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Panic disorder is a fairly common condition in which a person has uncomfortable episodes of fear or anxiety that occur suddenly and often without warning. The attacks - called panic attacks - can last from minutes to hours. They may occur occasionally or quite frequently and the cause or 'trigger' of these attacks may not be obvious right away. There is a familial tendency, with the age of onset before 25 years old. It occurs more often in women than men (2:1) and approximately 3-5% of the population is affected. Panic disorder can occur in children, but is often not recognized.
What happens during a panic attack?
The physiologic factors involved stem around arousal of the autonomic nervous system in the manner of a 'fight or flight' response to fearful inner impulses and emotions. This stress response results in the characteristic body sensations often seen in a person in a panic attack.[1]
Causes & Development; Risk Factors
Panic is not necessarily brought on by a recognizable circumstance, and it may remain a mystery to the person involved. These attacks come 'out of the blue'. At other times, excessive stress or other negative life conditions can trigger an attack.
What can contribute to Panic Attacks?- Estrogens Low. There have been research studies in the past that showed association of panic attacks with decreased levels of estrogen in women. In one article [Journal of Reproductive Medicine, 41(9): pp.633-9 1996], the authors concluded that womens' brains have been shown to be an estrogen target organ. It is proposed that whenever brain estrogen levels fall below the minimum brain estrogen requirement, for whatever reason and at whatever age, brain center dysfunction may ensue and may cause symptoms of anxiety.
- Thyroiditis. Occasionally an under-active thyroid condition called Hashimoto's autoimmune thyroiditis, known as HAIT or, simply, thyroiditis has been associated with a range of anxiety symptoms including panic attack.
- High Sugar Diet. Eating a lot of foods high in refined sugar increases blood lactate levels and may induce panic in susceptible persons.
- Smoking. A history of smoking may play a small role in the onset of panic disorder in women, but not men. In comparing 217 patients with panic disorder to 217 age-matched controls, it was found that female patients with panic disorder had a significantly higher smoking prevalence at the onset of their illness than did control subjects 10 years previously (54% versus 35%). Current smoking prevalence was also higher in those patients with panic attack versus controls (40% versus 25%). Male smoking rates did not differ between the groups and caffeine intake did not appear to explain these findings.
Signs & Symptoms
Panic attacks are often associated with physical symptoms such as shaking, a feeling your heart is pounding or racing, sweating, chest pain, shortness of breath, a feeling of choking, nausea, cramping, diarrhea, dizziness, an out-of-body sensation (a feeling of being apart from oneself), tingling in the hands, chills or hot flashes, and headache. A person may also have an extreme fear of losing control, going crazy or dying during a panic attack. It is very rare for a person to have all of these symptoms at once, although the presence of at least 4 symptoms strongly suggests the diagnosis of panic disorder.
Once panic starts, stresses that normally would have been small and manageable become overwhelming. A palpable, screaming fear rises inside and for no apparent reason; sufferers feel they are being choked by a panic that races the heart and paralyzes. Not surprisingly, they begin to fear the attacks themselves. This can lead to agoraphobia. Agoraphobia occurs when a person finds it difficult to leave home or another safe area because of the fear of having a panic attack in public or of not having an easy way to escape if the symptoms start.
Many of the symptoms that occur during a panic attack are the same as the symptoms of diseases of the heart, lung, intestine or nervous system. The similarities of panic disorder to other diseases may add to the person's fear and anxiety during and after a panic attack.
Treatment & Prevention
Nowadays, panic attacks and agoraphobia can be treated successfully in the majority of cases. In fact, it is estimated that the appropriate therapy from a knowledgeable therapist helps close to 90% of panic attack sufferers.
Should I seek treatment if I'm having panic attacks?
Because of embarrassment or the fear of taking medicine, many people who have panic attacks don't seek medical care. If you have panic attacks, it is very important to seek medical care and discuss your problem with your doctor. After you have been evaluated thoroughly, your doctor will be able to tell you if the panic attacks are related to panic disorder or are caused by another problem.
