Panic Attacks and Panic Disorder
What are panic attacks and panic disorder?
A panic attack is a sudden, intense fear or anxiety that may make you short of breath or dizzy or make your heart pound. You may feel out of control. Some people believe they are having a heart attack or are about to die. An attack usually lasts from 5 to 20 minutes but may last even longer, up to a few hours. You have the most anxiety about 10 minutes after the attack starts. If these attacks happen often, they are called a panic disorder.
Panic attacks can be scary and so bad that they get in the way of your daily activities. Treatment can help most people have fewer symptoms or even stop the attacks.
More women than men get panic attacks.
What causes panic attacks and panic disorder?
Experts aren't sure what causes panic attacks and panic disorder. But the body has a natural response when you are stressed or in danger. It speeds up your heart, makes you breathe faster, and gives you a burst of energy. This is called the fight-or-flight response. It gets you ready to either cope with or run away from danger. A panic attack occurs when this response happens when there is no danger.
Panic attacks and panic disorder may be caused by an imbalance of brain chemicals or a family history of panic disorder. They sometimes happen with no clear cause.
Panic attacks may also be brought on by:
- A health problem such as an overactive thyroid (hyperthyroidism), or heart or breathing problems.
- Depression or another mood disorder.
- Alcohol abuse.
- Using too much nicotine or too much caffeine.
- Taking certain medicines, such as those used to treat asthma and heart problems.
- Using illegal drugs such as marijuana or cocaine.
- Living with high levels of stress for a long time.
What are the symptoms?
Symptoms of a panic attack may include:
- A feeling of intense fear, terror, or anxiety.
- Trouble breathing or very fast breathing.
- Chest pain or tightness.
- A heartbeat that races or is not regular.
- Nausea or an upset stomach.
- Dizziness and shaking.
- Numbness or tingling.
Symptoms of panic disorder may include:
- Repeated panic attacks when there is no reason for the fight-or-flight response.
- Changing your daily activities because you worry that you will have another attack.
Some people have a fear of being in crowds, standing in line, or going into shopping malls. They are afraid of having another panic attack or of not being able to escape. This problem is called agoraphobia and can be so bad for some people that they never leave their homes.
About half of people who have panic disorder also have agoraphobia.1 People with panic disorder often have depression at the same time.
How are panic attacks and panic disorder diagnosed?
Your doctor will ask about your past health and do a physical exam. The exam may include listening to your heart, checking your blood pressure, and ordering blood tests to look for other causes of your problem. Your doctor may ask you to do some simple things that test your memory and other mental skills.
How are they treated?
Treatments for panic attacks and panic disorder include counseling and medicine. Using both will often work best. Treatment can help most people control or even stop attacks. But symptoms can come back, especially if you stop treatment too soon.2, 1
Frequently Asked Questions
Learning about panic attacks and panic disorder:
Health Tools help you make wise health decisions or take action to improve your health.
|Decision Points focus on key medical care decisions that are important to many health problems.|
|Panic disorder: Should I take medicine?|
|Actionsets are designed to help people take an active role in managing a health condition.|
|Anxiety: Using positive thinking|
|Positive thinking: Stopping unwanted thoughts|
|Stress management: Breathing exercises for relaxation|
|Stress management: Doing guided imagery to relax|
|Stress management: Doing meditation|
|Stress management: Doing progressive muscle relaxation|
|Stress management: Practicing yoga to relax|
|Stress management: Relaxing your mind and body|
Panic disorder also may be passed down through families (genetic). Children of parents who have panic disorder are up to 8 times more likely to develop panic disorder.3 You are also at a higher risk of developing panic disorder if you have a parent with either depression or bipolar disorder.4, 5 Stressors (such as the sudden loss of a relationship) may trigger symptoms of panic disorder as well.
You may experience a panic attack without having panic disorder. Panic attacks may be triggered by:
- Drinking large amounts of alcohol or abruptly stopping the use of alcohol.
- Drinking large amounts of caffeinated beverages.
- Chain-smoking, which causes the amount of nicotine in the blood to be very high.
