Why do I get anxiety attacks?

Contents

What Happens Inside Your Body

Your body’s “fight or flight” response is behind these intense physical symptoms. Normally when you encounter a threat — whether it’s a grizzly bear or a swerving car — your nervous system springs into action. The hormone adrenaline floods into your bloodstream, putting your body on high alert. Your heartbeat quickens, which sends more blood to your muscles. Your breathing becomes fast and shallow, so you can take in more oxygen. Your blood sugar spikes. Your senses get sharper.

All of these changes — which happen in an instant — give you the energy you need to confront a dangerous situation or get out of harm’s way quickly.

With random panic attacks, your body goes on alert for no reason. Researchers don’t know exactly what triggers them. But the physical effects are real: During a panic attack, the adrenaline levels in the body can spike by 2 1/2 times or more.

Panic attacks may not come as unexpectedly as they seem. The physical changes may start about an hour before an attack. In one study, people with panic disorder wore devices that tracked their heart activity, sweating, and breathing. The results showed lower-than-normal levels of carbon dioxide, a sign of rapid, deep breathing that can leave you breathless, as early as about 45 minutes before the panic attack.

Don’t panic. That’s a phrase we hear countless times in a day. We hear it in conversation, on TV, in the movies. We say it to ourselves. Why? Because when we panic– experience an intense sensation of fear or anxiety in response to an actual danger—we are more likely to lose control and react to potentially unsafe even life-threatening events in a frantic or irrational way. Panic inhibits our ability to reason clearly or logically. Think about the explosion of fear, the borderline hysteria you felt the day you momentarily lost sight of your six-year-old in the mall. Or the time your car skidded violently on a rain-soaked road. Even before you registered what was happening, your body released adrenaline, cortisol and other hormones that signal danger. Those hormones cause physical reactions: heart pounding, shallow breathing, sweating and shivering, shaking, and other unpleasant physical sensations.

At some point in our lives, most of us will experience a panic attack in response to an actual danger or acute stress. But when panic attacks occur or recur for no reason and in the absence of danger or extreme stress, or when the fear of experiencing another attack is so strong that you change your behavior by avoiding certain places or people, you may have panic disorder.

The End of Everything: What a Panic Attack Feels Like

Only 16, Caroline, had her first panic attack a year ago. Her mother was dropping her off at her summer job at a local school when, without warning, a full-blown panic attack engulfed her. “My heart started racing and my body felt so hot. I started to sweat and shake uncontrollably. My vision became distorted and my body felt limp, like a wet noodle,” she says. For 20 minutes, until the panic attacked passed, Caroline refused to get out of the car. Her mother didn’t know what to do.

Kirstie Craine Ruiz, 46, has lived with anxiety, panic attacks, and panic disorder for about ten years. For a long time, she had full-blown attacks 2-3 nights a week. “I would usually awake to a racing heart or the feeling of my heart expanding in my chest…like it might explode… From there, I would begin to panic and my heart would go even faster….and my body would shake so hard that it felt like I was having a convulsion. I could barely breathe and was usually pretty sure I was having a heart attack and that I was going to die. Sometimes I’d go the ER and they’d hold me overnight because my heart would be going so fast and they couldn’t get it to go down.”

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During the day if she was out, the attack felt “like my head suddenly weighed a thousand pounds and my chest would get really heavy. It literally felt like something was pulling me down. I would usually have to head home immediately. I would then experience foggy vision where it …actually looked like there was fog in the air. I also experienced double vision and parts of my body—like my neck or one arm or one entire side of my face– would go totally numb.”

In addition to the emotional turmoil and the physical manifestations that Caroline and Kirstie describe panic attacks can cause palpitations, pounding heart or accelerated heart rate; sweating; trembling or shaking; sensations of shortness of breath or smothering; feelings of choking; chest pain or discomfort; nausea or abdominal distress; feeling dizzy, unsteady, light-headed or faint; chills or overheating; numbness or tingling; feelings of unreality (derealization) or being detached from oneself (depersonalization); fear of losing control or “going crazy”; and fear of dying.

Isolated attacks are bad enough. But when the attacks recur in a short period of time or when the fear of another attack is so strong that you begin to avoid situations, places and people that may trigger an attack, you may be diagnosed with panic disorder.

Stopping Panic: What to Do When You’re Having a Panic Attack

Here, some strategies that have worked for others that may help you:

1) Deep breathing: Relaxing your body can help sidestep a panic attack. Practice breathing in through your nose for a count of five, hold it for five and then breathe out through mouth for a count of five. Or take a class in meditation and breathing techniques

2) If you suddenly feel your heart pounding or experience other physical clues that a panic attack is barreling for you, try this distraction suggested by Rob Cole, LHMC, clinical director of mental health services at Banyan Treatment Centers. Start counting backward from 100 by 3s. The act of counting at random intervals helps you to focus and override the anxious thoughts that are trying to sneak into your psyche. Better still keep loose change in your pocket. Add a dime to a nickel, then add two pennies and so on. By controlling your thoughts and focusing on something outside yourself you will being to feel calmer.

3) Grounding yourself is another helpful technique. Tune yourself into 4 things around you that you can see, 3 things you can touch, 2 that you smell and 1 you can taste. Again, forcing your mind to consider something outside yourself helps, says Cole.

4) Ice, Ice Baby. For nighttime panic attacks, Kirstie Craine Ruiz keeps about 4 ready-to-go ice packs—2 big and 2 small– in her freezer. When she feels panic coming she puts two small ones in her hand and the 2 large ones on my lower back. “If your heart is really racing and your breathing is bad, I would suggest taking the one on your belly and rubbing it from the middle of your chest down to the bottom of your belly, slowly, and over and over until your heart rate starts to mellow (over your shirt, of course- you don’t want to make yourself freezing!). I feel like when I do this, it literally moves the hyper energy down from my chest and alleviates any chest pain. This method always helps me when it feels like my heart is in my throat. Once you feel as though you can breathe again, place the packs on your lower belly or lower back, and in the palms of your hands. I don’t know if it’s pressure points but holding small smooth ice packs in both hands with palms up, does wonders for my panic, to this day.”

5) Caroline, 16, has found dialectical behavior therapy helpful and she’s discovered that her panic attacks may be heightened if not triggered by bright light. Her tip: wear sunglasses. She also shies away from conversation during the attack. “Don’t ask me if I’m OK,” she says.

Who Gets Panic Attacks?

