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Getting Treatment for Panic Disorder
Information for Patients, Families and Friends
This brochure is for people who want to find out whether they or someone
they know may have panic disorder and how it can be treated most
effectively. It may be helpful to refer to this pamphlet when consulting
with a health care professional.
Also in this brochure, three people with panic disorder comment on how
treatment has helped them regain their lives.
Chuck, 51, Copy Editor, Indiana:
"With treatment, I got my life back, yes. I'm free to travel--I'm
free to go wherever I want to. It's like being born again."
Laura, 42, Travel Agent, California:
"The test of success in life is not what you achieve but the
obstacles you overcome to achieve it. And I pass that test every
day. Not a day goes by that I am not learning to control my panic
disorder."
Lisa, 9, Laura's Daughter:
"I used to cry and get really scared...but since she's gotten
treatment I feel better."
Tammy, 34, Administrative Assistant, New York:
"Some people may not seek help because they feel that there is no
treatment. But there's no reason anyone should live in fear.
There is help out there, whether it's medication or
cognitive-behavioral therapy.
Could You Have A Panic Disorder?
Do you experience sudden episodes of intense and overwhelming fear
that seem to come on for no apparent reason?
During these episodes, do you also experience several of the following:
- Racing, pounding, or skipping heartbeat
- Chest pain, pressure, or discomfort
- Difficulty catching your breath
- Choking sensation or lump in your throat
- Excessive sweating
- Lightheadedness or dizziness
- Nausea or stomach problems
- Tingling or numbness in parts of your body
- Chills or hot flashes
- Shaking or trembling
- Feelings of unreality, or being detached from your body
During these episodes, do you have the urge to flee, or the feeling that
you need to escape?
During these episodes, do you think something terrible might happen--that
you might die, have a heart attack, suffocate, lose control, or embarrass
yourself?
Do you worry a lot about these episodes or fear that they will happen
again? And does this fear cause you to avoid places or situations that
you think might have triggered the attack?
If you answered yes to most of these questions, chances are you are
suffering from panic disorder. If so, you are not alone.
Panic disorder is very different from everyday anxiety. More than 3
million American adults have, or will have, panic disorder. Most
frequently, it starts in young adulthood. Usually, it does not go away
by itself. But with proper treatment, people with panic disorder can be
helped.
Why Seeking Treatment is Critical
Repeated episodes of fear--commonly called panic attacks--that are
typical of panic disorder can be devastating. The panic attacks, or
avoidance of them, can completely take control of your life.
Without treatment, you may continue to have panic attacks for
years. The disorder can seriously interfere with your relationships with
family, friends, and co-workers.
Without treatment, your life may become severely restricted. For
example, you may start to avoid certain situations where you fear you
will experience a panic attack--even normal, everyday activities, such
as grocery shopping or driving. In extreme cases, people with untreated
panic disorder grow afraid to leave the house, a condition known as
agoraphobia.
Without treatment, you may find it difficult to be productive at
work. Your symptoms may keep you from getting to your job or staying
there once you arrive. You may turn down promotions or job assignments
that you believe will make you more likely to have panic attacks. Some
people with panic disorder even quit their jobs. Many can keep working
but otherwise rarely leave home.
Without treatment, you may become severely depressed. You may try
unsuccessfully to numb the symptoms of panic disorder or depression with
alcohol or other drugs. You may even begin to have thoughts about
suicide.
You do not have to live this way. You need to know that panic
disorder is treatable . In fact, proper treatment reduces or
completely prevents panic attacks in 70 to 90 percent of people.
Many people feel substantial relief in just weeks or months.
Unfortunately, some people are reluctant to pursue treatment. Perhaps
they think their condition is not serious. Perhaps they feel
embarrassed. They may blame themselves or have trouble asking for help.
Perhaps they dislike the idea of medication or therapy. Or, maybe they
have sought help but are frustrated because their condition was not
diagnosed or treated effectively.
