Panic Attacks and Panic Disorder

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Panic Attacks and Panic Disorder Diagnosing and Treating Panic Disorder

Panic disorder has both biological and psychological causes. Because

the disorder runs in families, researchers are examining several genes that

might contribute to its development.

Some experiments suggest that panic disorder is the result of a hypersensitivity

to brain changes that transmit warning messages. In these experiments, panic

attacks were induced in susceptible people with high doses of a stimulant like

caffeine, which activates the sympathetic nervous system (a part of the

autonomic nervous system). The sympathetic nervous system transmits signals to

all parts of the body to prepare it for physical action, initiating the

" fight-or-flight " response. It speeds heart rate, narrows blood vessels, and

raises blood pressure.

In most people, large amounts of caffeine produce some of the physical symptoms

of panic, such as increased heart rate. But among individuals with panic

disorder, too much caffeine can trigger a full-blown panic attack. In similar

experiments, deep breathing caused by strenuous exercise or inhaling air with a

high concentration of carbon dioxide provoked attacks in people with panic

disorder. The brain seemingly misinterprets deep, rapid breathing as a sign that

the body is in trouble and triggers a stress response.

Researchers have found specific abnormalities in the brain that might cause

panic. One theory is that faulty brain receptors don’t respond to the body’s

anxiety-reducing chemicals, naturally occurring benzodiazepines. Some research

suggests that panic disorder may involve an abnormality in the limbic system.

Brain images of people having a panic attack show abnormal activity around the

hippocampus, a key element in the limbic system. (See The Brain and Anxiety.)

Psychological factors are also important because a major symptom is the fear of

having more panic attacks. Individuals become conditioned to anticipate the

attacks. This anticipation produces anxious thoughts, which may induce panic

attacks. Researchers think the amygdala (see The Brain and Anxiety) may play a

role in anticipatory anxiety and are studying this part of the brain, where fear

conditioning and other forms of unconscious emotional learning occur.

Prevalence: Panic disorder affects about 3% of the population.

Effective treatments: Selective serotonin reuptake inhibitors (SSRIs)are

first-line treatments. All SSRIs are comparable in effectiveness. Because these

antidepressants can take 3–8 weeks to work, they are often combined with a short

course of one of the benzodiazepines, which are antianxiety drugs that work

quickly to relieve panic disorder. SSRIs are the first choice because for many

people they have fewer and less severe side effects than other medications.

Tricyclic antidepressants or monoamine oxidase (MAO) inhibitors are used when

SSRIs don’t work. (See Medications for Anxiety Disorders.)

Cognitive-behavioral therapy can be helpful for those who fear future panic

attacks or who avoid situations or places that they think may trigger an attack.

The specific combination of treatments will depend, to a large degree, on the

individual’s other mental health conditions, if any. Studies show that

medication, cognitive-behavioral therapy, or a combination of both help 70%–90%

of people with panic disorder.