At least 6 million Americans suffer from panic attacks and panic disorder both conditions classified as anxiety disorders. According to the Anxiety and Depression Association of America (ADAA), about 2-3% of Americans experience panic disorder in a given year and it is twice as common in women as in men. Panic disorder typically affects individuals when they’re in their 20s but is also seen in young children, adolescents, and older adults.

What Causes Panic Disorder?

While the exact causes are not known, what researchers do know is that panic disorder does sometimes run in families. And it is often seen in individuals who suffer from other anxiety disorders explains Cole.

For example, a person with obsessive-compulsive disorder may experience a panic attack when their schedule or compulsions are interrupted. Individuals who struggle with specific phobias are also susceptible to panic attacks. A person with an extreme fear of heights (acrophobia) may experience a panic attack in a penthouse apartment. And for someone with generalized anxiety disorder (GAD), a condition characterized by extreme fear or worry, the unending anxiety can escalate to a panic attack. People with post-traumatic stress disorder (PTSD) have a higher incidence of panic disorder than the general population. Illness or traumatic events increase the chances of panic attacks.

People with hyperthyroidism (Graves’ disease), mitral valve prolapse and other conditions or diseases also may be more easily triggered.

Treatment Options

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 :

  1. Cognitive behavioral therapy (CBT), is based on the idea that our thoughts cause our feelings and behaviors, not external things, like people, situations, and events. According to the National Association of Cognitive Behavioral Therapists the benefit of this therapy is that we can change the way we think to feel and act better even if the situation does not change. CBT focuses on determining the thought and behavior patterns responsible for sustaining or causing the panic attacks. CBT is a time-limited process (treatment goals—and the number of sessions expected to achieve them—are established at the start) that employs a variety of cognitive and behavioral techniques to affect change.
  2. Dialectical Behavior Therapy (DBT) is form of Cognitive therapy that emphasizes individual psychotherapy as well as group skills training to help people learns new skills and strategies—including mindfulness and distress tolerance– to manage their anxiety and panic. According to the American Psychological Association therapists who practicing DBT aim to strike a balance between validation and change by clearly communicating acceptance of who the client is and the challenges the client faces, while at the same time helping the client to learn new skills to improve emotion regulation, interpersonal communication skills and how to participate in life and cope with problems without defaulting to impulsive behavior.
  3. Exposure therapy has been around for a long time. It involves exposing the patient in a safe and controlled environment to physical sensations they experience during a panic attack much the same way you‘d expose in small increments a person with a fear of trains or puppies or snakes to the things that scares them. With panic disorder, there’s often a heightened sensitivity to ordinary physical sensations such as racing heart, stomach ache or feeling faint. In exposure therapy, the therapist will ask you to mimic activities—like running around or doing jumping jacks or holding your breath—to cause panic symptoms. The idea is that by repeating the things that may trigger a panic attack those triggers will eventually lose their power.
  4. Medication can be used to control or lessen symptoms related to panic disorder. It is most effective when combined with other treatments, such as the aforementioned cognitive behavioral therapy and exposure therapy. Medications used to treat panic attacks and panic disorder include antidepressants, though they take several weeks to reach effectiveness. Benzodiazepines such as Ativan and Xanax work quickly. However they are addictive and should only be used for a short time,

Overall, the best treatment involves a combination of therapies along with mindfulness, learning deep breathing techniques, yoga and exercise.

Of course, everyone is different and what works for one person might not work for you. If you experience panic attacks or acute anxiety and if you’ve discovered helpful tips, tricks, and methods that help, let us know.

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You were fine a minute ago. Now your heart is racing, your hands and feet have gone numb and you feel like you can’t get enough air.

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Clearly, you’re freaking out. But why? Are you having a panic attack? An anxiety attack? Are they the same thing? Are you going crazy? (Why can’t you stop the flood of questions?!)

Deep breaths. Clinical psychologist Regina Josell, PsyD, explains what’s going on when your body goes haywire — and how to get back to a place of calm.

Anxiety and panic attacks

A lot of people use the terms “anxiety attack” and “panic attack” interchangeably, but anxiety and panic attacks are slightly different beasts, Dr. Josell says. What’s the difference?

Here’s a basic breakdown:

  • Anxiety is a typical human emotion. Big nerves before a big test, feeling super-stressed before a work presentation, fear before a medical exam — anxiety is unpleasant in the moment, but can also motivate us and protect us from threats, Dr. Josell says. “Everybody experiences anxiety.”
  • Anxiety disorders occur when anxiety starts to interfere with everyday life. They can come in many forms, like social anxiety, a phobia of spiders or planes, or generally feeling worried and on alert at all times. What anxiety disorders have in common: People respond to non-threatening things with outsized fear and dread.
  • Anxiety attacks aren’t technically a thing, at least not according to medical terminology. It’s a layperson’s term for a panic attack.
  • Panic attacks are intense attacks of fear and anxiety that may occur without warning. They often occur in response to a stressful event. But sometimes they strike for no apparent reason. “The body’s fight-or-flight response gets triggered when it shouldn’t. The body thinks it’s in danger, but it’s not,” Dr. Josell says. Panic attacks are scary, but not dangerous and usually last just 15 or 20 minutes. (Though that feels like a loooong time when you’re in the middle of one.)
  • Panic disorder is a type of anxiety disorder. It occurs when a person has repeated panic attacks. (Because one isn’t awful enough?)

Panic attack symptoms

It’s one thing to get nervous. A panic attack is different. To qualify as a panic attack, you have to experience four or more of these symptoms:

  • Increased heart rate.
  • Chest pain or discomfort.
  • Sweating.
  • Trembling or shaking.
  • Feeling that you might be choking.
  • Dizziness.
  • Chills or overheating.
  • Nausea.
  • Fear that you’re dying or going crazy.
  • Numbness.
  • A feeling that what’s happening around you isn’t real.

Unfortunately, if you have one panic attack, it’s common to have another. People often become so worried about it happening again that it becomes a self-fulfilling prophecy, says Dr. Josell. “People sometimes start to avoid certain situations or places where they had a panic attack before. They might even avoid leaving home,” she adds.

But you don’t have to become a hermit, reassures Dr. Josell. “Panic attacks are so treatable.”

Dealing with panic attacks

1. Label it

When someone has a panic attack, they often think they’re having a heart attack or losing their mind, Dr. Josell says. “It can be pretty intense and often happens out of the blue.”

