Your health care provider can determine if your panic disorder is caused by an underlying medical condition, such as heart disease or thyroid problems. This may require blood tests and an electrocardiogram (ECG). A complete assessment should also include questions about your caffeine and alcohol consumption, and any substance use, which can contribute to an anxiety disorder.
Anxiety attacks symptoms and heart attack symptoms can seem similar because their signs and symptoms can be similar. But most medical professionals can quickly tell the difference as heart attacks have distinct symptoms that aren’t anxiety-like. If you are unsure of which is an anxiety attack symptom and which is a heart attack symptom, seek immediate medical advice. If the doctor diagnoses your symptoms as anxiety attack symptoms, you can feel confident the doctor’s diagnosis is correct. Therefore, there is no need to worry about a heart attack.

Antidepressants called selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are commonly used as first-line treatments for anxiety. Less-commonly used — but effective — treatments for anxiety disorders are older classes of antidepressants, such as tricyclic antidepressants and monoamine oxidase inhibitors (MAOIs).
In deeper level psychoanalytic approaches, in particular object relations theory, panic attacks are frequently associated with splitting (psychology), paranoid-schizoid and depressive positions, and paranoid anxiety. They are often found comorbid with borderline personality disorder and child sexual abuse. Paranoid anxiety may reach the level of a persecutory anxiety state.[53]
I think i had an attack today while at work, I’ve been feeling overly anxious about going To work since my dad passed a month ago, I’ve been able to keep myself busy when I’m feeling anxious and will usually pass, but today I had the feeling I was trapped and I had to get out, Was shaking and couldn’t get my words out had the worst dry mouth, I literally got my things together and walked out of work, once home took me a good couple of hours of just sitting staring at the tv to feel ok again, in my profession being anxious is not a good thing, not sure on what is best to do
There are several different anxiety-related disorders. Some symptoms overlap across many of these disorders, and others are more specific to a single disorder. In general, however, all anxiety-related disorders feature worry, nervousness, or fear that is ongoing, excessive, and has negative effects on a person's ability to function. It can be tricky to decide when anxiety is typical or linked to a disorder, which is why diagnoses should be made by licensed professionals, such as psychologists or psychiatrists.

Prolonged exposure therapy is a specific type of CBT used to treat PTSD and phobias. The goal of this therapy is to help patients overcome the overwhelming disstress they experience when reminded of past traumas or in confronting their fears. With the guidance of a licensed therapist, the patient is carefully reintroduced to the trauma memories or reminders. During the exposure, the therapist guides the patient to use coping techniques such as mindfulness or relaxation therapy/imagery. The goal of this therapy is to help patients realize that trauma-related memories (or phobias) are no longer dangerous and do not need to be avoided. This type of treatment usually lasts 8-16 weekly sessions.

The typical course of panic disorder begins in adolescence and peaks in early to mid-twenties, with symptoms rarely present in children under the age of 14 or in older adults over the age of 64 (Kessler et al., 2012). Caregivers can look for symptoms of panic attacks in adolescents, followed by notable changes in their behavior (e.g., avoiding experiencing strong physical sensations), to help potentially identify the onset of panic disorder. Panic disorder is most likely to develop between the ages of 20-24 years and although females are more likely to have panic disorder, there are no significant sex differences in how the disorder presents (McLean et al., 2011).


Anxiety, worry, and stress are all a part of most people’s everyday lives. But simply experiencing anxiety or stress in and of itself does not mean you need to get professional help or that you have an anxiety disorder. In fact, anxiety is an important and sometimes necessary warning signal of a dangerous or difficult situation. Without anxiety, we would have no way of anticipating difficulties ahead and preparing for them.
If medications are prescribed, several options are available. Selective serotonin reuptake inhibitors (SSRIs), selective serotonin and norepinephrine reuptake inhibitors (SSNRIs), and the benzodiazepine families of medications are considered to be effective treatment of panic disorder. SSRIs include sertraline (Zoloft), fluoxetine (Prozac), paroxetine (Paxil), citalopram (Celexa), escitalopram (Lexapro), and fluvoxamine (Luvox). SSNRIs include duloxetine (Cymbalta) and venlafaxine (Effexor). Clinical trials have shown SSRIs reduce the frequency of panic attack up to 75%-85%. SSRIs must be taken three to six weeks before they are effective in reducing panic attacks and are taken once daily.
Moreover, this hypocapnia and release of adrenaline during a panic attack cause vasoconstriction resulting in slightly less blood flow to the head which causes dizziness and lightheadedness.[28][29] A panic attack can cause blood sugar to be drawn away from the brain and toward the major muscles. Neuroimaging suggests heightened activity in the amygdala, thalamus, hypothalamus, and brainstem regions including the periaqueductal gray, parabrachial nucleus, and Locus coeruleus.[30] In particular, the amygdala has been suggested to have a critical role.[31] The combination of high arousal in the amygdala and brainstem along with decreased blood flow and blood sugar in the brain can lead to dramatically decreased activity in the prefrontal cortex region of the brain.[32] There is evidence that having an anxiety disorder increases the risk of cardiovascular disease (CVD).[33] Those affected also have a reduction in heart rate variability.[33]
Simply put - agoraphobia means that you avoid a lot of ordinary activities and situations for fear of having panic attacks. To most people who get this diagnosis, the term sounds pretty scary, but that's all it means. It does not mean you are or will become house bound. That can happen to people, and is an extremely severe case of agoraphobia, but the great majority of people with agoraphobia do not experience it to that extent.
"This tends to make the individual vulnerable to developing an anxiety disorder, rather than cause them to directly inherit one," she says. Environmental factors, she adds, interact with genetic predispositions to trigger the onset of anxiety disorders. A study published in August 2017 in the journal Emotion may offer clues as to how both genes and environment combine to make anxiety take root. (4)

