Panic Attacks

Panic attacks are intense, discrete episodes of fear or discomfort that peak within minutes. A single panic attack does not constitute a disorder. Panic Disorder is distinguished by recurrent, unexpected attacks followed by persistent concern about future attacks (anticipatory anxiety) and maladaptive changes in behavior (avoidance).

Diagnosis examines the attack patterns: whether they are unexpected or situationally bound, frequency, duration, and behavioral changes following an attack. A critical step is ruling out medical causes such as cardiac arrhythmias, hyperthyroidism, hypoglycemia, or stimulant use.

Cognitive Behavioral Therapy (CBT) addresses catastrophic misinterpretation of bodily sensations and avoidance behavior. Psychoeducation is foundational. Interoceptive exposure involves deliberately inducing feared physical sensations to desensitize the fear response, and in vivo exposure targets avoided places.

SSRIs are the first-line pharmacological treatment, alongside SNRIs like venlafaxine. Clinicians often start at lower-than-usual doses because people with panic disorder can be sensitive to initial activation. Benzodiazepines are generally not recommended as standalone or first-line long-term therapy due to risks of tolerance and rebound panic.