Learning about panic attacks and recognizing the symptoms helps people keep it together if they have another. “It helps if you can say to yourself, ‘This is a panic attack, it’s not going to kill me, it will be uncomfortable — but it will end,’” she says.

2. Keep track

Keep a log of your panic attacks, including when and where they happened, how long they lasted and anything that might have triggered it. If you can identify a particular trigger, you can find specific ways to manage that trigger.

Tracking also helps you see if your current strategy for dealing with panic attacks is working. “When people see their panic attacks are happening less often, or lasting for a shorter time, it gives them confidence — and that helps them get better,” Dr. Josell says.

3. Breathe

Deep breathing exercises can help turn down your body’s panic response, helping your breath and heart rate return to normal. You can find breathing exercises online and in the app store.

4. Distract yourself

“The more you focus on your panic, the worse it gets,” Dr. Josell says. “Wash your face, brush your teeth, pet the dog, smell something pleasant — using your other senses, like smell and touch, can be helpful.”

5. Ask for help

Mental health professionals can help you find ways to manage anxiety as well as treat panic attacks and panic disorder. To tackle panic attacks, they often use a Jedi mind trick known as cognitive restructuring. You learn to identify and change the thoughts that go hand-in-hand with panic triggers.

“Once you learn to manage those thoughts instead of dreading them, it tends to reduce both the intensity and frequency of the panic attacks,” Dr. Josell says.

If you feel like panic attacks are controlling you, flip the script and start controlling them instead. “If panic attacks are interfering with your daily life, it’s a good time to get help,” she says.

Panic Disorder: Symptoms, Causes, and Treatment

This disorder may lead to phobias that cause people to completely avoid certain situations.

For a person with panic disorder, panic attacks occur frequently and sometimes out of nowhere. iStock.com

Panic disorder, a type of anxiety disorder, is a serious condition characterized by recurrent panic attacks and at least a month of worry or concern about future attacks, as well as behavioral changes centered on the attacks.

For people with panic disorder, panic attacks are recurrent and can happen at any time, often causing them to live with persistent worry that more attacks will occur.

What Can Trigger a Panic Attack?

Panic attacks, a hallmark of panic disorder, are sudden and repeated bouts of overwhelming fear. These attacks, which often begin in adolescence or early adulthood, are much more intense than normal feelings of anxiety or stress. They usually pass after a few minutes and typically last no longer than an hour, but can continue to recur throughout a day.

You do not need to be officially diagnosed with panic disorder to have an attack. Some people have only one or two panic attacks in their life and don’t have panic disorder. Panic attacks are actually much more common than panic disorder. According to one Harvard Medical School survey, about 23 percent of people interviewed experienced at least one panic attack in their lifetime, while only about 3 percent of people experienced panic disorder in their lifetime. (1)

Certain places or situations can trigger a panic attack in some people. Panic attacks can also happen without warning.

The physical symptoms of a panic attack are those of the fight-or-flight response to danger — except that no threat is present.

“The fight-or-flight system is hardwired for us humans to manage dangerous situations, and those of us with anxiety have an activated fight-or-flight response when the trigger is not really dangerous,” says Beth Salcedo, MD, the medical director of The Ross Center for Anxiety & Related Disorders and board president of the Anxiety and Depression Association of America.

“Our heart races, and our circulation favors our large muscle groups so we can run away, and we in turn get dizzy because the blood is flowing in a different way. Our body is readying us to try to get away from the danger,” she says.

Noah Clyman, a licensed clinical social worker and the director of NYC Cognitive Therapy in New York City, says he works with patients to realize that these often scary physical symptoms can be tolerated, and not feared. “A main goal of treatment is for the client to learn that panic sensations are normal and uncomfortable, but not dangerous.”

RELATED: How Yoga Helps With Depression, Anxiety, and Addiction

What Does a Panic Attack Feel Like?

Panic attacks usually include at least four of the following symptoms (2):

  • Heart palpitations (pounding or racing heartbeat)
  • Sweating
  • Trembling or shaking
  • Chest pain or discomfort
  • Shortness of breath
  • Feeling like you’re choking
  • Numbness or tingling, especially in the hands
  • Feeling hot or feeling a cold chill
  • Feeling dizzy, light-headed, or unsteady
  • Nausea or upset stomach
  • Feeling like you’re detached from yourself
  • Feeling like you’re losing control or going crazy
  • Fear of dying

How Do You Stop a Panic Attack?

Breathing exercises may be helpful in dealing with a panic attack. Slowing your breath slows down your heart rate and helps shut off your body’s alarm system.

Here’s a simple breathing exercise:

  • While you’re sitting or lying down, inhale slowly through your nose while counting to five.
  • Exhale through your mouth for a count of five.
  • Continue breathing in and out for three to five minutes

RELATED: 10 Ways to Stop a Panic Attack

When Is a Panic Attack a Heart Attack?

The symptoms of heart attacks and panic attacks can be similar, but there are a few ways that you may be able to distinguish one from the other. If you are having a heart attack, you will probably experience the following:

  • Severe and worsening pain and pressure in your chest area
  • Pain that spreads from the chest area to your limbs or up your neck
  • Deep breathing does not lessen the symptoms
  • Physical activity makes symptoms worse

Don’t avoid going to the emergency room if you’re not sure what your symptoms mean. If you’re worried that you are having a heart attack, call 911 or go to the nearest emergency room.

What Causes Panic Disorder?

The exact causes of panic disorder are unknown, but researchers believe that biological and biographical influences work together in ways that make some people more susceptible to the disorder.

Two main triggers can contribute to episodes:

Stressful life events Graduating from college, getting married, having a first child, moving, and getting divorced are major life changes that can induce feelings of intense worry and apprehension.

Genetics Like many other mood disorders, anxiety does tend to run in families, and having a parent with panic disorder can put you at higher risk for the condition.

How Common Is Panic Disorder?

In the United States, according to the National Institute of Mental Health (NIMH), the yearly prevalence of panic disorder is 2.7 percent. About 45 percent of these cases of panic disorder are considered “severe.” (3)

Panic disorder is twice as common in women as it is in men, according to the NIMH. (3)

What Happens If You Have Panic Disorder?

Without treatment, panic disorder can be debilitating.

In the most extreme cases, people with panic disorder may develop agoraphobia: a fear of places or situations from which escape might be difficult. This disorder can cause people to stay at home, indoors, at all times.

