Panic Disorder

Management and Resources

At home

Although people with panic disorder usually require treatment, there are some behavior changes individuals can try to provide some relief. These include tracking symptoms, deep breathing, meditation, movement, nutrition, and sleep.

Tracking symptoms

Panic attacks can feel like they come from nowhere and are hard to understand. Individuals with panic disorder can try tracking their symptoms to help them better understand how frequently, when, where, and how their panic attacks occur. One can begin by getting a journal or keeping a notepad by their bed. It can help to schedule a time during the day to reflect on one's panic symptoms and write down the relevant information. Individuals may start to find patterns or common triggers for their panic attacks. When they better understand their panic symptoms, they may find themselves feeling less threatened by these symptoms, and therefore, in a better place to manage them.

Deep breathing

Learning to control one's breathing can be extremely helpful during a panic attack. When having a panic attack, an individual may notice having a harder time breathing or that they just can’t catch their breath. Higher levels of anxiety can cause shallow breathing that often gives us less oxygen and requires us to breathe faster to get the oxygen our body needs. This is a common symptom of panic disorder and can make people feel uncomfortable and unwell.

When we breathe deep and through our diaphragm, specifically, we may feel calmer and more at ease. We call this technique deep breathing or diaphragmatic breathing. It is a simple technique that can be hard at first or uncomfortable, but with practicem, it can become second nature. Deep breathing is easier to learn when we practice the skill at times when anxiety is low. As an individual becomes more skilled and can deep breathe when calm, they will be able to use this skill even when they are feeling a panic attack coming on.

Meditation

The practice of meditation has been around for thousands of years. What was first a way for individuals to find spiritual connection is now widely used as a means of reducing stress and anxiety. Meditation, and specifically mindfulness meditation, involves setting aside time during one's day to focus on the present, and not their broad stream of thoughts. During this designated time, individuals try to keep their thoughts centered around this very moment: their sensations, an object, or a sound. When the thoughts stray, as they naturally do, meditation teaches people to acknowledge the distraction without judgement, and come back to the present. The repeated practice of meditation can be calming in the moment, but can also “build the muscle” that re-centers a person through life’s ups and downs, even when they're not meditating.

Movement

Research shows that 30 minutes of walking per day can decrease overall anxiety. The proven benefits of exercise are vast. Exercise is one of the most effective ways to manage stress and anxiety. Some people who experience panic attacks find exercise challenging at first because the feelings one can get while exercising may mimic a panic attack.

Individuals may start small by beginning a walking routine, taking the stairs, or doing gentle movement like yoga. These are just a few examples of low impact exercises that increase the heart rate safely, in turn releasing serotonin and other brain chemicals that reduce anxiety. The anti-anxiety effects of exercise are both immediate and long term. Movement and exercise can be a great complement to one's treatment plan and can even be social if bringing a friend along.

Nutrition

Serotonin is a brain chemical that is involved in anxiety. 95% of serotonin is produced in the stomach, which communicates information to the brain to influence emotion. Nourishing one's body with fruits, vegetables, nuts, eggs, grains, and legumes may help to reduce anxiety. Similarly important is the frequency at which one eats. Eating regular, well-balanced meals, helps to maintain a steady blood sugar, which can create a feeling of calm and may reduce panic symptoms.

Sleep

Individuals with panic disorder have intense periods of times where they feel like they are in overdrive, also known as the fight or flight response. This means that the body is always ready to escape danger, even if it may not actually exist. A full night of sleep, approximately 8 hours for most adults, helps the body control the fight or flight response associated with panic disorder. Creating a consistent and calming bedtime routine, avoiding blue light (that light from our phones and screens) one hour prior to bedtime, abstaining from daytime naps, and refraining from caffeine after noon all promote restful and continuous sleep.

At work and school

Panic disorder can affect people differently at work. Many people with panic disorder have found themselves at one point or another feeling unable to work, feeling unwell at work, or fear going to work. However, with treatment, most people with panic disorder feel more functional at work and if they do have panic attacks, they may only be a temporary challenge - at work.

