Panic disorder

**Panic disorder** is an anxiety disorder where a person regularly have sudden attacks of panic or fear. In addition, big changes in behavior might happen in at least one month, and the person might keep worrying about having other attacks. 

Everyone experiences feelings of anxiety and panic at certain times. It's a natural response to stressful or dangerous situations. But someone with panic disorder has feelings of anxiety, stress and panic regularly and at any time, often for no apparent reason. As with many mental health conditions, the exact cause of panic disorder is not fully understood. It is a serious condition that can happen at any age. It can be treated with psychotherapy and antidepressants.

It is usually treated with therapy or sometimes medicine. It can sometimes be difficult to talk about feelings, emotions and personal life experiences, but trying not to feel anxious or embarrassed helps with diagnosis and the outcome of therapy. Cognitive behavioural therapy (CBT) AKA talking therapy can he helpful. There may be support groups. Someone with panic disorder can be referred to a specialist mental health worker such as a psychiatrist or clinical psychologist.

If therapy doesn't work, certain medicines might.

## Treatment (including self help)
Treatment aims to reduce the number of panic attacks and ease symptoms. Talking therapies and medicine are the main treatments for panic disorder. Treatment will depend on symptoms. Self help is good.

### Medicine
Panic disorder is thought to be linked to many things. If it is caused by an imbalance of neurotransmitters (chemical messengers) in the brain, medicine might help. Everyone is different. Some medicines used are:
* a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI) or, if SSRIs are not suitable, a tricyclic antidepressant (usually imipramine or clomipramine)
* an anti-epilepsy medicine such as pregabalin or, if your anxiety is severe, clonazepam (these medicines are also beneficial for treating anxiety)

Antidepressants can take 2 to 4 weeks before they start to work, and up to 8 weeks to work fully.
### Things you can try yourself
**What to do during** a panic attack:
* stay where you are, if possible
breathe slowly and deeply
* remind yourself that the attack will pass
* focus on positive, peaceful and relaxing images
* remember it's not life threatening
**For preventing future attacks**, it may help to:
*read a self-help book for anxiety based on the principles of cognitive behavioural therapy (CBT) – ask a GP to recommend one
* try activities like yoga and pilates, for relaxation 
*learn breathing exercises for stress to help ease symptoms
* do regular physical exercise to reduce stress and tension
* avoid sugary food and drinks, caffeine and alcohol, and stopping smoking, as they can all make attacks worse

## Symptoms
A panic attack can be very frightening and distressing. Signs and symptoms include:
*a racing heartbeat (fast pulse)
*feeling faint
*sweating
*nausea
*chest pain
*shortness of breath
*trembling
*hot flushes
*chills
*shaky limbs
*a choking sensation
*dizziness
*numbness or pins and needles (and tingling in fingers)
*dry mouth
*a feeling of dread or a fear of dying
*a churning stomach
*feeling like you're not connected to your body
Most panic attacks last between 5 and 20 minutes. Some have been reported to last up to an hour.

The number of attacks will depend on how severe the condition is. Some people have attacks once or twice a month, while others have them several times a week.

Although panic attacks are frightening, they're not dangerous. An attack will not cause any physical harm, and it's unlikely someone will be admitted to hospital if they have one. Some of these symptoms can also be symptoms of other conditions or problems, so it may not always be a panic attack. For example, someone may have a racing heartbeat if they have very low blood pressure.

### Anxiety
Anxiety is a feeling of unease. It can range from mild to severe, and can include feelings of worry and fear. Panic is the most severe form of anxiety. Someone with panic disorder may start to avoid certain situations because of the fear that it will trigger another attack.

This can create a cycle of living "in fear of fear". It can add to the sense of panic and may cause even more attacks.

### Panic attacks
During a panic attack there might be a rush of intense mental and physical symptoms. It can come on very quickly and for no apparent reason.

## Panic disorder in children
Children can have the signs and symptoms of panic disorder. 

After taking a detailed medical history a GP will carry out a thorough physical examination to rule out any physical causes for the symptoms. They may refer the child to a specialist for further assessment and treatment. The specialist may recommend a course of CBT for the child.

## Related pages 
* Fibromyalgia
* Anxiety 

## References