Panic disorder is also associated with:

  • Depression and increased risk of suicide
  • Substance abuse
  • Medical complications
  • Financial issues and dependence on other people
  • Problems with work or school

How Do You Treat Panic Disorder?

To find out whether you have panic disorder, your doctor will give you a physical exam and order blood tests to rule out other possible causes of your symptoms, such as thyroid issues.

Your doctor will then give you a psychological examination, which may consist of a mental health questionnaire, or will refer you to a mental health professional, who will make a diagnosis on the basis of your symptoms.

It’s important to know and record your symptoms to get an accurate diagnosis.

Some research suggests that people may see 10 or more doctors before being diagnosed with panic disorder, according to the American Psychological Association (APA).

Cognitive behavioral therapy, called CBT for short, is a form of therapy in which individuals work with therapists to notice their negative thought patterns and identify ways to deal with them. According to the APA, it is very effective at treating panic disorder. (4)

What Medications Are Used to Treat Panic Disorder?

Medications — most often antidepressants and anti-anxiety drugs — can also be used to help treat panic disorder. Your doctor may initially prescribe you an anti-anxiety drug, such as Xanax (alprazolam), and then add an antidepressant, such as Effexor XR (venlafaxine). After a month or sooner, your doctor may stop the Xanax and have you remain on the antidepressant.

Commonly prescribed medications include:

  • Venlafaxine
  • Prozac (fluoxetine)
  • Xanax (alprazolam)

Additional reporting by Carlene Bauer

What to know about panic attacks and panic disorder

Share on PinterestPanic can lead to lightheadedness.

A panic attack often stems from a direct trigger or incident, but they can also begin suddenly and randomly with no obvious cause. They are believed to come from an evolutionary response to danger.

Having a panic attack is said to be one of the most intensely frightening, upsetting and uncomfortable experiences in a person’s life.

The American Psychological Association (APA), notes that an attack may only last for 15 seconds, but symptoms can to continue for about 30 minutes or longer, and sometimes for hours.

According to the Anxiety and Depression Association of America, a panic attack involves at least four of the following symptoms:

  • Chest pain and discomfort
  • Chills or feeling unusually hot
  • Derealization, or feeling detached
  • Dizziness and feeling lightheaded
  • Experiencing a strong, sudden fear of dying
  • Fear of losing control or feeling as if a person is “going crazy”
  • Feelings of choking
  • Heart palpitations, irregular heartbeat, or rapid heart rate
  • Nausea and stomach upset
  • Numbness or tingling
  • Shaking or trembling
  • Sweating
  • Trouble breathing, feeling as if a person is smothering

Panic attacks can also be associated with agoraphobia, a fear of places from which the individual considers to be dangerous, or difficult to escape from. People who have experienced a panic attack often say after that they felt trapped.

Sometimes the symptoms associated with a panic attack can mirror other medical conditions. Examples of these include lung disorders, heart conditions, or thyroid problems.

Sometimes a person may seek emergency medical attention for a heart attack, yet anxiety is the true cause. Panic attacks are highly treatable and don’t mean that a person is a hypochondriac or mentally ill.

What is panic disorder?

Panic disorder is an underlying medical condition, and panic attacks are a symptoms. According to the Anxiety and Depression Association of America, an estimated 6 million Americans have a panic disorder.

Women are most likely to experience the condition and it most commonly occurs when a person in early adulthood, from ages 18 to 25 years.

The condition occurs when a person has experienced multiple panic attacks and also lives in fear of having another panic attack. While everyone can experience a panic attack in their lifetime, those with a panic disorder experience recurrent attacks.

The fear they may experience another attack can cause them to withdraw from friends and family. They may fear going outside or in public places. A panic disorder can severely affect a person’s quality of life and should be treated.

What are panic attacks?

A panic attack is a sudden rush of intense fear or discomfort, which includes at least 4 of the following symptoms:

  • racing or pounding heart
  • sweating
  • shaking or trembling
  • shortness of breath or feelings of being smothered
  • feeling of choking
  • chest pain or discomfort
  • chills or hot flashes
  • nausea or upset stomach
  • dizziness or lightheadedness
  • a sense of things being unreal or feeling detached from oneself
  • numbness or tingling sensations
  • fear of losing control or “going crazy”
  • fear of dying

Panic attacks tend to start quickly and reach a peak within 10 minutes. The peak generally lasts for about 5 to 10 minutes before the symptoms start to settle. However, it can take quite some time for all the symptoms to subside.

What is the difference between panic attacks and panic disorder?

  • Panic attacks are fairly common and having one does not mean that you have panic disorder. For example, if you are feeling very stressed or overtired, or if you have been doing excessive exercise, you might have a panic attack. This does not mean that you have panic disorder.
  • Panic attacks only become a problem if you are regularly worried about having more attacks, or if you are afraid that something bad will happen because of a panic attack. For example, people worry that they will faint, embarrass themselves, have a heart attack, go crazy, or die.
  • In panic disorder, the panic attacks are unexpected and unpredictable. It is common for people with other anxiety disorders to have panic attacks, and this is not panic disorder. For example, people with a phobia of dogs might have a panic attack whenever they are near a dog. But in this case, the panic attack is expected, and the person is afraid of the dog not the panic attack.

Panic Disorder

  • Symptoms
  • Onset & Course
  • Causes
  • Agoraphobia
  • Limited Symptom Attacks

Symptoms

Individuals with panic disorder regularly suffer intense episodes of anxiety, known as panic attacks (see below). They worry a lot about having more attacks, or about what the attacks imply or might cause, or have made changes to their behaviors because of the attacks.

Panic Attacks

These intense anxiety attacks include 4 or more of the following symptoms:

  • shortness of breath
  • increased heart beats
  • trembling, shaking
  • dizziness
  • chest pain
  • sweating
  • chills or hot flashes
  • feelings of unreality or being detached from oneself
  • numbing or tingling sensations
  • nausea
  • choking sensations
  • fear of dying
  • fear of insanity or of losing control

Panic attacks begin suddenly and usually peak quickly, within 10 minutes or less of starting. Multiple attacks of different intensities may occur over several hours, which might feel as if one panic attack is rolling into the next, like waves. At first, panic attacks usually seem to come ‘out of the blue,’ but over time a person may come to expect them in certain situations. If a person begins to avoid these situations due to fear of a panic attack, they may also have agoraphobia (see below).