- Taking certain medicines (such as those used to treat asthma and heart conditions) or abruptly stopping certain medicines (such as those used to treat anxiety or sleep problems).
- Using illegal drugs, such as cocaine or marijuana.
- Having high levels of stress for a long time (chronic stress).
- Having recently had a baby.
- Having recently had surgery or been under general anesthesia.
Panic attacks also can be caused by or associated with other medical conditions, including:6
- Thyroid problems, such as an overactive thyroid (hyperthyroidism).
- Heart problems, such as mitral valve prolapse.
- Seizure disorders, such as epilepsy.
- Asthma .
- Respiratory problems, such as chronic obstructive pulmonary disease (COPD).
- Stopping the use of a prescription medicine, such as a heart medicine.
- Anxiety disorders such as post-traumatic stress disorder or obsessive-compulsive disorder.
The main symptom of a panic attack is an overwhelming feeling of fear or anxiety, along with physical reactions. An attack starts suddenly and usually lasts from 5 to 20 minutes but may last even longer, up to a few hours. You feel most anxious about 10 minutes into the attack. It is possible to have one panic attack after another in waves for an extended period of time, and it can seem like one continuous attack. But if you have continuous symptoms that do not go away within an hour, you probably are not having a panic attack and you should seek immediate medical care.
Symptoms of a panic attack may include:3
- Rapid breathing (hyperventilation), shortness of breath, or feeling "smothered."
- A pounding or racing heart or an irregular heartbeat.
- Chest problems.
- A choking feeling.
- Nausea or an upset stomach.
- Dizziness, shaking, or trembling.
- Numbness or tingling.
- Chills or hot flashes.
- Fear that you are going to die, lose control, or "go crazy."
- Feelings of being detached from yourself or from reality.
Panic attacks can begin with a stressful event or appear without cause. They also can be associated with medications, such as heart medications, and medical conditions, such as an overactive thyroid (hyperthyroidism).
Panic attacks may begin without a trigger or can be linked to certain situations, such as being in large crowds of people in restaurants or stadiums. Sometimes just the anticipation of being in a certain situation can cause severe anxiety. People who experience panic attacks often learn to avoid situations that they fear will trigger a panic attack or situations where they will not be able to escape easily if an attack occurs. If this pattern of avoidance and anxiety is severe, it can become agoraphobia.
The symptoms of a panic attack can be similar to those of a heart attack. Many people seek emergency medical treatment for a panic attack for this reason. If you have chest pain and other symptoms of a heart attack, get immediate medical treatment. For more information, see the topic Chest Problems.
Panic attacks are not common in children or younger teens. But children who have panic disorder or panic attacks often have other symptoms in addition to those listed above. They may be overly afraid of common objects such as bugs, or worry excessively about monsters or about going to bed alone. They also may refuse to go to school or become unusually upset when they are separated from a parent.
Not everyone who experiences panic attacks develops panic disorder. A person is diagnosed with panic disorder if he or she has at least two unexpected panic attacks along with fear or worry about having another panic attack and avoiding situations that may trigger it.3
You may be diagnosed with panic disorder after several unexpectedpanic attacks and if you continue to fear having another attack. These panic attacks can have mild to severe symptoms and usually last from 5 to 20 minutes but may last even longer, up to a few hours.
A first panic attack often starts without warning during an ordinary activity such as shopping or walking down the street. You may become confused and think you are "going crazy" or that something terrible is going to happen. You may feel a strong need to leave the area and go to a place that feels safe, such as your car or home. You may also experience physical symptoms such as shortness of breath, a pounding heart, or chest pain. The intensity of these symptoms usually peaks within 10 minutes. It is common to think you are experiencing a heart attack and to seek treatment in a hospital emergency room.
Panic attacks may be triggered by a specific action, such as drinking too much caffeine, or by a situation, such as being in a large crowd. Panic attacks may also start suddenly without a known trigger. You may greatly fear having another panic attack (anticipatory anxiety) and avoid all social situations (agoraphobia). As many as half of people who have panic disorder also have agoraphobia.1 Isolating yourself and avoiding social situations can interfere with your ability to work and your relationships, especially with your family members and close friends.
