Panic Disorder

Jay Winner, FAAFP, MD Reviewed 05/2023

BASICS

DESCRIPTION

A classic panic attack is characterized by rapid onset of a brief period of sympathetic nervous system hyperarousal accompanied by intense fear.
In panic disorder, multiple panic atta...

DIAGNOSIS

Panic attack: an abrupt surge of intense fear, reaching a peak within minutes in which ≥4 of the following symptoms develop abruptly: (i) palpitations, pounding heart, or accelerated heart r...

TREATMENT

Combined antidepressant therapy and psychotherapy is superior to either alone during initial treatment for panic disorder (2)[A]. Most effective therapy includes cognitive-behavioral therap...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Full therapeutic effect of antidepressants often does not occur until 4-6 weeks. Monitor (usually within 1-2 weeks) for suicidal ideation when starting antidepres...

REFERENCES

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders . 5th ed. Arlington, VA: Amer...

ADDITIONAL READING

DeGeorge KC, Grover M, Streeter GS. Generalized anxiety disorder and panic disorder in adults. Am Fam Physician. 2022;1606(2):157-164.

CODES

ICD10

F41.0 Panic disorder [episodic paroxysmal anxiety]

SNOMED

371631005 Panic disorder
35607004 Panic disorder with agoraphobia
56576003 Panic disorder without agoraphobia
417676004 O/E - panic atta...

CLINICAL PEARLS

First line pharmacological treatment is usually an SSRI or SNRI; patient education is also important and counseling, particularly CBT, is often helpful. Consider assessing suicidality ...

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