Some people suffer panic attacks on a daily or weekly basis. The outward symptoms of a panic attack frequently result in social difficulties, such as embarrassment, stigma, or social isolation. However, people who have had these attacks for a long time are often able to restrain outward signs of even very intense panic attacks. Sometimes people will suffer milder attacks with only 3 or less of the above symptoms, which are known as Limited Symptom Attacks (see below).

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Onset & Course

Panic disorder is a serious mental health problem, but it can be successfully treated. An estimated 2-3% of Americans have panic disorder at some point in their lives. It is observable before 14 years of age, but the prevalence is low in this age category. The rates gradually increase throughout puberty and peak during adulthood. This timeframe is particularly common if someone has been subjected to a traumatic experience. Women are twice as likely as men to develop panic disorder.

The frequency and severity of panic attacks vary widely between individuals. Panic disorder can continue for months or years, depending on how and when treatment is pursued. If left untreated, symptoms may become so severe that a person has significant problems with their friends, family, or job. Some people may experience several months or years of frequent symptoms, then many symptom-free years. In others, symptoms persist at the same level indefinitely. There is some evidence that many people, particularly those whose symptoms begin at an early age, may naturally experience a partial or even complete reduction in symptoms after middle age.

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Causes

Risk factors can be temperamental (i.e. neuroticism and anxiety sensitivity), environmental (i.e. childhood abuse and smoking), or genetic and physiological. The exact causes of panic disorder are not known, but like many other anxiety disorders, panic disorder runs in families, meaning that inheritance may play a strong role in determining who becomes affected by it. In fact, panic disorder is often found in combination with other hereditary disorders such as bipolar disorder and alcoholism. However, many people without a family history of panic disorder develop it. Malfunctioning in brain areas such as the amygdala and adrenaline glands may cause an overproduction of certain chemicals which produce the physical symptoms.

Other biological factors, stressful life events, and exaggerated thinking about common bodily reactions are also believed to play a role in the onset of panic disorder. Often the first attacks are triggered by physical illnesses, major stressors, or certain medications. People who take on too many responsibilities may develop a tendency to suffer panic attacks. Individuals with post-traumatic stress disorder (PTSD) also show a much higher rate of panic disorder than other people. Some evidence suggests that hypoglycemia, hyperthyroidism, mitral valve prolapse, labyrinthitis, and pheochromocytoma may trigger or worsen panic disorder.

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Agoraphobia

Agoraphobia is a disorder in which a person becomes anxious in and therefore begins to avoid situations from which escape might be difficult or help might be unavailable in the event of a panic attack. In the recent shift from the Fourth Edition of the Diagnostic and Statistical Manual of Mental Disorders, Text Revision (DSM-IV-TR) to the Fifth Edition of the DSM (DSM-5), agoraphobia was transitioned from only being diagnosed in individuals with panic disorder to being a standalone diagnosis. To be diagnosed with agoraphobia, the individual must exhibit explicitly observable fear or anxiety about two or more of the following situations:

  • Using public transportation
  • Being in open spaces
  • Being in enclosed spaces
  • Standing in line or behind a crowd
  • Being outside of the home alone

This anxiety is often increased by a fear of embarrassment, as the person fears suffering a panic attack and showing distress in public. About one of every three people with panic disorder develops agoraphobia.

Agoraphobics may experience panic attacks in the situations where they feel trapped, insecure, out of control, or too far from their comfort zone. In very severe cases, an agoraphobic may confine themselves to their home. These people may live for years without leaving their homes, while happily seeing visitors in and working from their personal safety zones.

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Limited Symptom Attacks

Many people with panic disorder have a mixture of panic attacks and limited symptom attacks. A limited symptom attack (LSA) is a lower-scale, less comprehensive onset of panic symptoms, when a person feels 3 or less of the panic symptoms listed above. For example, a sudden episode of trembling or nausea accompanied by a fear of dying would be considered an LSA. Not everyone who experiences an LSA has a mental illness. People often experience limited symptom attacks while recovering from or being treated for panic disorder. Like a panic attack, an LSA usually peaks in 10 minutes; however, an attack might last only 1 to 5 minutes, or could be part of a panic episode of varying intensity that lasts several hours.

Panic Attacks and Panic Disorder

Ever experienced a sudden surge of overwhelming anxiety and fear? Explore this guide to panic attacks, including symptoms, treatment, and self-help tips.

A panic attack is an intense wave of fear characterized by its unexpectedness and debilitating, immobilizing intensity. Your heart pounds, you can’t breathe, and you may feel like you’re dying or going crazy. Panic attacks often strike out of the blue, without any warning, and sometimes with no clear trigger. They may even occur when you’re relaxed or asleep.

A panic attack may be a one-time occurrence, although many people experience repeat episodes. Recurrent panic attacks are often triggered by a specific situation, such as crossing a bridge or speaking in public—especially if that situation has caused a panic attack before. Usually, the panic-inducing situation is one in which you feel endangered and unable to escape, triggering the body’s fight-or-flight response.

You may experience one or more panic attacks, yet be otherwise perfectly happy and healthy. Or your panic attacks may occur as part of another disorder, such as panic disorder, social phobia, or depression. Regardless of the cause, panic attacks are treatable. There are strategies you can use to reduce or eliminate the symptoms of panic, regain your confidence, and take back control of your life.

Paula’s story

Paula had her first panic attack six months ago. She was in her office preparing for an important work presentation when, suddenly, she felt an intense wave of fear. Then the room started spinning and she felt like she was going to throw up. Her whole body was shaking, she couldn’t catch her breath, and her heart was pounding out of her chest. She gripped her desk until the episode passed, but it left her deeply shaken.

Paula had her next panic attack three weeks later, and since then, they’ve been occurring with increasing frequency. She never knows when or where she’ll suffer an attack, but she’s afraid of having one in public. Consequently, she’s been staying home after work, rather than going out with friends. She also refuses to ride the elevator up to her 12th floor office out of fear of being trapped if she has a panic attack.

Panic attack signs and symptoms

The signs and symptoms of a panic attack develop abruptly and usually reach their peak within 10 minutes. They rarely last more than an hour, with most ending within 20 to 30 minutes. Panic attacks can happen anywhere and at any time. You may have one while you’re in a store shopping, walking down the street, driving in your car, or even sitting on the couch at home.