Other treatment considerations.
Several kinds of psychological counseling are very effective for treating panic disorder and are as effective as medicine, but do not work as quickly. If an underlying contributing condition can not be found, a combination of both psychological counseling and medicine seems to be the best treatment for panic disorder. Types of behavioral therapy involving counter-conditioning treatment of fear responses have helped to abort panic attacks, but are of little use during the attack. By
imagining a scene a person is just a little afraid of and then using relaxation techniques and affirmations to overcome the fear, people have been able to progressively face more stressful imagined fearful scenes until they were able to tolerate their worst fears.
One study reported that in 9 of 22 patients with panic disorders, attacks were more frequent in winter. The authors suggest that, since there was positive benefit from light therapy in a single patient who underwent light treatment, seasonal panic disorder may be a variant of seasonal affective disorder (SAD). They encouraged the possibility of light therapy in patients with seasonal panic disorder.
Urine samples were taken from 14 untreated panic attack patients and compared to those from 13 age- and sex-matched controls. It was found that panic attack patients had significantly higher pH (alkaline) levels than controls (7.0 versus 5.5). It was suggested that panic disorder individuals may have a series of subtle hyperventilating episodes (breathing too rapidly and/or deeply) that may account for this alkalinity. Urine pH could be a simple way to evaluate respiratory status and subsequently the success of breathing retraining in patients with panic disorder. Since slowing down the breathing rate or breathing into a paper bag will help restore normal pH, these techniques have helped reduce symptoms in some cases.
Additional support for an overly acidic system, apart from breathing, comes from the fact that in people with chronic anxiety unrelated to life events, an injection of sodium lactate can trigger a panic attack.
How long does treatment last?
How long treatment should continue depends on you. The complete elimination of panic attacks is a reasonable goal. Your doctor will design a treatment plan just for you. A treatment period lasting at least 6 to 9 months is usually recommended. Some people with panic disorder are able to stop taking medicine after only a short time, and some people need treatments over long periods of time or even for their lifetime.
References & Further Information
[1] Psychiatric specialists from the University of Göttingen in Germany recently reported results from a new study that found levels of the adrenal stress hormone cortisol surging in the beginning phase of a panic attack. Researchers had twenty-five patients with panic disorder collect multiple saliva samples over a two-hour period while in the grips of a panic attack. Then the patients collected samples again twenty-four hours later, after the attack had subsided. Investigators discovered that levels of cortisol were markedly higher, by nearly 40%, during the early stages of the panic attack than they were the next day, when symptoms had abated.
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Conditions that suggest Panic Attacks:
Risk factors for Panic Attacks: | | | | | Addictions |  Cigarette Smoke Damage | Female patients with panic disorder had a significantly higher smoking prevalence at the onset of their illness than did control subjects 10 years previously (54% vs. 35%). Current smoking prevalence was also higher in those patients with panic attack versus controls (40% vs. 25%). Male smoking rates did not differ between the groups. [Psychiatric Research, 1992;43: pp.253-62] |
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Autoimmune |
Chronic Thyroiditis |
Circulation |
 Mitral Valve Prolapse| | People with mitral valve prolapse (MVP) seem somehow to be 'wired' differently. Their autonomic response can be much more volatile and unstable so that normal stresses and surprises set off an exaggerated response, flooding their systems with stress hormones called the catecholamines. In fact, there may not be a specific stressor; people with MVP are intermittently and unpredictably awash in their own catecholamines. This leaves them alternately innervated and exhausted - "wired but tired" is a common feeling.
