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Elevating Psychiatric care What We Treat

Panic Disorder

Panic disorder is an anxiety disorder characterized by unexpected and repeated episodes of intense fear accompanied by physical symptoms like heart palpitations, chest pain, shortness of breath or dizziness or abdominal distress (panic attacks). These attacks occur “out of the blue”, not in conjunction with a known fear or stressor.

A panic attack can be frightening because symptoms can mimic a heart attack or other life-threatening condition and often send victims to the ER. Also, many people with panic disorder suffer with intense anxiety between panic attacks worrying about if or when it may happen again. Agoraphobia, irrational fear of places or situations that might cause a panic attack, often develops after one or more panic attacks.

1% to 5% of U.S. adults experience panic disorder at some time in their lives. Age of onset is 25 and is more common in women. 1% – 3% of adolescents suffer with panic disorder peaking between 15 and 19 years of age and is more common in girls. It has a serious impact on their social and academic function and general wellbeing. A near majority of people with a panic disorder have serious impairment. About 70% of people with a panic attack initially seek help from their primary care doctor or the emergency room.

A panic attack is a discrete period of fear and anxiety that comes on rapidly, reaches a peak within 10 minutes during which at least four of the symptoms listed below are experienced. While the attack lasts just 10 minutes the aftermath can last for hours.

The symptoms of a panic attack are:

  • a racing heart
  • chest pain or discomfort
  • sweating
  • shaking
  • dizziness or faintness
  • Chills or hot flashes
  • numbness or tingling
  • stomach churning or nausea
  • breathlessness
  • fearful thoughts
  • fear of losing control, going mad or dying
  • derealization – feeling detached from your body

The cause is unknown but may be related to sensitivity in responding to fear. There is also a link between panic attacks and phobias. Panic attacks run in the family. People with panic attacks often have difficulty dealing with negative emotions or have high levels of stress.

Triggers may be major life events such as the death of a person close to you, the birth of a baby, separation from family and a serious illness or accident.

Historical symptoms include:

  • a history of abrupt, incapacitating panic attacks
  • a propensity to avoid places, people and things associated with previous attacks and traumatic events
  • unceasing fear of a panic attack.

Co-occurring conditions may include:

  • Mitral valve prolapse which can trigger attacks
  • Irritable bowel syndrome characterized by cramps and constipation or diarrhea
  • Some unexplained medical problems like chest pain or chronic fatigue
  • Depression
  • Substance abuse
  • Agoraphobia
  • Obsessive Compulsive Disorder
  • Suicidal thoughts

Dr. Poulakos will want to assure that the cause is not physical so may refer you to your primary care doctor or he may have received a referral from them. He will review your medical history and ask about other medical conditions that can cause panic attacks. He will review you family history and ask about your symptoms, when and how often you experience them, what provokes them and how they affect your ability to perform daily activities and enjoy life. He will ask about persistent worries (rumination), behavioral changes due in response to the attacks, substance use (including nicotine caffeine, Alcohol, etc.) and rule out other mental health conditions.

The goal of treatment is to prevent further attacks, anticipatory anxiety, agoraphobia, and achieving full remission. The treatment of panic disorder includes a combination of medication and psychotherapy.

Antidepressants, primarily SSRIs as first line treatment, but are not always effective so other medications like Benzodiazepines (sedatives) may also be tried and may also be used to abort an attack. Cognitive behavioral therapy (CBT) is part of first line treatment. Additional treatments may include group therapy, relaxation, breath training and exposure therapy. With treatment the rate of remission is between 20% and 50%. However, 20% of patients may remain impaired and suffer panic disorder as a chronic, recurrent illness.

When you or a loved one seeks assistance and support for panic attacks, contact Dr. Poulakos at his New York City office to schedule a consultation where you will learn about the ways he can help you manage your symptoms and improve your quality of life.

Dr. Poulakos offers evidence-based, individualized treatment using medication and psychotherapy, and state-of-the-art therapies. When people are directly involved in creating their own treatment plan including wellness goals and support services, they experience improved outcomes. He is a caring and compassionate doctor who will work with you to find solutions that meet your unique needs.

At a Glance

Dr. Paul Poulakos

  • Attending Psychiatrist at Mount Sinai Beth Israel Medical Center
  • Assistant Professor of Psychiatry at the Icahn School of Medicine at Mount Sinai
  • Past Clinical Assistant Professor of NYU Langone Medical Center
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