Definition

Panic disorder occurs when you experience repeated panic attacks and remain afraid, and you feel persistent fear about the recurrence of panic attacks or the effects they cause. This fear is felt for at least a month and can disrupt your routine. The Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5) defines a panic attack as a wave of intense fear or discomfort that reaches its peak within a few minutes. Panic disorder is included in the anxiety disorders.

You may experience a panic attack when you feel sudden and overwhelming terror, but there is no clear cause for the terror. During a panic attack, physical complaints can appear such as a fast heartbeat, difficulty breathing, and sweating.

Usually, panic attacks appear at the age of 15-25 years. About a third of people have experienced a panic attack during their lifetime. However, most of them do not have panic disorder. Only 3% of adults have panic disorder, and this disorder is more common in women.

Although the symptoms of panic disorder are frightening, they can be managed and resolved with medication. Treatment is the most important part of reducing symptoms and improving your quality of life.

Causes

The cause of panic disorder is not yet known with certainty. Some studies have shown that panic disorder may be genetically linked, while other studies have not found a strong link between panic disorder and a person's genetics.

Panic disorder is also associated with significant life changes. Entering college, getting married, or having your first child are the most common life transitions that can cause stress and can trigger the development of panic disorder. Fear of having a panic attack or remembering a previous attack can lead to another panic attack.

Risk Factor

Although the causes of panic disorder are not yet clearly understood, certain groups are thought to be more at risk of experiencing panic disorder, such as women than men. Panic disorder also occurs more often in teenagers and young adults than in other age groups.

Panic attack symptoms often occur for no apparent reason. Usually, the symptoms do not correspond to the level of danger that triggers the symptoms. Because attacks are unpredictable, panic attacks can significantly impact daily life.

Symptoms

Panic attacks usually occur suddenly without any special signs. Attacks can occur at any time, such as when you are driving a car, at the mall, fast asleep, or in the middle of a business meeting. Attacks usually last 5-20 minutes. In severe cases, symptoms can last for more than 1 hour. Attacks vary in form, but symptoms usually peak within a few minutes. Then you will feel tired after the panic attack subsides.

Panic attack symptoms often occur for no apparent reason. Usually, the symptoms do not correspond to the level of danger that triggers the symptoms. Because attacks are unpredictable, panic attacks can significantly impact daily life.

Panic attack symptoms can vary from person to person. Common symptoms of a panic attack include:

• The heart beats fast and hard
• Hard to breathe
• Chest pain
• Feeling like you are suffocating or choking
• Dizziness, light headache, even fainting
• Constant tears come out
• Nauseous
• Stomach cramps
• Sweating or chills
• Shiver
• Changes in mental condition, such as feelings of derealization (feeling unreal and separated from the environment) or depersonalization (feeling separated from thoughts, feelings, and oneself)
• Numbness or tingling sensation in the hands or feet
• A feeling that doom or danger is impending
• There is a fear of losing control or dying

One of the worst things about a panic attack is the intense fear that you will have another panic attack. You are afraid of having a panic attack so you avoid certain situations that could trigger an attack.

Diagnosis 

If a patient experiences symptoms of a panic attack for the first time, he will usually immediately seek emergency medical treatment. Most people who experience a panic attack for the first time think they are having a heart attack. It can be difficult to differentiate the symptoms without the help of a medical professional. Doctors will usually perform several tests to rule out other medical problems before diagnosing panic disorder.

While at an urgent care facility, doctors will perform several tests to see whether your symptoms are caused by a heart attack or not. These examinations include blood tests and electrocardiography to assess the heart's electrical activity.

If the results show that you do not require emergency treatment, you will be referred back to a primary health care facility, if you have one. A primary care doctor will perform a mental health examination and ask about your symptoms. All other medical disorders will be ruled out first before the doctor makes a diagnosis of panic disorder. If suspicions point to panic disorder, you may be referred to a mental health specialist or psychiatrist.

Management

Panic disorder treatment focuses on reducing or eliminating symptoms. This goal can be achieved through therapy and medication in some cases.

Cognitive behavioral therapy

Therapy usually takes the form of cognitive behavioral therapy (CBT). This therapy teaches patients to change their thoughts and actions so they can understand panic attacks and manage fear.

Medications

Antidepressant medications can be used to treat panic disorder. There are several classes of antidepressant drugs, namely:

Selective serotonin reuptake inhibitors (SSRls)

Serotonin-norepinephrine reuptake inhibitors (SNRls)

Monoamine oxidase inhibitors (MAOls), antidepressants that are rarely used because they have serious side effects

Apart from antidepressants, anticonvulsant drugs that work by adjusting GABA levels (a compound that transmits signals between nerve cells) in the brain can also be given. Benzodiazepine anti-anxiety drugs that can treat anxiety can also be used to treat panic disorders.

Apart from these treatments, you can do the following things at home to reduce your symptoms.

• Set a daily routine schedule
• Regular exercise
• Get enough sleep
• Avoid consuming stimulants such as caffeine contained in coffee

Complications

If left untreated, panic disorder can interfere with daily life. Panic disorder complications include:

• Suicidal ideation
• Depression
• Agoraphobia, namely fear or anxiety when being in open places
• Developmental disorders in children and adolescents. Fear of panic attacks can disrupt school and social relationships
• Substance and alcohol use disorders are higher in people with anxiety disorders

Prevention

Panic disorder is often a long-term condition that is difficult to treat. Some people with this disorder do not respond well to treatment. While others can experience a reduction in symptoms through treatment.

Until now, no definite way has been found to prevent panic disorder. However, you can reduce symptoms by using medication prescribed by your doctor and avoiding alcohol or other stimulants that will worsen symptoms.

You can also pay attention to what events or situations usually trigger panic attacks so you can avoid them. If you are bothered by something you are experiencing, discuss it with your doctor before it escalates into a panic attack.

When to see a doctor? 

If you have symptoms of a panic attack, seek medical help as soon as possible. Panic attacks are not directly dangerous even though they feel very uncomfortable. However, panic attacks are difficult to treat on your own and can get worse without treatment. Panic attack symptoms can also resemble symptoms of other serious health problems, such as a heart attack. So, it is important to check your symptoms to rule out other, more serious health problems.