Panic Attacks & Panic Disorders (Signs, Diagnosis & Treatment)

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What is a Panic Disorder?

Frequent and unplanned panic attacks characterize panic disorder. Panic disorder is a type of anxiety disorder that involves recurrent unexpected panic attacks that aren’t brought on by any mental health issues or medical conditions. They often lack a clear trigger, distinguishing themselves from anxiety attacks, which often result from a perceived threat.¹

Panic attacks can happen at any time, as frequently as several times per day or as infrequently as a few times per year. Many people with panic disorder are concerned about having another episode. They may even make considerable lifestyle changes to prevent it.²

Panic attacks are quite frequent. In the United States, up to 11% of people have a yearly panic attack. Between 2% and 3% of Americans have panic disorder, and those assigned female at birth are twice as likely to develop panic disorder compared to those designated male at birth.

Panic Disorders & Panic Attacks

Not everyone who has a panic attack goes on to have a panic disorder. Many people only experience one or two panic attacks throughout their lives, and then the issue disappears.

You may still benefit from treatment if you have panic attacks but not necessarily panic attack disorder.

Signs & Symptoms of a Panic Disorder

Panic attack symptoms include the following:

• Overwhelming anxiety and panic that comes on suddenly and repeatedly
• A sense of losing control
• Fear of dying or approaching disaster
• Intense fear of having another panic attack
• Living in fear of or avoidance of places where panic attacks have previously happened
• Rapid or pounding heart
• Chills
• Sweating
• Trembling
• Having trouble breathing
• Dizziness or weakness
• Numb or tingly hands
• Chest discomfort
• Stomach discomfort or nausea

To diagnose panic disorder, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) lists these three main points:³

• You get sudden, frequent panic attacks.
• At least one attack has been followed by a month or more of persistent worry about having another attack. You constantly worry about how an attack will affect you—how you’ll lose control, get a heart attack, or have to stay away from situations that can trigger an attack.
• Your panic attacks aren’t brought on by alcohol or substance use, a physical illness, or another mental health issue like obsessive-compulsive disorder (OCD) or social phobia.

Your primary care provider may perform a complete physical examination to rule out other potential health issues, such as thyroid problems. Bloodwork and a psychological assessment to discuss your symptoms, worries, stressful situations, relationship issues, possible avoidance behaviors, and family history are also part of reaching a diagnosis.

If you are unsure of the source of your symptoms or believe they may be related to another significant health issue, such as a heart attack, it is critical to see your primary care provider for an evaluation.⁴ Moreover, anytime signs or symptoms of panic disorder interfere with your daily life – whatever that looks like for you – is reason enough to seek treatment.

Insurance may be able to help cover the cost of therapy. Find out if your insurance can help with the costs by calling your insurance provider or by contacting us below. One of our care coordinators can help you navigate your insurance coverage and get the care you need.

What Causes Panic Disorders?

There are instances where panic disorder runs in families. Still, no one is certain why some family members have it, and others do not. Researchers have discovered that several brain regions and particular biological functions may be significant in the development of fear and anxiety, resulting in panic disorder.

For example, the following may be significant factors in the development of panic disorder:

• Malfunctioning of the amygdala, the area of the brain responsible for processing fear and other strong emotions
• Gamma-aminobutyric acid (GABA)
• Cortisol
• Serotonin chemical abnormalities

According to some experts, panic attacks are similar to “false alarms,” in which our body’s natural survival mechanisms activate too frequently, intensely, or a mix of the two. For instance, an individual with panic disorder can feel like they’re having a heart attack. As a result, this could create a vicious cycle where a person experiences panic attacks that appear out of nowhere, which is the main symptom of panic disorder.

Scientists are investigating how the brain and body communicate in persons with panic disorder to develop more personalized treatments. Researchers are also examining the effect of stress and environmental variables on the condition.

How Are Panic Disorders Treated?

Therapy can help you live a more functional everyday life by reducing the severity and frequency of your panic attacks. Psychotherapy and medication are the two primary forms of treatment. One or both treatment methods may be suggested depending on your preferences, history, the severity of your disorder, and whether you have access to therapists who have received specialized training in treating panic disorders.

Obtaining a diagnosis from a mental health professional is the first step in receiving adequate treatment. A psychiatrist diagnoses, prescribes, and treats mental health conditions like panic disorder. A psychologist and other mental health professionals can provide psychotherapy (counseling).⁵

Counseling & Therapy

One of the most successful first-line treatments for panic attacks and panic disorder is psychotherapy, also known as talk therapy. Psychotherapy teaches you how to manage panic disorder and panic attack symptoms.

Cognitive behavioral therapy (CBT) is the most effective psychotherapy for anxiety disorders. CBT, typically a short-term treatment, focuses on giving you the knowledge and skills to reduce your symptoms and gradually resume activities you’ve avoided due to your condition.

With exposure therapy, a component of CBT, you gradually expose yourself to something that triggers fear and anxiety. Its aim is for you to gain confidence in your ability to control the circumstance and your related symptoms.