When at work, it can be helpful for individuals with panic disorder to keep a few tips in mind:

Identifying a safe space: Many fear having a panic attack at work. People who have a plan on how they are going to manage their panic attacks usually feel some relief knowing they have a safe place to go to. Individuals may identify a location at their place of work that they could go to for 15 minutes to breathe, reset, and feel less overwhelmed (like a break room, bathroom, or sitting area). Knowing they have a place they can go in the event they do have a panic attack can make all the difference.
Identifying a coping plan: When in a state of panic, individuals may find themselves forgetting the things that help them cope. A reminder can make it much easier to cope. Writing down three things they can do to relax safely at the workplace like deep breathing, listening to music, talking to a supportive person, or meditating can be helpful to the individual with panic symptoms.
Starting the day right: Having a morning routine can help start the day right, and help prepare a person for work. Individuals with panic symptoms can try identifying what makes mornings easier start a new morning schedule out to see what works for them. Having the time to wake up, get ready, and take care of their needs may help individuals reduce stress and make them less vulnerable to panic attacks at work.
Giving oneself grace: If an individual does have panic attacks frequently at work and in front of others, they may try to remember that this is not their fault. They are not crazy or “going crazy.” With time and treatment, their symptoms will improve and their current struggles will become temporary.

Accommodations at work

Others may find that workplace accommodations are necessary. For example, Panic Disorder might make it hard to be one's best self at work. Individuals might be able to request accommodations such as working from home if applicable, or having a desk in a certain location. Under the Americans with Disabilities Act (ADA), certain individuals with Panic Disorder, but not all, may qualify for reasonable accommodations at work. Vital considerations involved with qualifying include (1) Their employer’s type of business and operations, (2) how panic disorder is affecting their ability to carry out essential job functions, and (3) whether or not an accommodation would cause their employer an undue hardship.

A note from a prescribing physician should serve as a record of panic disorder, however, not all employers are required by law to offer accommodations. Effectively acquiring workplace accommodations often requires collaborating with the employer’s HR department to institute a plan that satisfies all involved.

Accommodations at school

The Americans with Disabilities Act also applies to public higher education programs and many private higher education programs, in addition to public primary and secondary schools. For the purposes of this law, Panic Disorder is considered a disability when it causes limitations in one's ability to participate in education at the same level of other students that do not have Panic.

Students with disabilities are entitled to reasonable accommodations designed to help mitigate symptoms and increase their likelihood of academic success. Accommodations may include “time and a half” testing, a separate room for taking exams, or a designated spot in the front of the classroom, among others. Each school’s process of requesting accommodations may look different, so it can be helpful to speak with the school's administrator to understand their process and what documentation is required from the individual with panic disorder.

Keep in mind

People with Panic Disorder do not ever need to tell anyone at work or school about having the condition, nor do they need to keep it a secret. The amount they share is their choice, though some people find it useful to share this information with a manager or colleague to help others understand that their brain might operate a little bit differently.

In relationships

Panic disorder can have an impact on relationships in many ways. If one's partner or friend has never had a panic attack, it can be difficult for them to understand what the individual is going through. They may expect a person to be able to “just relax,” or “have faith” that things will work out in the moment, which can add to one's worry.

Even so, opening up about the experience of having panic disorder can help bridge the gap in understanding -- although, sharing one's challenges is not always easy. Some may feel like they are burdening others with their thoughts or anxieties, but this may not be the case. Sometimes being open during these struggles can fortify relationships.

For some people, taking antidepressants can impact their sex lives

If individuals experience low libido, erectile dysfunction, etc... There is hope: The first step to addressing this issue is to acknowledge it. But, sharing this type of sensitive information with one's partner or provider is not always easy.

A couple steps one might try include:

Trying a new routine with one’s partner such as exercising before sex, or incorporating new types of stimulation into the routine.
A provider may adjust an individual’s dose of medication to find a level which balances effectiveness with libido.
Some of the commonly known medications for erectile dysfunction (Viagra, Cialis, etc..) can be helpful to antidepressant induced sexual dysfunction in men.
If the examples above do not work in a particular instance, a different type of medication that has fewer sexual side effects might be the next step.

Anxiety can cause impaired self esteem, which can also pose a challenge for relationships. Individuals with panic or anxiety symptoms may find themselves needing reassurance or outside validation during these episodes. It can help them to keep in mind that anxiety can require tenderness in relationships.

During moments of intense worry, it can become impossible to think about anyone or anything else besides one's object of anxiety, and this can be difficult for a partner. It is important for both parties in the relationship to focus on treatment, and to remember that this self-focus is temporary. In most cases, the right combination of therapy and medication can bring a partner back to the person they once were.

In the family

Panic disorder has a genetic component, and it can look different within the family. In children, anxiety can manifest as fear, and develop into full blown panic disorder after adolescence. Parents who have struggled with their own anxiety can be vigilant of their children. Getting early treatment for them will eliminate years of their potential suffering. And, getting treatment for oneself will ensure that their worries aren’t projected onto family.

Additional resources on panic disorder

Organizations & resources

Anxiety and Depression Association of America

National Institute of Mental Health

Tools

Headspace app for guided meditation