Other characteristics that are common in panic disorder include:
- Fearing sleep and feeling exhausted from lack of sleep.
- Using drugs or alcohol (to numb your fears or give you a false sense of courage to face feared situations).
- Having depression.
- Having irrational fears (phobias).
- Experiencing other anxiety disorders, such as post-traumatic stress disorder.
- Having difficulty relating to other people in social settings due to intense feelings of anxiety.
Although the first panic attack may occur during a routine activity, for many people it happens at the same time during their life when there is a lot of stress, such as a life-threatening illness or accident, the loss of a relationship, or separation from family. Sometimes an initial panic attack may occur after giving birth.
It is also possible for a first panic attack to occur as the result of a drug reaction or a reaction to nicotine or caffeine. But after the situation that caused the first panic attack is resolved, attacks may continue. Experts believe these stressful circumstances may start the cycle of panic attacks in people who are already prone to panic disorder.7
Recurrent panic attacks can be mild to severe and continue for years, especially if you also have agoraphobia (avoiding places where you fear another attack will occur).8 You may have long periods of time without panic attacks and other periods of time when attacks occur frequently.
You may need longer or different treatment if you have both panic disorder and agoraphobia. You may also experience other conditions associated with panic disorder and panic attacks such as drug or alcohol problems, depression, or other mental health disorders. You will need treatment for all these conditions.
Panic disorder may last a lifetime, but its symptoms can be controlled with treatment. Most people with panic disorder get better with treatment. They are able to get back to a normal lifestyle, although relapse can occur, especially if treatment is discontinued too soon.2, 1
What Increases Your Risk
- Have a family history of panic disorder. You are 8 times more likely to develop panic disorder if a family member has been diagnosed with it.1 You are also at increased risk if you have a parent with either depression or bipolar disorder.4, 5
- Have other conditions associated with panic disorder or panic attacks, such as depression.
- Drink alcohol, use illegal drugs, chain-smoke cigarettes, or drink large amounts of coffee or other caffeinated beverages.
- Take medicines known to trigger panic attacks, such as those used to treat asthma or heart problems.
- Have mitral valve prolapse, a heart condition in which one of the valves in the heart does not close as it should.
- Have had previous, unexpected panic attacks.
- Have experienced an episode of major depression.
- Are a woman who has recently gone through menopause.9
When To Call a Doctor
Call your doctor if you experience:
- Attacks of intense fear or anxiety that seem to come on without a reason.
- A panic attack or worry that you will have another one and your worrying interferes with your ability to do your daily activities.
- Occasional physical symptoms (such as shortness of breath and chest pain) and you are not sure what is causing them.
It can be difficult to tell the difference between the symptoms of a panic attack (such as shortness of breath and chest pain) and the symptoms of a heart attack or another serious medical problem. If you have symptoms of a panic attack, you should seek immediate medical care so that other medical conditions can be ruled out.
Who To See
- Emergency medicine specialist
- Family medicine physician
- General practitioner
- Physician assistant
- Nurse practitioner
Treatment for panic attacks and panic disorder may also be provided by a:
Many community mental health centers, hospital outpatient clinics, and family service agencies have treatment programs for people with panic disorder.
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Exams and Tests
Panic disorder usually is diagnosed through a medical history and a physical exam. The doctor will ask you questions about your symptoms and will listen to your heart, check your blood pressure, and may order blood tests. The doctor may need to rule out other physical conditions that have symptoms similar to panic disorder, such as a heart attack, mitral valve prolapse, or hyperthyroidism.
Panic disorder can be controlled with medicines (such as antidepressants) and professional counseling (such as cognitive-behavioral therapy). Successful treatment reduces the number and frequency of panic attacks, lowers the anxiety you feel because of the fear of future attacks, and improves the quality of your life.