Anyone who’s ever had a panic attack can tell you what a rollercoaster-of-a-ride it can be. It comes on suddenly, gripping its victims in extreme fear and heart-thumping, breathtaking physical distress. Minutes later, it’s over. When panic attacks occur repeatedly and people’s lives are gripped by fear of having the next panic episode, they may be diagnosed with panic disorder.
The philosopher Søren Kierkegaard, in The Concept of Anxiety (1844), described anxiety or dread associated with the "dizziness of freedom" and suggested the possibility for positive resolution of anxiety through the self-conscious exercise of responsibility and choosing. In Art and Artist (1932), the psychologist Otto Rank wrote that the psychological trauma of birth was the pre-eminent human symbol of existential anxiety and encompasses the creative person's simultaneous fear of – and desire for – separation, individuation, and differentiation.
If you’re constantly dogged by worries, you might be diagnosed with generalized anxiety disorder (GAD). This mental illness is defined as excessive anxiety and worry with symptoms that are present most of the time and persist for more than 6 months. GAD is characterized by feelings such as nervousness, restlessness, fatigue, muscle tension, and difficulty concentrating and sleeping.
Heredity, other biological factors, stressful life events, and thinking in a way that exaggerates relatively normal bodily reactions are all believed to play a role in the onset of panic disorder. Some research suggests panic attacks occur when a “suffocation alarm mechanism” in the brain is activated, falsely reporting that death is imminent. The exact cause or causes of panic disorder are unknown and are the subject of intense scientific investigation.

So I can tell you that panic attacks aren't dangerous, but I recognize that this is "easy for me to say". If you're having anxiety attacks, especially if they're a relatively new occurrence for you, you might not be able to believe this right now. That's entirely understandable when you feel that your life is threatened! You don't need to take anything here on faith. Instead, check it all out. Test everything I say against your own experience, as you work your way through this site.
The disorder in younger children is less likely to have the symptoms that involve ways of thinking (cognitive symptoms). For example, panic attacks in children may result in the child's grades declining, decreased school attendance, and avoiding that and other separations from their parents. Both children and teens with panic disorder are further at risk for developing substance abuse and depression as well as suicidal thoughts, plans, and/or actions.
If I might make a suggestion for another coping mechanism: go near someone you trust – a friend, family member, or spouse. There’s safety in numbers, and even your subconscious knows that. Being near someone you trust can be comforting, as you’ll be able to get their help if something really does happen. It doesn’t matter if you talk to them, if they’re paying attention to you, or even if they’re sleeping – them simply being nearby and available to call upon if something happens will dull your fear.
A variety of medical and mental health professionals are qualified to assess and treat panic disorders. From purely medical professionals like primary care doctors, emergency room physicians to practitioners with mental health training like psychiatrists, psychologists, and social workers, a variety of health care providers may be involved in the care of panic disorder sufferers. Some practitioners will administer a self-test of screening questions to people whom they suspect may be suffering from panic disorder. In addition to looking for symptoms of repeated panic attacks using what is described in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), asking detailed questions about the sufferer's history and conducting a mental-status examination, mental health professionals will explore the possibility that the individual's symptoms are caused by another emotional illness instead of or in addition to the diagnosis of panic disorder. For example, people with an addiction often experience panic attacks, but those symptom characteristics generally only occur when the person is either intoxicated or withdrawing from the substance. Someone who has post-traumatic stress disorder (PTSD) may have panic attacks when reminded of trauma they experienced and in a person with obsessive-compulsive disorder, panic attacks may be triggered by their being unable to perform a compulsive behavior. The practitioner will also likely ensure that a physical examination and any other appropriate medical tests have been done recently to explore whether there is any medical problem that could be contributing to the occurrence of panic attacks. That is particularly important since many medical conditions may have panic attacks as a symptom and therefore require that the underlying medical condition be treated in order to alleviate the associated anxiety. Examples of that include the need for treatment with antibiotics for infections like Lyme disease or vitamin supplements to address certain forms of anemia.
DBT uses a skills-based approach to help patients regulate their emotions. It is a prefered treatment for Borderline Personality Disorder, but call also be effective for anxiety disorders such as PTSD. This treatment teaches patients how to develop skills for how to regulate their emotions, stress-management, mindfulness, and interpersonal effectiveness. It was developed to be employed in either one-on-one therapy sessions or group sessions. This type of therapy is typically long-term and patients are usually in treatment for a year or more.
While the use of drugs in treating panic attacks can be very successful, it is generally recommended that people also be in some form of therapy, such as cognitive behavioral therapy. Drug treatments are usually used throughout the duration of panic attack symptoms, and discontinued after the patient has been free of symptoms for at least six months. It is usually safest to withdraw from these drugs gradually while undergoing therapy.[14] While drug treatment seems promising for children and adolescents, they are at an increased risk of suicide while taking these medications and their well-being should be monitored closely.[59]