Panic attack symptoms include:

  • Shortness of breath or hyperventilation
  • Heart palpitations or racing heart
  • Chest pain or discomfort
  • Trembling or shaking
  • Choking feeling
  • Feeling unreal or detached from your surroundings
  • Sweating
  • Nausea or upset stomach
  • Feeling dizzy, light-headed, or faint
  • Numbness or tingling sensations
  • Hot or cold flashes
  • Fear of dying, losing control, or going crazy

Is it a heart attack or a panic attack?

Most of the symptoms of a panic attack are physical, and many times these symptoms are so severe that you may think you’re having a heart attack. In fact, many people suffering from panic attacks make repeated trips to the doctor or the emergency room in an attempt to get treatment for what they believe is a life-threatening medical problem. While it’s important to rule out possible medical causes of symptoms such as chest pain, elevated heart rate, or difficulty breathing, it’s often panic that is overlooked as a potential cause—not the other way around.

Signs and symptoms of panic disorder

While many people experience just one or two panic attacks without further episodes or complications—and there’s little reason to worry if that’s you—some people go on to develop panic disorder. Panic disorder is characterized by repeated panic attacks, combined with major changes in behavior or persistent anxiety over having further attacks.

You may be suffering from panic disorder if you:

  • Experience frequent, unexpected panic attacks that aren’t tied to a specific situation
  • Worry a lot about having another panic attack
  • Are behaving differently because of the panic attacks, such as avoiding places where you’ve previously panicked

While a single panic attack may only last a few minutes, the effects of the experience can leave a lasting imprint. If you have panic disorder, the recurrent panic attacks take an emotional toll. The memory of the intense fear and terror that you felt during the attacks can negatively impact your self-confidence and cause serious disruption to your everyday life. Eventually, this leads to the following panic disorder symptoms:

Anticipatory anxiety – Instead of feeling relaxed and like your normal self in between panic attacks, you feel anxious and tense. This anxiety stems from a fear of having future panic attacks. This “fear of fear” is present most of the time, and can be extremely disabling.

Phobic avoidance – You begin to avoid certain situations or environments. This avoidance may be based on the belief that the situation you’re avoiding caused a previous panic attack. Or you may avoid places where escape would be difficult or help would be unavailable if you had a panic attack. Taken to its extreme, phobic avoidance becomes agoraphobia.

Panic disorder with agoraphobia

Agoraphobia was traditionally thought to involve a fear of public places and open spaces. However, it is now believed that agoraphobia develops as a complication of panic attacks and panic disorder. Although it can develop at any point, agoraphobia usually appears within a year of your first recurrent panic attacks.

If you’re agoraphobic, you’re afraid of having a panic attack in a situation where escape would be difficult or embarrassing. You may also be afraid of having a panic attack where you wouldn’t be able to get help. Because of these fears, you start avoiding more and more situations.

For example, you may begin to avoid:

  • Crowded places such as shopping malls or sports arenas.
  • Cars, airplanes, subways, and other forms of travel.
  • Social gatherings, restaurants, or other situations where it would be embarrassing to have a panic attack.
  • Physical exercise in case it triggers panic.
  • Certain food or drinks that could provoke panic, such as alcohol, caffeine, sugar, or specific medications.
  • Going anywhere without the company of someone who makes you feel safe. In more severe cases, you might only feel safe at home.

Causes of panic attacks and panic disorder

Although the exact causes of panic attacks and panic disorder are unclear, the tendency to have panic attacks runs in families. There also appears to be a connection with major life transitions such as graduating from college and entering the workplace, getting married, or having a baby. Severe stress, such as the death of a loved one, divorce, or job loss can also trigger panic attacks.

Panic attacks can also be caused by medical conditions and other physical causes. If you’re suffering from symptoms of panic, it’s important to see a doctor to rule out the following possibilities:

  1. Mitral valve prolapse, a minor cardiac problem that occurs when one of the heart’s valves doesn’t close correctly
  2. Hyperthyroidism (overactive thyroid gland)
  3. Hypoglycemia (low blood sugar)
  4. Stimulant use (amphetamines, cocaine, caffeine)
  5. Medication withdrawal

Self-help tips for panic attacks

No matter how powerless or out of control you may feel about your panic attacks, it’s important to know that there are many things you can do to help yourself. The following self-help techniques can make a big difference to helping you overcome panic:

Learn about panic and anxiety. Simply knowing more about panic can go a long way towards relieving your distress. Read up on anxiety, panic disorder, and the fight-or-flight response experienced during a panic attack. You’ll learn that the sensations and feelings you have when you panic are normal and that you aren’t going crazy.

Avoid smoking, alcohol, and caffeine. These can all provoke panic attacks in people who are susceptible. If you need help to kick the cigarette habit, see How to Quit Smoking. Also, be careful with medications that contain stimulants, such as diet pills and non-drowsy cold medications.

Learn how to control your breathing. Hyperventilation brings on many sensations (such as lightheadedness and tightness of the chest) that occur during a panic attack. Deep breathing, on the other hand, can relieve the symptoms of panic. By learning to control your breathing, you can calm yourself down when you begin to feel anxious. And if you know how to control your breathing, you’re also less likely to create the very sensations that you’re afraid of.

Practice relaxation techniques. When practiced regularly, activities such as yoga, meditation, and progressive muscle relaxation strengthen the body’s relaxation response—the opposite of the stress response involved in anxiety and panic. And not only do these relaxation practices promote relaxation, but they also increase feelings of joy and equanimity.

Connect face-to-face with family and friends. Symptoms of anxiety can become worse when you feel isolated, so reach out to people who care about you on a regular basis. If you feel that you don’t have anyone to turn to, explore ways to meet new people and build supportive friendships.

Exercise regularly. Exercise is a natural anxiety reliever so try to get moving for at least 30 minutes on most days (three 10-minute sessions is just as good). Rhythmic aerobic exercise that requires moving both your arms and legs—like walking, running, swimming, or dancing—can be especially effective.

Get enough restful sleep. Insufficient or poor quality sleep can make anxiety worse, so try to get seven to nine hours of restful sleep a night. If sleeping well is a problem for you, these tips to getting a good night’s sleep can help.

Treatment for panic attacks and panic disorder

The most effective form of professional treatment for tackling panic attacks, panic disorder, and agoraphobia is therapy. Even a short course of treatment can help.

Cognitive behavioral therapy focuses on the thinking patterns and behaviors that are sustaining or triggering your panic attacks and helps you look at your fears in a more realistic light. For example, if you had a panic attack while driving, what is the worst thing that would really happen? While you might have to pull over to the side of the road, you are not likely to crash your car or have a heart attack. Once you learn that nothing truly disastrous is going to happen, the experience of panic becomes less terrifying.