If your panic attacks were caused by a specific trigger, such as a medication reaction, you may not need treatment after the trigger has been removed, which in this case would mean stopping the medicine with the help of your doctor. But sometimes panic attacks caused by outside factors can continue after the trigger has been removed and may develop into panic disorder.
Initial treatment for panic disorder depends upon how bad your panic attacks are, how much fear or anxiety you feel about having another attack, and whether you have agoraphobia (avoiding situations or places that might trigger an attack) along with panic disorder.
In general, initial treatment includes:
- Cognitive-behavioral therapy, which focuses on changing certain thinking and behavior patterns, is the most effective type of therapy for panic disorder. For more information on changing how you think, see:
- Exposure therapy is a type of cognitive-behavioral therapy that focuses on confronting a feared object or situation. It can be especially helpful in treating agoraphobia or anxiety linked to a particular place or situation.
- The most common medicines used to treat panic disorder are selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac), sertraline (Zoloft), or paroxetine (Paxil). If these medicines are not effective or do not work because of their side effects, other antidepressants may be tried.
- Antidepressants with mixed neurotransmitter effects, such as venlafaxine (Effexor) are sometimes used.7
- Benzodiazepines such as alprazolam (Xanax), diazepam (for example, Valium), lorazepam (Ativan), or clonazepam (Klonopin) sometimes are prescribed either alone or combined with an antidepressant. Benzodiazepines are most commonly used for rapid, short-term relief of symptoms and may also be used as a part of ongoing treatment either alone or combined with an antidepressant.
- Other antidepressants used to treat panic disorder include tricyclic antidepressants (TCAs) such as imipramine (Tofranil), desipramine (Norpramin), or clomipramine (Anafranil) and monoamine oxidase inhibitors (MAOIs) such as isocarboxazid (Marplan), phenelzine (Nardil), or tranylcypromine (Parnate).
Your symptoms of panic disorder may start to improve within a few weeks after beginning medicines. If improvement is not seen within 6 to 8 weeks, a higher dose or another medicine may be needed.10
Treatment for recurring or ongoing panic disorder usually consists of continuing or changing initial measures, which include professional counseling and medicines.
During initial treatment, a short-term medicine such as a benzodiazepine may be prescribed to help you deal with immediate symptoms. The short-term medicine will likely need to be tapered off and stopped after long-term medicines begin working and your symptoms improve.
You will be continually assessed to determine whether you have developed any other conditions associated with panic disorder, such as depression or problems with drugs or alcohol. These additional conditions will also need treatment.
An important part of ongoing treatment is making sure you are taking your medicine as prescribed. Often people who feel better after using medicine for a period of time may believe they are "cured" and no longer need treatment. But when medicine is stopped, symptoms usually return, so it is important that you continue the treatment plan.
Recurrent panic attacks can be mild to severe and continue for years, especially if you also have agoraphobia (avoiding places where you fear another attack will occur).8 You may have long periods without panic attacks or times when attacks occur frequently. Even after treatment is stopped because the attacks appear to be under control, attacks can suddenly return. Learn to identify your early warning signs and triggers so you can seek treatment early.
Treatment if the condition gets worse
If your panic attacks become severe or continually recur, you may need to be hospitalized until they are under control. You also may need a brief hospital stay if you have panic attacks along with another health condition, such as agoraphobia or depression, because these conditions combined can be more difficult to treat.
If you are taking medicines that do not seem to be helping, your doctor may prescribe a different medicine or a combination of medicines.
If medicine is currently your only treatment, counseling may be added to your treatment. Counseling may include cognitive-behavioral therapy, which focuses on modifying certain thinking and behavior patterns, or exposure therapy, which focuses on confronting a feared object or situation. If you are in counseling, but it does not seem to be working, more intensive, more frequent, or a different type of counseling may be added to your treatment.
If counseling is currently your only treatment, medicines may be added.
What To Think About
Although medicines to treat panic disorder often may prevent another panic attack, they may not take away the fear of having another attack. Counseling can help you handle this fear. The fear of having an attack may actually bring on another attack.