A large brief current is passed through a wire coil that is placed on the front of the head which is near the areas that regulate mood. The transient current creates a magnetic field that produces an electric current in the brain and stimulates nerve cells in the targeted region. The current typically only affects brain regions that are 5 centimeters deep into the brain which allows doctors to selectively target which brain regions to treat. Typical sessions lasts 30-60 minutes and do not require anesthesia. Sessions are administered 4-5 times a week for about 6 weeks. Although the procedure is painless, patients may experience a gentle tapping in the area of the head where the current is being administered. Neuromodulation has very few side effects but they may include headaches, slight tingling or discomfort in the area in which the coil is placed. rTMS may be administered alone or in combination with medication and/or psychotherapy.
Once someone has had a panic attack, he or she may develop irrational fears, called phobias, about the situations they are in during the attacks and begin to avoid them. That, in turn, may reach the point where the mere idea of doing things that preceded the first panic attack triggers terror or dread of future panic attacks, resulting in the individual with panic disorder being unable to drive or even step out of the house. If this occurs, the person is considered to have panic disorder with agoraphobia.

Panic attacks and panic disorder are treatable once the underlying cause of is identified. “Usually medical conditions and other factors (substance use or withdrawal from substances) are ruled out before making the diagnosis,” says Flo Leighton, psychiatric nurse practitioner, and therapist with Union Square Practice in Manhattan. Getting to the root cause typically takes a couple of sessions, says Leighton. Here are some options that may be recommended to you :

Some research suggests that your body's natural fight-or-flight response to danger is involved in panic attacks. For example, if a grizzly bear came after you, your body would react instinctively. Your heart rate and breathing would speed up as your body prepared for a life-threatening situation. Many of the same reactions occur in a panic attack. But it's unknown why a panic attack occurs when there's no obvious danger present.

Although phobias can be crippling, they're not obvious at all times. In fact, they may not surface until you confront a specific situation and discover you're incapable of overcoming your fear. "A person who's afraid of snakes can go for years without having a problem," Winston says. "But then suddenly their kid wants to go camping, and they realize they need treatment."

“Panic disorder is diagnosed if the individual has recurrent panic attacks (minimum four in a four-week period), and at least one of the attacks is accompanied by one or more physical symptoms, including persistent concern about having another attack, worry about the implication or consequences of the attack (i.e., having a heart attack), and/or a significant change in behaviour due to the attacks, such as quitting a job.7 In addition, the panic attacks cannot be due to the physiological effects of a substance or another general medical condition.”[1]


It is important to note that genetic factors can also bestow resilience to anxiety disorders, and the field continues to pursue large-scale genomics studies to identify novel genetic factors that are associated with anxiety disorders in hopes of better understanding biological pathways that: 1) contribute to the development and maintenance of anxiety; and 2) may lead to better treatment for these disorders. Most people are not aware of what specific genetic markers they may have that confer risk for anxiety disorders, so a straightforward way to approximate genetic risk is if an individual has a history of anxiety disorders in their family. While both nature and nurture can be at play with family history, if several people have anxiety disorders it is likely that a genetic vulnerability to anxiety exists in that family.
A person with social anxiety disorder has significant anxiety and discomfort about being embarrassed, humiliated, rejected or looked down on in social interactions. People with this disorder will try to avoid the situation or endure it with great anxiety. Common examples are extreme fear of public speaking, meeting new people or eating/drinking in public. The fear or anxiety causes problems with daily functioning and lasts at least six months.
Please Note: In some cases, children, teenagers, and young adults under 25 may experience an increase in suicidal thoughts or behavior when taking antidepressant medications, especially in the first few weeks after starting or when the dose is changed. Because of this, patients of all ages taking antidepressants should be watched closely, especially during the first few weeks of treatment.
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