorder Diagnosed?
  • How Is Panic Disorder Treated?

What Is Panic Disorder?



Panic disorder is when you’ve had at least two panic attacks (you feel terrified and overwhelmed, even though you’re not in any danger) and constantly worry and change your routine to keep from having another one. It’s a type of anxiety disorder.

One in 10 adults in the U.S. have a panic attack each year and they usually begin between the ages of 15 and 25. About a third of people have one in their lifetime. But most of them don’t have panic disorder. Only about 3% of adults have it, and it’s more common in women than in men.

What Are Panic Disorder Symptoms?

A panic attack is a sudden strong feeling of fear that can happen anywhere, at any time. You’ll have four or more of these signs:

  • A sense of approaching danger
  • Pounding or fast heartbeat
  • Sweating
  • Trembling or shaking
  • Shortness of breath or a feeling of being smothered
  • Throat tightness
  • Cramps in your belly
  • Headache
  • A choking feeling
  • Chest pain
  • Nausea or stomach pains
  • Feeling dizzy or faint
  • Chills or hot flashes
  • Numbness or tingling
  • Feeling unreal or detached
  • A fear of losing control or going crazy
  • A fear of dying

An attack usually passes in 5 to 10 minutes, but it can linger for hours. It can feel like you’re having a heart attack or a stroke. So people with panic attacks often wind up in the emergency room for evaluation.

Many people with panic disorder relate an attack to what they were doing when it happened. They may think the restaurant, elevator, or classroom caused the attack. Then they'll avoid those places. That may lead to something called agoraphobia, the fear of leaving home or being in public places.

If you feel like you're having a panic attack, see your doctor right away. They aren’t dangerous, but they can get worse without treatment.

Also keep in mind that symptoms of a panic attack are similar to those for more serious conditions. If you're not sure if what you're having is a panic attack, call your doctor, just to be safe.

What Causes Panic Disorder?

Doctors don’t know exactly what causes panic disorder, but one possibility is that the brains of people who have it may be especially sensitive in responding to fear. There's a link between panic attacks and phobias, like school phobia or claustrophobia. There’s also a theory that panic disorder may come from an oversensitivity to carbon dioxide, which makes your brain think you're suffocating.

A few things can make you more likely to have panic disorder:

  • Someone in your family has it (though it’s not clear how much of that is because of your genes or the environment you grew up in)
  • High levels of stress
  • Frequent negative feelings or trouble dealing with negative emotions

Some believe there are ties between panic attacks and:

  • Depression
  • Alcohol abuse
  • Cigarette smoking
  • Suicide risk
  • Seasonal affective disorder, a type of depression that happens in winter

Most often, panic attacks come "out of the blue. " One may even begin while you're sleeping. Using drugs or alcohol to try to deal with panic disorder can make the symptoms worse. Attacks may come after the use of mind-altering drugs. And some medications can cause panic attacks, including some antidepressants.

Panic disorder may start after:

  • A serious illness or accident
  • The death of a close friend
  • Separation from family
  • The birth of a baby

People with this disorder often also have major depression, although  there is no evidence that one condition causes the other. If you're 40 or older and have panic disorder, you may have depression or another hidden medical condition. Talk to your doctor to find out what's going on.

How Is Panic Disorder Diagnosed?

There isn't a lab test specifically for panic disorder. Because the symptoms can feel a lot like those of a heart attack, your doctor probably will start by examining you and ruling out other health issues. If no other condition is causing your symptoms and you’ve had two or more random panic attacks and live in fear of a repeat episode, you probably have panic disorder.

How Is Panic Disorder Treated?

