Getting treatment for panic disorder.

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.

Could You Have 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 ,our 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 your doctor in making a diagnosis. For example, your 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." If you need a copy, call the number below.

Clinical experience sulpests that for many patients with panic disorder, a combination of CBT and medication may be the best treatment. The National Institute of Mental Health (NIMH) is conducting a large study to confirm this and to help determine the kinds of patients most likely to need combined therapy.

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, it at any time you feel uncomfortable w h 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.

The NIMH Referral List can help you find a support group in your area. If there are no groups near you, you may want to form your own. Some of the sources listed can aid you in doing this. NIMH also has a Resource List that provides some self-help information about panic disorder, including books, articles, and videotapes.

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.

NIMH wishes to extend its appreciation to the numerous patients, mental health professionals, primary care professionals, and emergency service professionals who reviewed this pamphlet. All material in this publication is free of copyright restrictions and may be copied, reproduced, or duplicated without permission of the Institute. Citation of the source is appreciated.