Do not let these or any other reasons stop you from getting proper
treatment. If you have panic disorder, you should get whatever help is
necessary to overcome it, just as you would for any serious medical
illness.
Do not be discouraged if some people say, "It's nothing to worry about,"
"It's just stress," "It's all in your head," or "Snap out of it." While
they often mean well, the fact is that most people who do not have panic
disorder do not understand that it is REAL and, therefore, tend to doubt
its seriousness.
Most importantly, do not try to numb the effects of panic attacks with
alcohol or other drugs. This will only make the problem worse.
Getting A Diagnosis
Since panic disorder can mimic a variety of medical conditions, such as
heart problems and digestive complaints, the first thing you should do
is have a full medical evaluation.
Although it is important for you and your doctor to concentrate on your
physical symptoms, you should not overlook other aspects of your attacks.
You may want to re-read the questions at the beginning of this pamphlet
and tell your doctor anything you notice about how your attacks make you
feel and when they usually occur.
Information on both the physical and emotional aspects of the attacks can
be very useful to the doctor in making a diagnosis. For example, the
doctor will want to know if your attacks, or fear of having attacks, keep
you from carrying out any of your normal activities.
Many people with panic disorder also suffer from depression--feelings of
intense sadness, even hopelessness. Depression is accompanied by an
impaired ability to think, concentrate, and enjoy the normal pleasures
of life. Be sure to make your doctor aware of these symptoms as well.
If you have been drinking or using drugs to try to control your symptoms,
let your doctor know about that too.
Once you have been properly diagnosed, your doctor--perhaps in
consultation with a mental health specialist--can help you determine
which treatment is best for you.
Effective Treatments for Panic Disorder
Treatment for panic disorder can consist of taking a medication to adjust
the chemicals in your body--just as you might take medicine to correct
a thyroid imbalance.
Or treatment might involve working with a psychotherapist to gain more
control over your anxieties--just as some people work with specialists
to learn techniques to control migraine headaches or lower their blood
pressure.
Research shows that both kinds of treatment can be very effective. For
many patients, the combination of medication and psychotherapy appears
to be more effective than either treatment alone. Early treatment can
help keep panic disorder from progressing.
Cognitive-Behavioral Therapy
Cognitive-behavioral therapy (CBT) teaches you to anticipate and prepare
yourself for the situations and bodily sensations that may trigger panic
attacks. CBT usually includes the following elements:
A therapist helps you identify the thinking patterns that lead you
to misinterpret sensations and assume "the worst" is happening. These
patterns of thinking are deeply ingrained, and it will take practice to
notice them and then to change them.
A therapist can teach you breathing exercises that calm you and
that can prevent the overbreathing, or hyperventilation, that often
occurs during a panic attack.
A therapist can help you gradually become less sensitive to the
frightening bodily sensations and feelings of terror. This is done by
helping you, step-by-step, to safely test yourself in the places and
situations you've been avoiding.
CBT generally requires at least 8 to 12 weeks. Some people may need a
longer time in treatment to learn the skills and put them into practice.
Most panic disorder patients are successful in controlling or preventing
their panic attacks after completing treatment with CBT.
CBT requires a motivated patient and a specially trained therapist. Make
sure any therapist you work with has proper training and experience in
this method of panic disorder treatment. Indeed, in some parts of the
country, you may find limited access to professionals trained and
experienced in CBT.
Medication
Several types of medication that alter the ways chemicals interact in the
brain can reduce or prevent panic attacks and decrease anxiety. Two
major categories of medication that have been shown to be safe and
effective in the treatment of panic disorder are antidepressants and
benzodiazepines.
Each medication works differently. Some work quickly and others more
gradually. All of them have to be taken on a regular basis. Usually,
treatment with medication lasts at least 6 months to a year. But within
8 weeks, you and your doctor should be able to assess whether it's
effectively blocking the panic attacks. More details on medications can
be found in the brochure "Understanding Panic Disorder." To get a copy,
see the back of this pamphlet.