Your doctor may refer you to a specialist called a psychotherapist. They might recommend:

  • A type of talk therapy called cognitive behavioral therapy that helps you learn how to change unhealthy thoughts and behaviors that bring on panic attacks
  • Antidepressants, like selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs)
  • Benzodiazepines, which are sedatives that affect your central nervous system (These aren’t used for long because you can get dependent on them.)
  • Anti-anxiety medications (Like benzodiazepines, these work better in the short term.)
  • Cutting back on caffeine
  • Regular exercise
  • Limiting alcohol
  • Deep breathing exercises

Anxiety & Panic Disorders Guide

  1. Overview
  2. Symptoms & Types
  3. Treatment & Care
  4. Living & Managing

Panic attacks

Panic attacks (episodic paroxysmal anxiety) - attacks of severe anxiety (panic) or fear (most often - fear of death, less often - fear of losing consciousness, loss of control, helplessness or fear of "going crazy"), accompanied by a rapid heartbeat and a feeling of " suffocation, shortness of breath. Sometimes there are additional symptoms such as increased blood pressure, a feeling of "internal trembling", trembling in the limbs, a feeling of "hot flashes" of heat or cold, numbness of the extremities, increased sweating, a feeling of "unstability" or dizziness, nausea, derealization or depersonalization, etc. nine0005

Panic attacks last on average 5 to 30 minutes. However, sometimes they can last several hours, and in rare cases - up to several days.

I must say that even 30 years ago this disease was extremely rare. But now the incidence of panic attacks is increasing exponentially every year! Especially in big cities. Alas, panic attacks are considered a “disease of megacities”. And they suffer, most often, people with increased anxiety and the so-called perfectionists. nine0005

Earlier, in Soviet medicine, this disorder was called " sympathoadrenal crises ". This name, more than the modern one, reflected the essence of the processes occurring in the body during panic attacks. Nevertheless, I will not bother readers with a description of biochemical processes and a list of the hormones and neurotransmitters involved in these reactions. Knowing this practically does not affect the fact of the occurrence of seizures. Because biochemical processes are just an "intermediate link" in the chain of cause and effect relationships occurrence of panic attacks . What then is the "primary link", so to speak, the root cause?

Panic attacks occur suddenly, and, as it often seems, without any external causes or under the influence of minor unpleasant factors (an ordinary quarrel in the family, another trouble at work, overcrowding and stuffiness in a subway or train car, a long “traffic jam” on the road, etc.). etc.). In fact, panic attacks always occur against the background of an already long-term depression (most common), or after repeated or severe stress (or rather, distress). Don't be surprised by this, because it is quite difficult for an ordinary person, not a specialist, to diagnose depression. Especially, at himself. Moreover, its mild or atypical forms. Especially if it lasts a year or several years (and for some people - since childhood!). In this case, they may not even remember how they felt without depression. In this variant, the body functions “with the last of its strength”, works “at the limit of its capabilities”; and some minor unpleasant event can be the “last straw” for him! nine0003 Figuratively speaking, a panic attack is “hysteria of the body”, its “desperate cry: “I can’t do this anymore !!!”

Well, in the question "Who is to blame?" figured it out. Now let's move on to the equally important question "What to do?" The fact that no one in the world has yet died from panic attacks is little consolation for those suffering from this excruciating disorder. To say that panic attacks are an unpleasant state is an understatement! These are unbearable sensations, and in the most severe cases, a real feeling of approaching death, which a person is sometimes forced to experience daily! And most importantly, he does not understand what is happening to him, and how to stop it! nine0005

Panic attacks sharply reduce the quality of a person's life, subordinating her entire expectation of the next attack. And, accordingly, they affect social activity, sometimes making a person completely incapacitated.

When panic attacks first appeared in the clinical practice of physicians, they were treated empirically with various sedatives and tranquilizers. However, after their cancellation, the seizures reappeared, and with prolonged use of these drugs, tolerance (insensitivity) inevitably and rather quickly set in. Therefore, in order to stop panic attacks, it was necessary to constantly increase doses or resort to more “strong” tranquilizers. But everywhere there is a limit: the number of tranquilizers is not unlimited, especially their doses. It was necessary to remember another very important aspect: long-term use of these drugs causes dependence on them. And after the abolition of tranquilizers, the symptoms of mental and physical withdrawal joined the renewed panic attacks, which further worsened the patient's condition. nine0005