If the sympathetic nervous system of a person with MVP is aroused, they can suddenly feel crushing chest pain, with heartbeat racing and pounding. They may begin to hyperventilate, feel short of breath, and break out into a cold sweat. This may occur without warning or immediate threat. There can be sensations of chest pain, a feeling of doom or detachment, a fear of dying, or a desire to flee. If they don't know why this is happening, the symptoms themselves are scary, and the fear of the unknown can prompt an even greater release of stress hormones, driving them into the kind of meltdown of the autonomic nervous system called a panic attack. This is an intense and scary experience, the sensations of which can easily be confused with those of a heart attack. Once people experience this, they generally have a persistent fear of having another attack, which puts them on a "hair trigger", ready to respond to the slightest symptoms by releasing the very stress hormones that induce the panic attacks, thus escalating a new attack. |
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Diet |
Excess Sugar Consumption| | Eating a lot of foods high in refined sugar increases blood lactate levels and may induce panic in susceptible persons. |
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Environment / Toxicity |
Mercury Toxicity (Amalgam Illness)
Electrical Hypersensitivity |
Hormones |
Progesterone Low or Estrogen Dominance| | It has been reported that women with low progesterone levels experience less intense or less frequent panic attacks after progesterone supplementation. In some cases, sublingual progesterone in olive oil has produced immediate benefit. |
Low Adrenal Function / Adrenal Insufficiency| | When adrenal function is low, caffeine consumption may contribute to panic attacks. Caffeine interferes with adenosine, a brain chemical that normally has a calming effect, and raises the level of lactate, a biochemical known to produce panic attacks. |
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Metabolic |
Pyroluria
Aspartame Side-Effects |
Nutrients |
EFA (Essential Fatty Acid) Type 3 Requirement| | In one study, 3 out of 4 patients with panic attacks or a history of agoraphobia for 10 or more years improved within 3 months after taking flaxseed oil. |
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Panic Attacks suggests the following may be present: | | | | | Circulation | Mitral Valve Prolapse| | People with mitral valve prolapse (MVP) seem somehow to be 'wired' differently. Their autonomic response can be much more volatile and unstable so that normal stresses and surprises set off an exaggerated response, flooding their systems with stress hormones called the catecholamines. In fact, there may not be a specific stressor; people with MVP are intermittently and unpredictably awash in their own catecholamines. This leaves them alternately innervated and exhausted - "wired but tired" is a common feeling.
If the sympathetic nervous system of a person with MVP is aroused, they can suddenly feel crushing chest pain, with heartbeat racing and pounding. They may begin to hyperventilate, feel short of breath, and break out into a cold sweat. This may occur without warning or immediate threat. There can be sensations of chest pain, a feeling of doom or detachment, a fear of dying, or a desire to flee. If they don't know why this is happening, the symptoms themselves are scary, and the fear of the unknown can prompt an even greater release of stress hormones, driving them into the kind of meltdown of the autonomic nervous system called a panic attack. This is an intense and scary experience, the sensations of which can easily be confused with those of a heart attack. Once people experience this, they generally have a persistent fear of having another attack, which puts them on a "hair trigger", ready to respond to the slightest symptoms by releasing the very stress hormones that induce the panic attacks, thus escalating a new attack. |
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Recommendations and treatments for Panic Attacks:
KEY | | Weak or unproven link | | | Strong or generally accepted link |  | | Proven definite or direct link |  | | May do some good |  | | Likely to help |  | | Highly recommended |
GLOSSARY
Adrenal (Adrenal Gland, Adrenal Glands, Adrenals)
The adrenal glands sit on top of each kidney and consist of an outer cortex and an inner medulla. Of the 50 or so hormones the adrenals make, only cortisone and adrenaline are recognized by most people. Some of these hormones must be produced to preserve life, while others help resist stress. Other hormones from the adrenals control normal energy output (along with the thyroid) and govern the breakdown of stored energy into quick energy sources. The medulla produces epinephrine and norepinephrine, which are specifically designed to help the body deal with stressful situations. The adrenals control the body's potassium/sodium balance, which is vital for energy production. They also produce sex hormones in minute amounts, which is important for later years when the gonads drop or cease their production.