Exposure therapy for panic disorder allows you to experience the physical sensations of panic in a safe and controlled environment, giving you the opportunity to learn healthier ways of coping. You may be asked to hyperventilate, shake your head from side to side, or hold your breath. These different exercises cause sensations similar to the symptoms of panic. With each exposure, you become less afraid of these internal bodily sensations and feel a greater sense of control over your panic.

Exposure therapy for panic disorder with agoraphobia includes exposure to the situations you fear and avoid is also included in treatment. As in exposure therapy for specific phobias, you face the feared situation until the panic begins to go away. Through this experience, you learn that the situation isn’t harmful and that you have control over your emotions.

Medication for panic attacks and panic disorder

Medication can be used to temporarily control or reduce some of the symptoms of panic disorder. However, it doesn’t treat or resolve the problem. Medication can be useful in severe cases, but it should not be the only treatment pursued. Medication is most effective when combined with other treatments, such as therapy and lifestyle changes, that address the underlying causes of panic disorder.

Medications used may include:

Antidepressants. It takes several weeks before they begin to work, so you have to take them continuously, not just during a panic attack.

Benzodiazepines. These are anti-anxiety drugs that act very quickly (usually within 30 minutes to an hour). Taking them during a panic attack provides rapid relief of symptoms. However, benzodiazepines are highly addictive and have serious withdrawal symptoms, so they should be used with caution.

How to help someone having a panic attack

Seeing a friend or loved one suffering a panic attack can be frightening. Their breathing may become abnormally fast and shallow, they could become dizzy or light-headed, tremble, sweat, feel nauseous, or think they’re having a heart attack. No matter how irrational you think their panicked response to a situation is, it’s important to remember that the danger seems very real to your loved one. Simply telling them to calm down or minimizing their fear won’t help. But by helping your loved one ride out a panic attack, you can help them feel less fearful of any future attacks.

Stay calm yourself. Being calm, understanding, and non-judgmental will help your loved one’s panic subside quicker.

Focus your loved one on their breathing. Find a quiet place for your friend to sit and then guide them to take slow, deep breaths for a few minutes.

Do something physical. Together, raise and lower your arms or stamp your feet. It can help to burn off some of your loved one’s stress.

Get your friend out of their own head by asking them to name five things around them or talking soothingly about a shared interest.

Encourage your loved one to seek help. Once the panic attack is over, your loved one may feel embarrassed about having an attack in front of you. Reassure them and encourage them to seek help for their anxiety.

Out-of-the-blue panic attacks aren’t without warning: Body sends signals for hour before

A study based on 24-hour monitoring of panic sufferers while they went about their daily activities captured panic attacks as they happened and discovered waves of significant physiological instability for at least 60 minutes before patients’ awareness of the panic attacks, said psychologist Alicia E. Meuret at Southern Methodist University in Dallas.

In a rare study in which patients were monitored around-the-clock, portable recorders captured changes in respiration, heart rate and other bodily functions, said Meuret, lead researcher on the study.

The new findings suggest sufferers of panic attacks may be highly sensitive to — but unaware of — an accumulating pattern of subtle physiological instabilities that occur before an attack, Meuret said. Monitoring data also showed patients were hyperventilating on a chronic basis.

“The results were just amazing,” Meuret said. “We found that in this hour preceding naturally occurring panic attacks, there was a lot of physiological instability. These significant physiological instabilities were not present during other times when the patient wasn’t about to have a panic attack.”

It is notable that patients reported the attacks as unexpected, lacking awareness of either the coming attack or their changing physiology.

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“The changes don’t seem to enter the patient’s awareness,” Meuret said. “What they report is what happens at the end of the 60 minutes — that they’re having an out-of-the blue panic attack with a lot of intense physical sensations. We had expected the majority of the physiological activation would occur during and following the onset of the panic attack. But what we actually found was very little additional physiological change at that time.”

Unexpected attacks have been a mystery; little research to explain them

The diagnostic standard for psychological disorders, the DSM-IV, defines panic attacks as either expected or unexpected. Those that are expected, or cued, occur when a patient feels an attack is likely, such as in closed spaces, while driving or in a crowded place.

“But in an unexpected panic attack, the patient reports the attack to occur out-of-the-blue,” Meuret said. “They would say they were sitting watching TV when they were suddenly hit by a rush of symptoms, and there wasn’t anything that made it predictable.”

To sufferers and researchers alike, the attacks are a mystery.

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Change-point analysis uncovered physiological instabilities one hour before attacks

Meuret and her colleagues discovered the significant physiological instabilities using change-point analysis, a statistical method that searches for points when changes occur in a “process” over time.

“This analysis allowed us to search through patients’ physiological data recorded in the hour before the onset of their panic attacks to determine if there were points at which the signals changed significantly,” said psychologist David Rosenfield of SMU, lead statistician on the project.

The study is significant not only for panic disorder, but also for other medical problems where symptoms and events have seemingly “out-of-the blue” onsets, such as seizures, strokes and even manic episodes.

“I think this method and study will ultimately help detect what’s going on before these unexpected events and help determine how to prevent them,” Meuret said. “If we know what’s happening before the event, it’s easier to treat it.”

Meuret, an assistant professor in the SMU Department of Psychology, reported the results in the journal Biological Psychiatry in the article “Do Unexpected Panic Attacks Occur Spontaneously?” Rosenfield is an associate professor in SMU’s Department of Psychology.

A multi-disciplinary collaboration, other authors on the study were psychologist Thomas Ritz, SMU Department of Psychology; psychologist Frank H. Wilhelm, University of Salzburg, Austria; electrical engineer Enlu Zhou, University of Illinois at Urbana-Champaign; and psychologist Ansgar Conrad and psychiatrist Walton T. Roth, both of Stanford University.

Subtle physical changes impact panic sufferers more severely

People with panic disorder probably won’t be surprised by the results, Meuret said.

By definition, the majority of the 13 symptoms of panic attack are physiological: shortness of breath, heart racing, dizziness, chest pain, sweating, hot flashes, trembling, choking, nausea and numbness. Only three are psychological: feeling of unreality, fear of losing control and fear of dying.

“Most patients obviously feel that there must be something going on physically,” Meuret said. “They worry they’re having a heart attack, suffocating or going to pass out. Our data doesn’t indicate there’s something inherently wrong with them physically, neither when they are at rest nor during panic. The fluctuations that we discovered are not extreme; they are subtle. But they seem to build up and may result in a notion that something catastrophic is going on.”