Additional psychotherapy approaches include:

• Mindfulness-based Stress Reduction: Mindfulness requires focusing on something in the moment, on intention, and with an open mind.⁶
• Panic-focused Psychodynamic Psychotherapy (PFPP): PFPP aims at clarifying emotional conflicts and prior events that may have influenced the emergence of your panic and anxiety.⁷
• Acceptance and Commitment Therapy (ACT): a form of mindful psychotherapy that aids in maintaining present-moment awareness and accepting thoughts and feelings without judgment. Psychotherapists who use this approach assist you in navigating challenging emotions to focus your energy on healing rather than lingering on the negative.⁸

Medications

Medication can assist with the symptoms related to panic disorder, such as in the case of depression. Medication management for panic attack disorder can be successful with several different types of medication, including:

• Selective serotonin reuptake inhibitors (SSRIs): SSRI antidepressants are frequently advised as the first choice of medications to treat panic attacks because they are generally safe and have a low risk of developing significant side effects.
• Tricyclic Antidepressants (TCA): Tetracyclic and tricyclic antidepressants work by changing certain brain chemicals to reduce depressive symptoms.⁹
• Monoamine Oxidase Inhibitors (MAOI): Different from conventional antidepressants, MAOIs treat many types of depression as well as other nervous system illnesses such as social phobia and panic disorder.¹⁰
• High Potency Benzodiazepines (BDZ): These sedatives inhibit the central nervous system. Because they have the potential to become habit-forming and lead to mental or physical dependence, BDZs are often only taken temporarily. If you have previously struggled with alcohol or drug abuse, BDZs are not a good fit for you.

Since the efficacy of these four types of drugs is almost identical, selecting the best medication for panic disorder patients primarily depends on considering side effects. Given the favorable side-effect profile of SSRIs, all the existing guidelines suggest an SSRI compound as a first-choice medication for treating panic disorder.¹¹

Panic Disorder Treatment Costs & Insurance Coverage

Cognitive behavioral therapy sessions are typically 45+ minutes long and cost between $100 and $200.¹² Keep in mind that CBT is generally regarded as short-term, with therapy sessions ranging from 5 to 20.

Insurance usually covers a portion of the cost of CBT therapy in Tennessee. However, many insurance providers will require a formal diagnosis and may only cover a designated number of sessions. In addition, several other factors can influence your out-of-pocket cost, including your specific insurance plan, the treatment location, and whether or not the provider is in or out-of-network.

When purchased without insurance, brand-name anxiety medication typically costs $1,083.97 for 60 tablets or capsules.¹³ In contrast, generic brand medications are less expensive.  Remember that prices will differ depending on the type of medication, the dosage, the pharmacy, and where you live in Tennessee.

Insurance coverage might vary greatly, but most prescription drug policies cover antidepressants and anti-anxiety medications. Insurance policies, however, might only cover specific antidepressant classes, dosage schedules, or the generic form, not the brand name.

Many people may still need to pay copays or deductibles despite having insurance. Many pharmacies and online prescription medicine coupons are available to help customers save money on prescription medications. Yet, occasionally these are only useful for those without insurance.¹⁴

Athena Care has multiple mental health clinics throughout Tennessee. We are also in-network with most major insurance plans. Therefore, filling out our free, no-obligation online insurance verification form is the best way to obtain all the information needed to begin testing or treatment for panic disorders.

Allow our highly experienced, knowledgeable care coordinators to handle the challenges of contacting your insurance carrier for more information about your coverage. After submitting the form, a care coordinator will review your policy and thoroughly explain your options. Any information you provide or discuss is entirely confidential.

Panic Disorder Treatment Success & Outlook

It is uncommon to have panic disorder without any underlying psychopathology. Even after a period of no panic attack symptoms, the majority of patients will have a relapse of their symptoms. Symptom relapse is prevalent with panic disorder since treatment compliance is a significant issue.¹⁵

Given the high degree of related morbidity and medical expenses, it is crucial to keep researching and developing new treatments for panic disorder.¹⁶ Although there is no cure, therapy can successfully train you to manage panic attacks and your fears.

Cognitive behavioral therapy (CBT) effectively treats panic disorder in randomized controlled research. Results indicate that between 70% and 90% of patients achieved a panic-free state. Depending on the criteria used, rates of clinically meaningful improvement ranged from 38% to 79%.¹⁷

In addition, 7,725 patients from 53 studies were examined for pharmacological outcomes. SSRI and TCA were superior to BDZ in reducing depression associated with panic disorder. TCA, SSRI, and BDZ had a similar effect on alleviating anxiety (symptoms and frequency of panic attacks), and agoraphobia, which is the severe or illogical fear of going into public or crowded areas, leaving one’s house, or being in situations where escaping is challenging.^18,19

Furthermore, pain-focused psychodynamic psychotherapy indicated efficacy for panic disorder in a randomized controlled trial compared to the less effective psychotherapy known as applied relaxation training (ART).²⁰

Because there is “no convincing evidence that one modality is superior for all patients or for a particular subpopulation of patients,” and because “drug and psychological treatments, delivered singly, have broadly similar efficacy in acute treatment,” both the American Psychiatric Association (APA) and the British Association for Psychopharmacology (BAP) recommend either medications or CBT.^21,22

It may require some time and effort to see therapeutic outcomes. After a few weeks, you might see a decrease in panic attack disorder symptoms; usually, however, this happens over several months. You should arrange periodic maintenance appointments to control your panic attacks or treat recurrences.