It can take up to several weeks or longer before a medicine becomes fully effective. You may need to try several medicines or combinations before you find the one that works best for you.
People who have panic disorder may be at an increased risk for suicide if they also have depression or another mood or personality disorder. These conditions can also have a significant impact on social functioning and quality of life. Diagnosis and treatment of conditions that occur along with panic disorder are essential.
Unfortunately, many people don't seek treatment for anxiety disorders. You may not seek treatment because you think the symptoms are not bad enough or that you can work things out on your own. But getting treatment is important.
If you need help deciding whether to see your doctor, see some reasons why people don't get help and how to overcome them.
Although panic disorder cannot be prevented, you may be able to prevent or reduce the number of additional panic attacks with proper treatment. Simply avoiding certain situations or places does not guarantee that a panic attack will not occur under new circumstances. In fact, avoiding situations and places where panic attacks have occurred often increases your level of anxiety.
You may be able to reduce the severity of future attacks if you follow home treatment practices such as:
- Reducing anxiety and limiting triggers like caffeine and alcohol.
- Continuing medical treatment and counseling, such as exposure therapy.
- Calling your doctor if symptoms recur or get worse.
- Reducing anxiety by doing tension-reducing activities and lowering the amount of stress in your life.
- Doing relaxation exercises which involve 10 to 20 minutes of deep breathing and muscle relaxation daily.
- Changing how you think can change how you feel—and that can reduce your anxiety. For more information on changing how you think, see:
- Getting regular physical exercise that gets your breathing and heart rate up several times a week.
- Restricting alcohol and caffeine (or eliminating these altogether).
- Joining a self-help and support group such as one organized by the Anxiety Disorders Association of America (ADAA).
- Eating a balanced diet, which includes eating fresh, healthy foods and limiting your intake of foods that are high in sugar and fat.
Support for family members
When a person has panic attacks, that person's entire family is affected. If someone in your family has panic attacks, you may feel frustrated, overworked (because you have to take over his or her responsibilities), or socially isolated because the person restricts family activities. These feelings are normal. Family therapy, a type of counseling that involves the entire family, may be helpful for all family members. For more information, see:
Medicines for panic disorder are often used to control the symptoms of panic attacks, reduce their number and severity, and reduce the anxiety and fear associated with having another attack. Medicines work best if they are used along with counseling and home treatment, such as relaxation exercises.2
Medicines used most often to treat panic attacks include the following:8
- Selective serotonin reuptake inhibitors (SSRIs), such as Prozac, Zoloft, or Paxil
- Benzodiazepines, such as Xanax, Valium, Ativan, or Klonopin
Medicines sometimes used to treat panic disorder include the following:
- Antidepressants with mixed neurotransmitter effects, such as venlafaxine (Effexor)7
- Tricyclic antidepressants (TCAs), such as Tofranil, Norpramin, or Anafranil
- Monoamine oxidase inhibitors (MAOIs), such as Marplan, Nardil, or Parnate
What To Think About
Panic disorder is best treated with both medicines and counseling such as cognitive-behavioral therapy, which focuses on modifying certain thinking and behavior patterns. When these two therapies are combined, relapses of panic attacks occur far less frequently than when only one treatment is used.11
Your symptoms of panic disorder should start to improve within a few weeks after beginning medicines. If improvement is not seen within 6 to 8 weeks, a higher dose or another medicine may be needed.10
Most medicines used to treat panic attacks need to be continued for a year or longer and then may be decreased gradually over several weeks.12 If you experience panic attacks again while medicines are being stopped, the medicines may be continued for at least a few months more. Some people may need to stay on medicines for a long time to keep symptoms under control.
You may also need to be reevaluated for other conditions associated with panic disorder, such as depression or substance abuse, because having one of these conditions makes treatment more difficult.8, 1
There is no surgical treatment for panic disorder at this time.
Other treatments for panic disorder include:
- Counseling. Cognitive-behavioral therapy is most effective in treating panic disorder. Other types of counseling you might choose to seek include:2
- Self-help materials, such as instructional videos, books, and audio materials, that can help you learn to cope with panic disorder or anxiety.
