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Treatment Of Panic Disorder
PETER HAM, M.D., DAVID B. WATERS, PH.D., and M. NORMAN OLIVER, M.D., University of Virginia School of Medicine, Charlottesville, Virginia
Am Fam Physician. 2005 Feb 15 71:733-739.
Panic disorder with or without agoraphobia occurs commonly in patients in primary care settings. This article assesses multiple evidence-based reviews of effective treatments for panic disorder. Antidepressant medications successfully reduce the severity of panic symptoms and eliminate panic attacks. Selective serotonin reuptake inhibitors and tricyclic antidepressants are equally effective in the treatment of panic disorder. The choice of medication is based on side effect profiles and patient preferences. Strong evidence supports the effectiveness of cognitive behavior therapy in treating panic disorder. Family physicians who are not trained in cognitive behavior therapy may refer patients with panic disorder to therapists with such training. Cognitive behavior therapy can be used alone or in combination with antidepressants to treat patients with panic disorder. Benzodiazepines are effective in treating panic disorder symptoms, but they are less effective than antidepressants and cognitive behavior therapy.
CBT reduces panic frequency and severity, and improves global functioning in patients with panic disorder, with or without agoraphobia.
CBT = cognitive behavior therapy SSRIs = selective serotonin reuptake inhibitors TCAs = tricyclic antidepressants.
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What Do Panic Attacks Feel Like
During a panic attack, physical symptoms can build up very quickly. These can include:
- a pounding or racing heartbeat
- feeling faint, dizzy or light-headed
- feeling very hot or very cold
- sweating, trembling or shaking
- pain in your chest or abdomen
- struggling to breathe or feeling like you’re choking
- feeling like your legs are shaky or are turning to jelly
- feeling disconnected from your mind, body or surroundings, which are types of dissociation.
During a panic attack you might feel very afraid that you’re:
- losing control
- going to die.
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When To Get Help
See a GP if you’ve been experiencing symptoms of panic disorder.
They’ll ask you to describe your symptoms, how often you get them, and how long you have had them.
They may also carry out a physical examination to rule out other conditions that could be causing your symptoms.
It can sometimes be difficult to talk about your feelings, emotions and personal life, but try not to feel anxious or embarrassed.
You may be diagnosed with panic disorder if you have regular and unexpected panic attacks followed by at least a month of continuous worry or concern about having further attacks.
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 youre suffering from symptoms of panic, its important to see a doctor to rule out the following possibilities:
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Cbd Capsules & Edibles For Panic Attacks
Capsules and edibles take the oral route of administration. They need to pass through the digestive system before being released into the bloodstream. For this reason, it may take anywhere between 3090 minutes before the effects of capsules and edibles take hold. On the other hand, the effects last longer because the CBD is released gradually. Relief from anxiety may last 810 hours depending on your metabolism and the potency of your capsules/gummies.
Treatment For Panic Disorder
Research shows that the most successful treatment for panic disorder is a combination of antidepressant medication and cognitive behavioral therapy . Many clinicians recommend CBT as the first-line treatment, with medication added if necessary to make the patient comfortable enough to participate in CBT.
In treating someone who has panic disorder with CBT, the clinician starts by working with the patient to think more flexibly about his anxiety. Rather than viewing the physical symptoms as dangerous, he practices tolerating them, knowing that they arent harmful.
To help the person disconnect the negative feelings associated with attacks, the therapist induces those physical sensations the patient does jumping jacks or stair climbing to get the heart racing, spinning to get dizzy, breathing through a coffee straw to get shortness of breath. Were exposing you to the actual, physical feelings of a panic attack, one symptom at a time, Dr. Bubrick explains.
Then, instead of simply tolerating the anxiety and waiting for it to subside, the person is taught how to do deep breathing techniques, to calm the physical symptoms down. Some clinicians dont do the deep breathing, on the grounds that the symptoms will pass on their own. But Dr. Bubrick likes to give kids tools to give them a sense of empowerment, to have them feel that they can control the symptoms.