Clinical experience suggests that for many patients with panic disorder,
a combination of CBT and medication may be the best treatment.
How to Choose the Right Treatment for You
Various types of health professionals may have the training and
experience needed to treat panic disorder. Sometimes panic disorder
patients are treated by two health care professionals--one who prescribes
and monitors medication and another who provides CBT.
Each professional will use the treatments with which he or she is most
familiar and successful. It is vital to choose a professional who is
trained and experienced in the treatment methods described earlier; it
is equally important to choose someone with whom you feel comfortable.
Many people begin looking for treatment by visiting their family doctor
or a local clinic or health maintenance organization. Other places to
seek help include your local health department or community mental health
clinic. If there is a university near you, you may wish to ask about
participating in a panic disorder study. Many universities have ongoing
treatment research programs in their psychology or psychiatry departments
that may provide care at less expense.
To help you locate mental health professionals in your area, NIMH has
available a Referral List, which gives the names and telephone numbers
of organizations that can provide you with a referral. If you did not
receive a copy of the list with this brochure, you can get one by calling
1-800-64-PANIC.
When seeking a health care professional to treat your panic disorder, you
may want to ask the following questions:
- How many patients with panic disorder have you treated?
- Do you have any special training in panic disorder treatment?
- What is your basic approach to treatment--cognitive-behavioral
therapy, medication, or both? If you provide only one type of
treatment, how do I get the other if I need it?
- How long is a typical course of treatment?
- How frequent are treatment sessions? How long does each session
last?
- What are your fees?
- Can you help me determine whether my health insurance will cover
this?
How to Make Your Treatment Successful
From the beginning, it is important to be a full participant in your
treatment. Be active and assertive. Ask questions. Maintain open
communication with your treatment professional and let him or her know
your concerns.
Every patient responds differently, but it is important to know that none
of the treatments for panic disorder works instantly. So, you must stick
with a particular treatment for at least 8 weeks to see if it works. If
you do not see significant improvement within that time, you and your
treatment professional can adjust your treatment plan. It may take a bit
of trial and error before you find what works best for you. Be patient
and be sure to communicate with your treatment professional. Of course,
if at any time you feel uncomfortable with the professional you have
chosen or don't think your treatment is going well, you should feel free
to consider seeking a second opinion or even changing providers.
If your treatment involves medication, talk with your doctor about how
often and in what manner your dosage will be monitored. No matter what
medication you are taking, your doctor is likely to start you on a low
dose and gradually increase it to the full dose. You should know that
every medication has side effects, but they usually become tolerated or
diminish with time. If side effects become a problem, the doctor may
advise you to stop taking the medication and to wait a week or so before
trying another medication. When your treatment is near an end, your
doctor will taper the dosage gradually.
Support Groups and Self-Help Tools
Patient-run support groups can be a rich source of information for people
with panic disorder. These groups typically involve 5 to 10 people who
meet weekly to talk about their experiences, encourage each other, and
share tips on coping strategies and local treatment resources.
Sometimes, family members are invited to attend.
Another way to get help is to enlist the support of friends and family
members. You may want to share this booklet and other materials with
them so they can better understand panic disorder and its treatment.
Take the Next Step Today
Panic disorder is far too serious--and far too treatable--to delay
getting help. Recognizing the situation is the first step to recovery.
Now take the next step. If you think you may have panic disorder, act
now. See your health professional for a diagnosis and then follow the
suggestions in this booklet for making your treatment successful.
Educate yourself about your condition. The more you know about panic
attacks and panic disorder, the better you will understand your role in
treatment. To obtain the materials referred to in this booklet, call 1-800-64-PANIC.
Remember, Panic Disorder is Very Treatable
National Institutes of Health
National Institute of Mental Health
NIH Publication No. 94-3641
Printed 1994
Posted: June 01, 1999
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