- Support groups. Support groups are often good places to share information, problem-solving tips, and emotions related to panic disorder.
- Online discussion forums and Web sites.
Body-centered relaxation exercises can be useful for reducing anxiety and treating symptoms of stress. They include:
- Breathing exercises, such as roll breathing (a type of deep breathing).
- Progressive muscle relaxation, which reduces muscle tension by relaxing individual muscle groups.
- Massage, such as shoulder and neck massage.
- Aromatherapy, which uses the aroma-producing oils (essential oils) from plants to promote relaxation.
- Yoga, tai chi, and qi gong, forms of exercise and meditation. They generally require initial instruction.
Mindfulness activities help relax the mind and are often combined with body-centered relaxation exercises. These include:
- Autogenic training, which is used to return the body to a normal state after a stress response.
- Self-hypnosis, which can open the mind to suggestions that can relieve stress or change the way you respond to stressful situations.
- Meditation, where you focus your attention on the things that are happening right now in the present moment. One way to do this is by paying attention to your breathing. For information, see:
- Guided imagery (visualization), a method of using your imagination to help you relax and release tension caused by stress. Your body responds to the images in your mind. To try guided imagery, see:
- Music therapy, which can relax your body, improve your mood, and change the pace of your day.
- Humor therapy, which is becoming widely accepted as a tool for reducing stress and boosting the body's immune system.
Other Places To Get Help
|Anxiety Disorders Association of America (ADAA)|
|8730 Georgia Avenue|
|Silver Spring, MD 20910|
The Anxiety Disorders Association of America (ADAA) works to improve the lives of people who have anxiety disorders. Members of the association are not only people who have or are interested in anxiety disorders but also health professionals who do research and treat people who have anxiety disorders.
|Mental Health America|
|2000 North Beauregard Street, 6th Floor|
|Alexandria, VA 22311|
|Phone:||1-800-969-NMHA (1-800-969-6642) referral service for help with depression
Mental Health America (formerly known as the National Mental Health Association) is a nonprofit agency devoted to helping people of all ages live mentally healthier lives. Its Web site has information about mental health conditions. It also addresses issues such as grief, stress, bullying, and more. It includes a confidential depression screening test for anyone who would like to take it. The short test may help you decide whether your symptoms are related to depression.
|National Alliance on Mental Illness (NAMI)|
|Colonial Place Three|
|2107 Wilson Boulevard|
|Arlington, VA 22201-3042|
|Phone:||1-800-950-NAMI (1-800-950-6264) hotline for help with depression
The National Alliance on Mental Illness is a national self-help and family advocacy organization dedicated solely to improving the lives of people who have severe mental illnesses such as schizophrenia, bipolar disorder (manic depression), major depression, obsessive-compulsive disorder, and panic disorder. NAMI focuses on support, education, advocacy, and research. The mission of the organization is to "eradicate mental illness and improve the quality of life of those affected by these diseases."
|National Institute of Mental Health (NIMH)|
|6001 Executive Boulevard|
|Room 8184, MSC 9663|
|Bethesda, MD 20892-9663|
The National Institute of Mental Health (NIMH) provides information to help people better understand mental health, mental disorders, and behavioral problems. NIMH does not provide referrals to mental health professionals or treatment for mental health problems.
- American Psychiatric Association (1998). Practice guideline for the treatment of patients with panic disorder. American Journal of Psychiatry, 155(5 Suppl): 1–34.
- Gorman JM, et al. (2000). Neuroanatomical hypothesis of panic disorder, revised. American Journal of Psychiatry, 157(4): 493–505.
- American Psychiatric Association (2000). Anxiety disorders. In Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text rev., pp. 429–441. Washington, DC: American Psychiatric Association.
- MacKinnon DF, et al. (2002). Comorbid bipolar disorder and panic disorder in families with a high prevalence of bipolar disorder. American Journal of Psychiatry, 159(1): 30–35.
