What is Panic Disorder (PD)?
At some point, we all experience anxiety symptoms as a normal reaction to everyday problems or major life events. However, some individuals have exaggerated “attacks” of anxiety that are not related to the surroundings. These patients actually suffer from a recognised psychiatric illness: Panic disorder.
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Panic Disorders is a Chronic and Disabling Disease
Panic Disorder Often Starts Early on in Life
Patients with Panic Disorder often Suffer from Other Diseases
The Impact of Panic Disorder on Quality of Life is Immense
There are Serious Consequences for Society as Well as for the Individual
There Are Effective Treatment Options for Panic Disorder
Panic Disorder is a Chronic and Disabling Disease
Individuals suffering from panic disorder experience intense periods of fear and worry.Their symptoms are not only emotional, but are often associated with physical symptoms, such as chest pain, dizziness, or sweating. People with panic disorder often fear new panic attacks. As the condition progresses, a large part of their life is taken up by what is called anticipatory anxiety - the worry of having new attacks - and they develop specific avoidance behaviour in an attempt to stay clear of them.
One patient has described a panic attack as being “…almost a violent experience. I feel like I'm going insane. It makes me feel like I'm losing control in a very extreme way. My heart pounds really hard, things seem unreal, and there's this very strong feeling of impending doom.”
Panic Disorder Often Starts Early on in Life
Panic disorder is actually the most common problem among patients seeking medical help for mental health reasons (ref.2). The disease typically starts in young adults, and as it is a chronic illness, their participation in a normal social and working adult life is often severely affected (ref.3). The lifetime prevalence of panic disorder (the risk of developing the disease during your lifetime) has been reported to be approximately 3.5% percent (ref.4). Approximately eight percent of the population will, during their lifetime, experience the key symptom of panic disorder: a panic attack (ref.5). There is a clear gender difference, as more women than men (at least twice as many) suffer from the disease (ref.6).
Patients with Panic Disorder often Suffer from Other Diseases
Many people with panic disorder also develop symptoms of agoraphobia: (ref.6) They fear being caught in places or situations where it might be difficult to get away should they experience panic symptoms. In severe cases of agoraphobia, a person may end up completely housebound.
Panic Disorder is often seen along with other illnesses such as alcohol abuse and/or depression; up to 60 percent also develop depression (ref.7). Even in those people who suffer from Panic Disorder without any other simultaneous diseases, there is a higher risk of suicide than in the general public. (ref.5) This risk increases if a person also suffers from another condition with a risk of suicide, such as depression.
The Impact of Panic Disorder on Quality of Life is Immense
Quality of life is greatly impaired for an individual patient suffering from panic disorder, as the disease has an enormous impact on many aspects of their life. Family and social functioning are severely affected as individuals risk isolating themselves from social contact. In addition, productivity (and thereby job satisfaction) in the work place is reduced.
There are Serious Consequences for Society as Well as for the Individual
Panic disorder poses a serious problem for society as well as for the individual, as the economic burden of treating and managing the disorder is considerable. There is not only a need for targeted healthcare resources targeted to these patients, but the costs of lost productivity and lost time from work are a drain on the economy (ref.8).
There Are Effective Treatment Options for Panic Disorder
While people with panic disorder do require psychological support, it is important that effective medication therapy is started promptly (ref.3). The biological rationale behind treatment with medication is to modify dysfunction of specific neurotransmitter systems in the brain. In the past, several types of medication have been used, including tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), and benzodiazepines. In recent years, selective serotonin reuptake inhibitors (SSRIs) have increasingly become first line therapy, (ref.3) as they are both effective and far better tolerated. For those with depression in addition to panic disorder, SSRIs have the added benefits, compared to benzodiazepines, of proven efficacy in depression.
Panic disorder requires prompt recognition and effective long-term management; a short period of therapy only alleviates or removes symptoms during treatment, and cannot provide sustained recovery.
The treatment goal is to stop the panic attacks and to decrease or (preferably) remove the risk of the individual experiencing anticipatory anxiety. This will allow the sufferer to function normally in daily relationships as well retaining productivity in the work place.
References:
1. Diagnostic and Statistical Manual of Mental Disorders. Fourth Ed. (DSM-IV). Washington DC: American Psychiatric Association; 1994.
2. Lader MH, Uhde TW. Anxiety, Panic and Phobias. Oxford (UK). Health Press Limited; 2000.
3. Ballenger JC, Davidson JRT, Lecrubier Y, Nutt DJ, Baldwin DS et al. Consensus statement on panic disorder from the international consensus group on depression and anxiety. J Clin Psychiatry 1998; 59 (Suppl 8): 47-54.
4. Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshleman S et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the national comorbidity survey. Arch Gen Psychiatry 1994; 51: 8-19.
5. Montgomery SA, den Boer JA, editors. SSRIs in depression and anxiety. 2nd ed. Chichester (UK): John Wiley & Sons, Ltd; 2001.
6. Pollack MH, Marzol PC. Panic: course, complications and treatment of panic disorder. J Psychopharmacol 2000; 14 (2 Suppl 1): 25-30.
7. Kasper S, Resinger E. Panic disorder: the place of benzodiazepines and selective serotonin reuptake inhibitors. Eur Neuropsychopharmacol 2001; 11: 307-321.
8. Greenberg PE, Sisitsky T, Kessler RC, Finkelstein SN, Berndt ER, Davidson JR et al. The economic burden of anxiety disorders in the 1990s. J Clin Psychiatry 1999; 60 (7): 427-35.