Notably, the researchers found that patients’ carbon dioxide, or C02, levels were in an abnormally low range, indicating the patients were chronically hyperventilating. These levels rose significantly shortly before panic onset and correlated with reports of anxiety, fear of dying and chest pain.

“It has been speculated, but never verified with data recordings in daily life, that increases in CO2 cause feelings of suffocation and can be panic triggers,” Meuret said.

Fanny pack monitor tracked physiological changes before, during and after attacks

To capture the physiological data, 43 patients wore the monitoring devices for 24 hours on two separate occasions. The researchers collected 1,960 hours of ambulatory monitoring data, including 13 unexpected panic attacks.

Participants, all of whom suffer from panic disorder, were each outfitted with an array of electrodes and sensors attached to various parts of their bodies.

The ambulatory monitoring device was toted in a small waist pack the patients wore. Also included was a portable capnometer to measure CO2 collected from exhaled breath. The physiological responses were recorded continuously as digital data in a time series.

Each monitoring pack included a “panic button.” Patients were instructed to press the button if they had an attack and to write down their symptoms. By triggering the panic button, patients inserted a marker into the time-series data, marking the moment the attack began.

The sensors measured eight physiological indices, including changes in respiration, such as how deep, fast or irregular people were breathing; cardiac activity; and evidence of sweating.

Data analysis found strikingly significant changes in the hour before attacks

From the nearly 2,000 hours of data, the change-point analysis program allowed the researchers to slice out 70-minute periods around each of the 13 panic attacks ??? from one hour before onset until 10 minutes after the attacks began.

For each index, the program checked for any significant change in the signal that remained stable over a specified period of time.

Those results were collapsed across all 13 panic attacks, with minute-by-minute averages. The information was then compared to a 70-minute control period randomly chosen during non-panic periods.

“We found 15 subtle but significant changes an hour before the onset of the panic attacks that followed a logical physiological pattern. These weren’t present during the non-panic period,” Meuret said.

“Why they occurred, we don’t know. We also can’t say necessarily they were causal for the panic attacks. But the changes were strikingly and significantly different to what was observed in the non-panic control period,” she said.

Findings prompt look at “panic” definition and treatment

The study’s results invite a reconsideration of the DSM diagnostic definition that separates “expected” from “unexpected” attacks, Meuret said.

Also, the study might explain why medication or interventions aimed at normalizing respiration for treating panic are effective, she said. Medication generally buffers arousal, keeping it low and regular, thereby preventing unexpected panic attacks.

For psychological treatments such as Cognitive Behavior Therapy (CBT), the results are more challenging. CBT requires a patient to focus on examining thoughts to prevent an attack.

“But a patient can’t work on something they don’t know is going to happen,” Meuret said.

New methodology can be universalized to other unexpected medical problems

The study’s use of change-point analysis can be applied to other medical issues. Traditional statistics are ineffective at analyzing such data, Meuret said, because they look only at level differences at pre-determined times and won’t find a signal for an unknown point.

“This study is a step toward more understanding and hopefully opening more doors for research on medical events that are difficult to predict. The hope is that we can then translate these findings into new therapies,” she said.

The research was funded by the National Institutes of Mental Health, Department of Veterans Affairs and the Beth and Russell Siegelman Foundation.

Panic Disorder: When Fear Overwhelms

Panic disorder is generally treated with psychotherapy, medication, or both. Talk with your doctor about the best treatment for you.

Psychotherapy. A type of psychotherapy called cognitive behavioral therapy (CBT) is especially useful as a first-line treatment for panic disorder. CBT teaches you different ways of thinking, behaving, and reacting to the feelings that come on with a panic attack. The attacks can begin to disappear once you learn to react differently to the physical sensations of anxiety and fear that occur during panic attacks.

For more information on psychotherapy, see http://www.nimh.nih.gov/health/topics/psychotherapies.

Medication. Doctors also may prescribe different types of medications to help treat panic disorder:

  • Selective serotonin reuptake inhibitors (SSRIs)
  • Serotonin-norepinephrine reuptake inhibitors (SNRIs)
  • Beta-blockers
  • Benzodiazepines

SSRIs and SNRIs are commonly used to treat depression, but they are also helpful for the symptoms of panic disorder. They may take several weeks to start working. These medications may also cause side-effects, such as headaches, nausea, or difficulty sleeping. These side effects are usually not severe for most people, especially if the dose starts off low and is increased slowly over time. Talk to your doctor about any side effects that you have.

Another type of medication called beta-blockers can help control some of the physical symptoms of panic disorder, such as rapid heart rate. Although doctors do not commonly prescribe beta-blockers for panic disorder, they may be helpful in certain situations that precede a panic attack.

Benzodiazepines, which are sedative medications, are powerfully effective in rapidly decreasing panic attack symptoms, but they can cause tolerance and dependence if you use them continuously. Therefore, your doctor will only prescribe them for brief periods of time if you need them.

Your doctor will work with you to find the best medication and dose for you.

Don’t give up on treatment too quickly. Both psychotherapy and medication can take some time to work. A healthy lifestyle can also help combat panic disorder. Make sure to get enough sleep and exercise, eat a healthy diet, and turn to family and friends who you trust for support.

Finding Help

Mental Health Treatment Program Locator

The Substance Abuse and Mental Health Services Administration (SAMHSA) provides this online resource for locating mental health treatment facilities and programs. The Mental Health Treatment Locator section of the Behavioral Health Treatment Services Locator lists facilities providing mental health services to persons with mental illness. Find a facility in your state at https://findtreatment.samhsa.gov/. For additional resources, visit www.nimh.nih.gov/findhelp.

Questions to Ask Your Doctor

Asking questions and providing information to your doctor or health care provider can improve your care. Talking with your doctor builds trust and leads to better results, quality, safety, and satisfaction. Visit the Agency for Healthcare Research and Quality website for tips at http://www.ahrq.gov/patients-consumers/index.html.

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For More Information

To learn more information about panic disorder, visit:

Medline Plus (National Library of Medicine) http://medlineplus.gov (En Español: http://medlineplus.gov/spanish)

For information on clinical trials, visit:

ClinicalTrials.gov: http://www.clinicaltrials.gov (En Español: http://salud.nih.gov/investigacion-clinica/)

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