- Biederman J, et al. (2001). Patterns of psychopathology and dysfunction in high-risk children of parents with panic disorder and major depression. American Journal of Psychiatry, 158(1): 49–57.
- Merritt TC (2000). Recognition and acute management of patients with panic attacks in the emergency department. Emergency Medicine Clinics of North America, 18(2): 289–300.
- Hollander E, Simeon D (2008). Anxiety disorders. In RE Hales et al., eds., American Psychiatric Publishing Textbook of Clinical Psychiatry, 5th ed., pp. 505–529. Washington, DC: American Psychiatric Publishing.
- Kumar S, Oakley-Browne M (2007). Panic disorder, search date May 2006. Online version of BMJ Clinical Evidence. Available online: http://www.clinicalevidence.com.
- Smoller JW, et al. (2003). Prevalence and correlates of panic attacks in postmenopausal women: Results from an ancillary study to the Women’s Health Initiative. Archives of Internal Medicine, 163(17): 2041–2050.
- Nicholas LM, et al. (2004). Panic disorder. In JE Tintinalli et al., eds., Emergency Medicine: A Comprehensive Study Guide, 6th ed., pp. 1826–1830. New York: McGraw-Hill.
- Greist JH, Jefferson JW (2000). Anxiety disorders. In Review of General Psychiatry, 5th ed., pp. 284–300. New York: McGraw-Hill.
- Pollack MH, et al. (2003). WCA recommendations for the long-term treatment of panic disorder. CNS Spectrums, 8(Suppl 1): 17–30.
Other Works Consulted
- Barlow DH, et al. (2000). Cognitive-behavioral therapy, imipramine, or their combination for panic disorder. JAMA, 283(19): 2529–2536.
- Cahill SP, Foa EB (2005). Anxiety disorders: Cognitive-behavioral therapy section of Anxiety disorders. In BJ Sadock, VA Sadock, eds., Kaplan and Sadock's Comprehensive Textbook of Psychiatry, 8th ed., vol. 1, pp. 1788–1799. Philadelphia: Lippincott Williams and Wilkins.
- Campbell-Sills L, Stein MB (2006). Guideline Watch: Practice Guideline for the Treatment of Patients With Panic Disorder. Arlington, VA: American Psychological Association. Available online: http://www.psychiatryonline.com/pracGuide/loadGuidelinePdf.aspx?file=Panic.watch.
- Hayward C, et al. (2000). Predictors of panic attacks in adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 39(2): 207–214.
- Pace B, Glass RM (2000). Panic disorder. JAMA, 283(19): 2612.
- Pine DS, McClure EB (2005). Panic disorder and agoraphobia section of Anxiety disorders: Clinical features section of Anxiety disorders. In BJ Sadock, VA Sadock, eds., Kaplan and Sadock's Comprehensive Textbook of Psychiatry, 8th ed., vol. 1, pp. 1768–1771. Philadelphia: Lippincott Williams and Wilkins.
- Sadock BJ, et al. (2007). Panic disorder and agoraphobia. In Kaplan and Sadock's Synopsis of Psychiatry, Behavioral Sciences/Clinical Psychiatry, 10th ed., pp. 587-597. Philadelphia: Lippincott Williams and Wilkins.
- Stein MB (2005). Anxiety disorders: Somatic treatment. In BJ Sadock, VA Sadock, eds., Kaplan and Sadock's Comprehensive Textbook of Psychiatry, 8th ed., vol. 1, pp. 1780–1788. Philadelphia: Lippincott Williams and Wilkins.
- Wulsin L, et al. (2002). A randomized, controlled trial of panic disorder treatment initiation in an emergency department chest pain center. Annals of Emergency Medicine, 39(2): 139–143.
|Editor||Susan Van Houten, RN, BSN, MBA|
|Associate Editor||Pat Truman, MATC|
|Primary Medical Reviewer||Kathleen Romito, MD - Family Medicine|
|Specialist Medical Reviewer||Lisa S. Weinstock, MD - Psychiatry|
|Last Updated||September 16, 2008|
Last Updated: September 16, 2008