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What Causes Panic Attacks
Experts dont know why some people experience panic attacks or develop panic disorder. The brain and nervous system play key roles in how you perceive and handle fear and anxiety. Your risk of having panic attacks increases if you have:
- Family history:Anxiety disorders, including panic disorders, often run in families. Experts arent sure why.
- Mental health issues: People who have anxiety disorders, depression or other mental illness are more prone to panic attacks.
- Substance abuse problems:Alcoholism and drug addiction can increase the risk of panic attacks.
Try Muscle Relaxation Techniques
Another symptom of panic attacks is muscle tension. Practicing muscle relaxation techniques may help limit an attack. This is because if the mind senses that the body is relaxing, other symptoms such as rapid breathing may also diminish.
A technique called progressive muscle relaxation is a popular method for coping with anxiety and panic attacks.
This involves tensing up and then relaxing various muscles in turn. To do this:
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Close Your Eyes And Breathe
Whenever you find yourself having a panic attack, take a moment to lie down, close your eyes, and take a deep breath in. Then out. In. Then Out. In. Out. Breathing deep naturally helps slow your heart rate to help you calm your anxiety. Taking the time to focus on your breath helps move your mind into the present inside of the past or future. Find time each day to get that quiet moment to yourself just to breathe. The more you practice mindful breathing, the fewer panic attacks youll have.
When Might I Have Panic Attacks
Panic attacks happen at different times for everyone. Some people have one panic attack then don’t ever experience another, or you might find that you have them regularly, or several in a short space of time. You might notice that particular places, situations or activities seem to trigger panic attacks. For example, they might happen before a stressful appointment.
Most panic attacks last between 5 to 20 minutes. They can come on very quickly. Your symptoms will usually be at their worst within 10 minutes. You might also experience symptoms of a panic attack over a longer period of time. This could be because you’re having a second panic attack, or you’re experiencing other symptoms of anxiety.
“My panic attacks seem to come out of the blue now. But in fact, they seem to be triggered mainly at night when I want to go to sleep but cannot stop my mind racing, experiencing worry and panic about anything that may be on my mind.”
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Personal Stories About People Deciding Whether To Take Medicine To Treat Panic Disorder
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
I was having lunch with some friends and suddenly began to feel strangeâlike I couldn’t breathe and my heart was pounding. I didn’t know what was happening I thought I was having a heart attack. Although the symptoms began to go away after about 10 minutes, I went to the emergency room, where they did some tests and didn’t find anything wrong. A week later, the same thing happened in the middle of the night. I went to see my doctor, and she suggested I may have had a panic attack. Since then, the attacks have been occurring at least once a week, and I have been diagnosed with panic disorder. Although each attack is still a horrible experience, I now know what is happening and that I will get through it. I have been going to therapy for several weeks and am learning how to deal with the symptoms of panic attacks. They are less frequent now and less intense. I think I can get through this without taking any medicine.
Annie, age 32
Manuel, age 43
Louis, age 28
Top 3 Exercises For Relieving Anxiety
The exercises discussed above are useful tools your client can use to prevent and control a panic attack.
They might also find it useful to know techniques for managing generalized anxiety that might exist in the broader context of their panic attacks.
As you learned above, anxiety can act as a sensitizing factor, making it more likely for a panic attack to occur. In a more general sense, your client may find it easier to engage with their therapy and maintain a positive attitude if they feel confident controlling their everyday mental health.
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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 youre 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
- Feeling unreal or detached from your surroundings
- Feeling dizzy, light-headed, or faint
- Numbness or tingling sensations
- 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 youre 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 its important to rule out possible medical causes of symptoms such as chest pain, elevated heart rate, or difficulty breathing, its often panic that is overlooked as a potential causenot the other way around.
How Are They Treated
Treatments for panic attacks and panic disorder include counselling, especially cognitive-behavioural therapy . Medicines may also help. Treatment can help most people control or even stop attacks. But symptoms can come back, especially if you stop treatment too soon.
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Latest Research Into The Effectiveness Of Cbd For Panic Attacks
The majority of studies investigating the benefits of CBD for panic attacks and anxiety have tested acute CBD dosing in healthy people. This means that we need additional research to determine if consistent dosing is effective in the relevant clinical subjects.
