Panic Disorder: How to Manage Anxiety and Panic Attacks

Contents

• What is Panic Disorder?
• The Symptoms
• When to Seek Help
• Treatments
• Self-Care Tips
• Other Sources of Help
• Complications
• Causes
• Panic Disorder in Children

What is Panic Disorder?

Panic disorder is an anxiety condition where you experience recurrent, unexpected panic attacks. Everyone feels anxious and panicky sometimes – it’s a perfectly normal response to dangerous or stressful situations. But people with panic disorder deal with feelings of stress, anxiety and panic on a regular basis, often without any apparent reason.

The Symptoms

Anxiety

Anxiety is that uneasy, worried feeling ranging from mild to severe. It includes worry, fear, and panic – the most intense form of anxiety. With panic disorder, you may begin to start avoiding certain situations because you are worried that they’ll bring on another panic attack. This “fear of fear” cycle can make your sense of panic worse and cause more attacks.

Panic Attacks

During a panic attack, you get a sudden rush of intense mental and physical symptoms that come on quickly without an obvious cause. Panic attacks are extremely frightening and distressing. Symptoms include:

• Racing heartbeat
• Feeling faint
• Sweating
• Nausea
• Chest pain
• Shortness of breath
• Trembling
• Hot flushes
• Chills
• Shaky limbs
• Choking sensation
• Dizziness
• Numbness or pins and needles
• Dry mouth
• Sense of dread or fear of dying
• Churning stomach
• Tingling in fingers
• Feeling disconnected from your body

Panic attacks typically last 5–20 minutes, although they can last up to an hour. The number of attacks depends on the severity of your condition – some people have them monthly, others weekly. While extremely scary, panic attacks themselves are not usually physically harmful. However, many of these symptoms can also indicate other medical conditions, so you aren’t always experiencing a panic attack.

If you experience new or unexplained symptoms, seek medical advice rather than assuming they are caused by anxiety. Call 999 if you have sudden chest pain that does not go away, particularly if it spreads to your arms, neck, jaw or back, or is accompanied by sweating, nausea, light-headedness or shortness of breath.

When to Seek Help

See your GP if you’re experiencing panic disorder symptoms. Describe your symptoms, how often you get them, and how long you’ve had them. Your GP may do a physical exam to rule out other causes. It can be hard to open up, but try not to feel anxious or embarrassed.

You may be diagnosed with panic disorder when you have recurrent, unexpected panic attacks followed by a month or more of persistent worry about having more attacks or changes in behaviour related to the attacks.

For further information, see the NHS guidance on panic disorder.

Treatments

Treatment aims to reduce your number of panic attacks and ease symptoms. The main treatments are talking therapies and medication, depending on your specific symptoms.

Talking Therapies

You can self-refer for cognitive behavioural therapy (CBT) or ask your GP for a referral. Your therapist will discuss how you react during panic attacks and teach ways to change your behaviour to stay calm. You may need to see your GP regularly during CBT to monitor your progress.

Medication

If suitable, you may be prescribed an antidepressant such as a selective serotonin reuptake inhibitor (SSRI). If an SSRI is unsuitable or ineffective, your doctor may consider another antidepressant, including certain tricyclic antidepressants.

Antidepressants can take several weeks to start working, and the time needed to experience their full effects varies. Keep taking your medicines as prescribed, even if you don’t think they’re working, unless your GP advises you to stop. Do not stop antidepressants suddenly without medical advice.

Medicines such as pregabalin and benzodiazepines, including clonazepam, are not recommended as routine treatments for panic disorder. Your doctor will consider the most appropriate treatment based on your symptoms and medical history.

For more information about recommended treatments, see NICE guideline CG113: Generalised anxiety disorder and panic disorder in adults.

Referral to a Specialist

If your symptoms don’t improve with CBT, medication, and a support group, your GP may refer you to a mental health specialist like a psychiatrist or clinical psychologist. The specialist will assess you and devise a plan to manage your symptoms.

Self-Care Tips

During a Panic Attack:

• Stay where you are if that’s an option and it is safe to do so
• Try to breathe slowly and gently
• Tell yourself that it will pass
• Focus on positive, peaceful imagery
• Remind yourself that a familiar panic attack will usually pass, while seeking medical help for new or concerning symptoms

Preventing Further Attacks:

• Read a CBT-based self-help book for anxiety (ask your GP for a recommendation)
• Try relaxing activities like yoga and pilates
• Learn breathing exercises
• Exercise regularly to reduce stress
• Limit caffeine and alcohol if they trigger your symptoms, and seek support to stop smoking
• Try to maintain regular sleep and eating habits

Other Sources of Help

Panic disorder can hugely impact your life, but support is available. Speaking with others who have the condition or connecting with a charity may help. Some useful links:

• Anxiety UK
• Mind: Understanding Anxiety and Panic Attacks
• No Panic
• Triumph Over Phobia (TOP UK)

Ask your GP about local panic disorder support groups as well. There are mental health services across the country that can provide help.

Complications

Panic disorder is treatable, so get medical help as soon as possible. If left untreated, it can escalate and become extremely difficult to cope with. You’re at higher risk of developing other mental health issues like agoraphobia or alcohol/drug problems.

Panic disorder can affect your ability to drive. You must inform the Driver and Vehicle Licensing Agency (DVLA) if your condition affects your ability to drive safely and meets the notification requirements. Check the current GOV.UK guidance on health conditions and driving and ask your GP if you are unsure.

Causes

Like many mental health conditions, the exact causes of panic disorder aren’t fully understood. It’s thought to be linked to a combination of factors:

• Traumatic or highly stressful life events like bereavement
• Family history of panic disorder
• Differences in how the brain and body respond to fear and stress

There is no single proven chemical imbalance that explains panic disorder.

Panic Disorder in Children

If your child shows signs of panic disorder, they should see a GP. After getting a medical history and physical exam to rule out physical causes, the GP may refer your child to a specialist. The specialist is likely to recommend cognitive behavioural therapy (CBT).

There are good resources online about anxiety disorders in children and mental health support services for young people if you need more information.

The key takeaway is that panic disorder is treatable with the right help. Don’t hesitate to seek support to break the cycle of panic and anxiety. With therapy, medication if appropriate, and self-care strategies, you can get your symptoms under control and improve your quality of life.

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