Adrenal Insufficiency (Adrenal Exhaustion, Low Adrenal Function)
A condition in which the adrenal gland is compromised in its production of epinephrine, norepinephrine, cortisol, corticosterone or aldosterone. Symptoms include primarily fatigue, weakness, decreased appetite with ensuing weight loss, as well as nausea, vomiting, abdominal pain, diarrhea or constipation, or increased pigmentation of the skin. Cortical insufficiency (low or no corticosteroids) produces a more serious condition called Addison’s Disease, characterized by extreme weakness, low blood pressure, pigmentation of the skin, shock or even death.
Alkaline
A substance having a pH above that of neutral water (7.0) when in solution. Signified as pH (potential of Hydrogen), alkaline fluids, such as the blood (pH about 7.4), have the ability to neutralize acids (solutions below pH 7.0). Metabolic wastes are acids, and the alkaline reserve of the blood neutralizes them until they are excreted.
Anxiety
Apprehension of danger, or dread, accompanied by nervous restlessness, tension, increased heart rate, and shortness of breath unrelated to a clearly identifiable stimulus.
Autoimmune Disease (Autoimmune, Autoimmunity)
One of a large group of diseases in which the immune system turns against the body's own cells, tissues and organs, leading to chronic and often deadly conditions. Examples include multiple sclerosis, rheumatoid arthritis, systemic lupus, Bright's disease and diabetes.
Catecholamine (Catecholamines)
Any of various amines (as epinephrine, norepinephrine, and dopamine) that function as hormones and/or neurotransmitters.
Chronic (Chronicity)
Usually referring to chronic illness: Illness extending over a long period of time.
Commission E
The body of scientists and panel of experts that provides advice on herbal treatments and evaluates the safety, effectiveness and dosage of medicinal herbs; Germany's equivalent of the FDA.
Cramp (Cramping, Cramps)
A sudden, involuntary, painful muscular contraction.
Diarrhea
Excessive discharge of contents of bowel.
Estrogen (Oestrogen)
One of the female sex hormones produced by the ovaries.
Gram (gm, gms, Gramme, Grammes, Grams)
A metric unit of weight, there being approximately 28 grams in one ounce.
Hormones (Hormone)
Chemical substances secreted by a variety of body organs that are carried by the bloodstream and usually influence cells some distance from the source of production. Hormones signal certain enzymes to perform their functions and, in this way, regulate such body functions as blood sugar levels, insulin levels, the menstrual cycle, and growth. These can be prescription, over-the-counter, synthetic or natural agents. Examples include adrenal hormones such as corticosteroids and aldosterone; glucagon, growth hormone, insulin, testosterone, estrogens, progestins, progesterone, DHEA, melatonin, and thyroid hormones such as thyroxine and calcitonin.
Inositol
Usually considered part of the vitamin B complex. It is thought that along with choline, inositol is necessary for the formation of lecithin within the body. Involved in calcium mobilization.
Lactation (Lactate, Lactates, Lactating)
Production of milk; period after giving birth during which milk is secreted in the breasts.
Lung (Lungs, Pulmonary)
Organ of the body, located in the chest cavity which is designed to bring oxygen from the air into the blood stream, while also expelling carbon dioxide and other waste gases out of the body. Pulmonary: Related to the lungs.
Nausea
Symptoms resulting from an inclination to vomit.
Nervous System
A system in the body that is comprised of the brain, spinal cord, nerves, ganglia and parts of the receptor organs that receive and interpret stimuli and transmit impulses to effector organs.
Neurotransmitters (Neurotransmitter)
Chemicals in the brain that aid in the transmission of nerve impulses. Various Neurotransmitters are responsible for different functions including controlling mood and muscle movement and inhibiting or causing the sensation of pain.
