Overview of panic disorder

Panic disorder affects 2 to 3% of the population and is 3 times more common in females than males. It is characterised by recurrent panic attacks, in which the onset of the attack is not associated with a trigger (ie occur spontaneously), and not caused by a substance, drug, medical condition or another psychiatric disorder (eg depression, bipolar disorder).

Associated symptoms of panic disorder include:

• anticipatory anxiety (ie persistent concern about having a panic attack)
• elevated levels of generalised anxiety or tension
• somatic preoccupation
• phobic avoidance (agoraphobia occurs in 80% of patients; social phobia occurs in 10% of patients).

The presentation in children is similar to that in adults and young people.

For information on diagnosing and differentiating anxiety disorders, see Overview of anxiety disorders.

Use psychosocial interventions as first-line treatment for panic disorder. If psychosocial interventions are not available, not effective or not preferred, consider pharmacotherapy—see here for adults and young people, and here for children. Pharmacotherapy is usually only used for children with severe symptoms.

When evaluating treatment options for a young person, also consider:

• there are few data on psychotropic use in young people because young people are poorly represented in clinical trials
• young people are more susceptible to developing activation and suicidal thoughts when starting treatment with an antidepressant; this effect has been most often observed with selective serotonin reuptake inhibitors (SSRIs)
• if pharmacotherapy is used, it should ideally be started by a clinician with expertise in using psychotropics in young people.

For treatment considerations for females of childbearing potential, including advice on contraception, preconception planning and psychotropic use, see here.

Physical symptoms of pregnancy (eg tachycardia, sweating, dizziness, shortness of breath) can mimic or precipitate a panic attack. Pregnant females are more likely to experience panic disorder than those who are not pregnant; onset tends to be in the first and second trimesters. Individuals with panic disorder may avoid antenatal appointments because they fear having panic attacks during travel to or attendance at appointments. Poorer antenatal care attendance increases the risk of poor obstetric outcomes. For additional considerations in managing anxiety disorders in the perinatal period, see here or for considerations in partners, see here.