The Facts

Panic disorder is a type of anxiety disorder. People with this condition may become anxious to the extent that their feelings interfere with daily life. While most people have experienced a panic attack brought on by particular events or situations, the attacks in panic disorder often develop suddenly and for no apparent reason.

Panic disorder affects up to 3.7% of Canadians, and is twice as likely in women as in men. The disorder can appear at any age, but it most commonly appears in young adults.

The risk of developing a panic disorder is increased if there is a family history of panic attacks or disorders, a history of abuse, the experience of a traumatic event, the experience of high levels of stress, and the need to adapt to significant changes in your life.


The exact cause of panic disorder is not entirely understood. However, researchers believe that panic disorder may be due to chemical imbalances in the brain. Panic disorder also tends to run in families, so there is likely a strong genetic connection. For example, for a person with a close relative who suffers from panic disorder, there is a 10 – 20% increased risk of having panic disorder. Excessive stress and trauma may also be linked to the development of panic disorder.

Panic disorder may also be caused by certain medical conditions, such as an overactive thyroid (i.e.,hyperthyroidism) and certain heart problems.

Things that may trigger a panic attack include:

  • drinking large amounts of alcohol
  • drinking excessive amounts of caffeine (e.g., coffee, tea, colas)
  • taking stimulants or cocaine
  • taking or suddenly stopping taking certain prescription medications

Symptoms and Complications

Panic attacks occur with the sudden appearance or occurrence of at least four of the following symptoms:

  • chest pain or discomfort
  • choking
  • dizziness, or feeling faint or unsteady
  • fear of dying
  • fear of losing control
  • feelings of not being part of your environment
  • flushing or chills
  • nausea, stomach ache, or diarrhea
  • numbness or tingling
  • racing heart
  • sweating
  • trembling or shaking
  • trouble breathing

Panic attacks do not usually last longer than 10 minutes. However, since the symptoms affect the lungs, heart, and other important organs, a person might worry that they are having a serious medical problem that requires emergency medical treatment. However, the panic attack is usually over by the time the doctor sees the person who has had the attack.

Since panic attacks are unpredictable, a person often worries about having another attack. If a person starts to avoid the places where they had previous panic attacks, they may develop a condition called agoraphobia. While agoraphobia may occur at any time during the course of panic disorder, it is most common within the first year – nearly one-third of people with panic disorder experience agoraphobia in the first year of the disorder. In Canada, between 0.5 to 1% of people are affected by agoraphobia. This type of anxiety disorder causes a person to avoid many places (including places with many people) and may lead them to become housebound.

Making the Diagnosis

Your doctor will diagnose panic disorder based on symptoms, family history, and a physical examination. Your doctor will also rule out any other medical causes before making the diagnosis.

Treatment and Prevention

The treatment of panic disorder usually involves a combination of medications and behavioural or cognitive therapy. Combination therapy (i.e., medications and psychotherapy) has been associated with lower rates of relapse of panic disorder. The goals of treatment are to reduce the number and frequency of panic attacks and improve your quality of life.

The most commonly used medications for treating panic disorder include:

  • selective serotonin re-uptake inhibitors (SSRIs) such as paroxetine*
  • serotonin norepinephrine re-uptake inhibitors (SNRIs) such as venlafaxine
  • tricyclic antidepressants (TCAs) such as imipramine
  • monoamine oxidase inhibitors (MAOIs) such as phenelzine
  • anti-anxiety medications, including benzodiazepines such as lorazepam

The duration of treatment for any of these medications depends on the severity and duration of the illness, intensity of the symptoms, associated conditions, and any medical or psychosocial factors.

Your doctor may also recommend behavioural therapy such as exposure or relaxation therapy to help reduce fear and anxiety. In exposure therapy, you are slowly exposed to the same situation that triggers panic attacks until fear and anxiety are reduced to a tolerable level or are eliminated. In relaxation therapy, you are provided with techniques to help you relax in situations that have previously caused panic attacks.

Cognitive therapy (psychotherapy) may also be recommended. Cognitive therapy attempts to change your thought patterns by helping you analyze your reactions to panic attack triggers.

*All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol®). The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For information on a given medication, check our Drug Information database. For more information on brand names, speak with your doctor or pharmacist.