Panic disorder

Panic disorder is characterized by the recurrent onset of unexpected and intense fear occurring without a clear trigger. Most commonly fear is accompanied by a variety of physical symptoms, including chocking sensation, nausea, sweating, shortness of breath, palpitations, pounding heart, or accelerated heart rate.

Frequently, panic disorder is associated with comorbid diseases such as major depression, bipolar illness, and other anxiety disorders but may also be linked to habitual alcohol and substance abuse. In some cases, it can also precede the onset of depression, and may lead to the development of agoraphobia, i.e. the avoidance of familiar places or situations that the patient believes to be triggers of their panic attacks, which often results in poor quality of life.

Moreover, as panic attack symptoms may resemble the symptoms of other medical illnesses, patients are often preoccupied with their health and tend to spend significant time of their life in unnecessary healthcare appointments, often miss work, or work less productively.

Symptoms of panic disorder generally includes four of the following

  • Fast or pounding heartbeat

  • Trembling/shaking

  • Sweating

  • Choking feeling or feeling you are being smothered

  • Chest pain

  • Hot flushes or chills

  • Feeling faint or dizzy

  • Fear of losing control

  • Fear of dying

  • Feeling that you are going crazy or losing control

Treatment of panic disorder

Pharmacotherapy

Most commonly benzodiazepines are prescribed to rapidly reduce the physical discomfort associated with panic attacks. However, their use can lead to abuse and dependence.

Randomized controlled trials suggest that panic disorder can be effectively treated with selective serotonin reuptake inhibitors (SSRIs), including fluoxetine, fluvoxamine, sertraline, paroxetine, citalopram, and escitalopram. However, other evidence supports the use of second-generation antidepressant agents such as venlafaxine.

Cognitive remediation therapies

Cognitive behavioural therapy (CBT) has been shown to be effective in the treatment of panic disorder when administered to a person alone or in a group setting. Other forms of psychotherapy include insight-oriented therapies, relaxation training without exposure, stress management, hypnosis, eye movement desensitization and reprocessing (EMDR) therapy, and neurofeedback training.