One of the most recent reviews of studies on CBD and anxiety was published in 2017 by Soares and Campos in the Current Neuropharmacology journal. The review was titled Evidences for the Anti-panic Actions of Cannabidiol. The authors of the paper underlined that SSRIs, the current treatment of choice for Panic Disorder, lack consistency and arent effective in the long run. They also pointed out that these medications carry a range of side effects that causes patients to give up the treatment .
At the same time, the researchers are touting CBD as a potentially effective alternative for Panic Disorder.
As we can read in the conclusion part of the paper:
CBD seems to be a promising drug for the treatment of PD . More clinical trials involving patients with Panic Disorder are needed to determine the specific mechanism of action of CBD along with its safe and ideal therapeutic doses.
When To Seek Help
Panic attacks can be frightening and disorienting. If someone is worried about a panic attack, they can talk to their doctor for advice and reassurance.
A person may want to talk to a healthcare professional if their panic attacks:
- are recurring and unexpected
- are getting in the way of daily life
- do not pass with home coping methods
A doctor can talk a person through both short-term coping methods and long-term treatment options.
The symptoms of a panic attack can resemble those of a heart attack. These include chest pain, anxiety, and sweating. If someone suspects a heart attack or stroke, the person needs immediate medical attention.
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What Happens If I Don’t Feel Better After Psychological Treatment Medication Or Self
If you have tried one type of treatment and it hasn’t worked, your healthcare professional should discuss with you whether to try another type of treatment.
If you have tried any two treatments and you still have significant symptoms, your healthcare professional should discuss with you whether you wish to have an appointment with a specialist.
About Curing Panic Attacks
Panic attacks are complex. One of the issues that adds to its complexity is that panic attacks are often reactionary, and occur more often the more you think about them and the more you worry about them.
While panic attacks can hit out of the blue, they are usually caused by an over-sensitivity to the way you feel, in a pattern that resembles this:
- You live your life worried about panic attacks.
- You feel something – anything – like a slight increase in heart rate or a mild discomfort.
- You _always_ notice it, because your panic attacks make you over-sensitive to them.
- You then worry or believe you’re about to get a panic attack.
- This worry floods your body with anxiety.
- You get a panic attack.
The oversensitivity is known as being hypersensitive, and it’s a condition that is extremely common in those with anxiety and panic attacks.
Essentially, you become overly attuned to your body because you’re always worrying about another panic attack, and this makes you notice every single change that your body experiences, which flood you with anxiety because you’re worried it may mean another panic attack. In addition, anxiety over worrying about panic attacks can cause an increase in heart rate on its own, which may act as the sensation that triggers the attack.
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Key Points To Remember
- Two types of medicines work well for treating panic attacks. Benzodiazepines can help you feel better right away. You can take antidepressants for long-term treatment.
- Counselling works at least as well as medicines, and the effects may last longer.
- If you take medicines, follow your doctor’s directions with care. You may have side effects such as headaches or trouble sleeping. Some medicines can treat both depression and panic attacks.
- For some people, taking medicines along with getting counselling works best.
- Don’t feel bad about taking medicines. Panic disorder is a medical problem, not a weakness. The medicines won’t change your personality.
Differentiating Panic Attacks From Anxiety Attacks
Anxiety builds over time, while panic tends to be sudden. Anxiety attacks often arise from an intensified anxiety level, whereas panic attacks result from an intense sense of dread or fear. Those who suffer from anxiety attacks usually feel anxious before an attack occurs. On the other hand, those who experience anxiety attacks often feel fine until they encounter dreadful situations that make them panic.
Anxiety attacks usually take considerable time to build up and may last for some time. Conversely, panic attacks tend to last for a shorter period, usually 20 to 30 minutes. Typically, the attacks reach their most intense level of about ten minutes in.
When panic attacks become frequent, patients tend to develop panic disorder. This is an anxiety disorder characterized by recurrent panic attacks and the fear of having panic attacks. Even so, patients who dont have panic disorder may also experience panic attacks.
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