Then the tactics of treatment were somewhat changed: antidepressants were added to "light" or small doses of "medium-powered" tranquilizers. And it was a "breakthrough" in the treatment of panic attacks! Because antidepressants do not just "relieve" the symptoms, but they affect the foundation on which these attacks are based - depression itself! Of course, in modern medicine there are a huge number of antidepressants, and the effectiveness of their effect on panic attacks is very different. But an experienced psychotherapist or psychiatrist can quite accurately select a drug that is suitable for a particular person. It is important to note that antidepressants have a cumulative effect, so their therapeutic effect does not appear immediately after the appointment, but after a certain time (on average, after a month). And, here, the full duration of treatment with antidepressants is, at best, from 6 to 12 months, and sometimes up to several years. nine0005

At the same time, there are cases of especially severe courses of panic attacks, when the appointment of even "powerful" antidepressants for a sufficiently long time does not bring the desired effect, i. e. panic attacks do not stop completely, but only become less pronounced or occur less frequently. In this version, a person, anyway, does not feel healthy and constantly lives in fear of the next attack. In this case, doctors are forced to launch "heavy artillery" - to add NEUROLEPTICS to the treatment, which patients have to take for quite a long time. Antipsychotics have a large number of unpleasant side effects, which is why many patients refuse them. nine0005

However, there is another way to treat panic attacks. He is not a drug! That is, there is a REAL METHOD OF COMPLETE CURING FROM PANIC ATTACKS, ABSOLUTELY WITHOUT RESORTING TO ANY KIND OF MEDICINES !!! This method is PSYCHOTHERAPEUTIC.

In the modern world there are a lot of different types and directions of psychotherapy. But, it must be said bluntly that with panic attacks, most of them are not effective without medical support. nine0005

However, the method that I use in my psychotherapeutic work is unique. It often allows you to completely eliminate panic attacks in 1 session! One or two more sessions are required to eliminate the FEAR of the appearance of seizures (or their expectation).

But in order to begin the direct elimination of panic attacks, a certain “intellectual” preparation of the patient is necessary. It requires from 8 to 12 sessions (depending on the severity of the disease and the personal characteristics of the patient) with a frequency of 1-2 sessions per week. nine0005

After eliminating panic attacks and the fear of their occurrence, it is extremely important to “develop” the underlying causes that led to their appearance. This will be a kind of "insurance" against the occurrence of panic attacks in the future. This requires 3-4 months on average (with the frequency of classes 1 time per week). But, having worked through these “deep roots”, a person not only completely gets rid of panic attacks, but also depression, solves many personal problems and begins to live a full life! nine0005

Treatment of depression in panic attacks, anxiety and fear in Moscow

  • Home
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  • >Depression in panic attacks and anxiety anxiety and panic attacks develop. Therefore, for the doctor before starting treatment, the main task is to establish the initial disease.

    Depression is characterized by a decrease or lack of interest or pleasure, accompanied by an increase or decrease in appetite, weight loss or gain, insomnia or drowsiness, psychomotor retardation, a feeling of fatigue or loss of energy, a feeling of worthlessness, inadequacy, guilt, a decrease in the ability to think or focus on repetitive thoughts of death or suicide. nine0005

    Depression in panic attacks is most often the primary disease, when panic attacks develop in its background. It is less common when, after a panic attack, depression develops due to a violation of social ties. However, panic attacks and depression are different diseases and require different approaches to treatment.

    How do you find out if you have depression and if it needs to be treated?

    Considering that depression is often the main disease against which panic attacks and anxiety , you can conduct a simple self-diagnosis to determine the presence of depression and its severity. To do this, you need to answer several questions and calculate the amount of points, where the answer is "no" - 0; "several days" - 1; "more than half of the days" - 2; "almost every day" - 3.

    How often in the past two weeks have you been bothered by any of the following problems:

    1. Loss of interest in things that previously gave pleasure. nine0052
    2. Feeling of depression, hopelessness, deterioration of mood.
    3. Sleep problems: insomnia or vice versa, you slept too much.
    4. You felt tired or lacked energy.
    5. Decreased or increased appetite.
    6. You have experienced feelings of dissatisfaction with yourself or thought that you are a failure or that you are letting yourself and your family down.
    7. Difficulty concentrating, for example when reading newspapers or watching TV. nine0052
    8. You did everything or spoke so slowly that other people started to notice. Or vice versa, you could not sit still or you were so tireless that you did much more than usual.
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