Panic Attack (Panic Attacks)
A brief, irrational episode of fear that is perceived as so real that an individual may be driven to escape from the place or situation where it occurs. The attack is sudden and increases in severity until it leaves, usually within ten minutes. Panic attack symptoms are numerous and involve both mental and physical signs and symptoms. A panic attack can occur in other anxiety states such as agoraphobia and with certain activities and places. It may occur spontaneously without an apparent cause.
Panic Disorder
A condition whereby an affected individual has recurrent and unexpected panic attacks and worries a great deal of the time about having another. The individual may also have persistent concern or fear that a panic attack might cause unrelated health problems or a demonstrable change in usual behavior. The symptoms of panic disorder must be present for at least one month to confirm the diagnosis.
pH
A measure of an environment's acidity or alkalinity. The more acidic the solution, the lower the pH. For example, a pH of 1 is very acidic; a pH of 7 is neutral; a pH of 14 is very alkaline.
Progesterone
This is the hormone secreted after ovulation by the corpus luteum. It is a steroid (similar to a cholesterol), enters receptive cells to stimulate their growth, and acts as an anabolic agent. Estrogen should be viewed as the primary coat underneath all the cycles during a woman's reproductive years, with progesterone, its antagonist, surging for ten or twelve days in ovulatory months. Most of the actions of progesterone cannot occur without estrogen having previously induced the growth of progesterone-receptive binding sites.
Refined Sugar (Refined Sugars)
The term 'refined sugar' includes not only the "sugar" listed in ingredient listings, but also brown sugar, glucose, fructose and dextrose. Obvious sources include jams and jellies; hidden sources are often mayonnaise, ketchup, salad dressings and other condiments.
Serotonin
A phenolic amine neurotransmitter (C10H12N2O) that is a powerful vasoconstrictor and is found especially in the brain, blood serum and gastric membranes of mammals. Considered essential for relaxation, sleep, and concentration.
Sodium
An essential mineral that our bodies regulate and conserve. Excess sodium retention increases the fluid volume (edema) and low sodium leads to less fluid and relative dehydration. The adult body averages a total content of over 100 grams of sodium, of which a surprising one-third is in bone. A small amount of sodium does get into cell interiors, but this represents only about ten percent of the body content. The remaining 57 percent or so of the body sodium content is in the fluid immediately surrounding the cells, where it is the major cation (positive ion). The role of sodium in the extracellular fluid is maintaining osmotic equilibrium (the proper difference in ions dissolved in the fluids inside and outside the cell) and extracellular fluid volume. Sodium is also involved in nerve impulse transmission, muscle tone and nutrient transport. All of these functions are interrelated with potassium.
Sublingual (Sublingually)
Situated or administered under the tongue, for example sublingual glands or sublingual tablets.
Sympathetic Nervous System
Portion of the autonomic nervous system that is generally associated with “flight or fight” reactions by increasing blood circulation and respiration and decreasing digestion.
Thyroid (Thyroid Gland)
The thyroid gland is an organ with many veins, anchored around the front of the throat near the voice box. It is essential to normal body growth in infancy and childhood. It absorbs iodine from the diet and releases thyroid hormones - iodine-containing compounds that help govern the rate of the body's metabolism (its total life processes), affecting body temperature, and regulating protein, fat and carbohydrate catabolism in all cells. They keep up growth hormone release, skeletal maturation, and heart rate, force, and output. They promote central nervous system growth, stimulate the making of many enzymes, and are necessary for muscle tone and vigor. To a high degree, metabolism is regulated by the hormone thyroxine, which can be made by the thyroid if enough organic iodine is available. An enlarged thyroid gland that is not cancer is sometimes called goitre.
Thyroiditis (Chronic Thyroiditis, Hashimoto's Thyroiditis)
Inflammation of the thyroid; there are several forms of thyroiditis, including chronic or Hashimoto's thyroiditis (also called autoimmune or chronic lymphocyctic thyroiditis), subacute thyroiditis, and painless or postpartum thyroiditis. Thyroiditis often results in hypothyroidism.
Last updated: Apr 13, 2008
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