“My heart suddenly races on the train and I can’t breathe.” “I’m too afraid of having an attack to leave the house.” “Every time it happens, I think I’m going to die.” If you have been experiencing episodes like these, they may be signs of panic disorder.
Panic disorder is a condition in which sudden, intense anxiety attacks occur repeatedly, and the fear of those attacks limits daily life. It is not “all in your head” — with appropriate treatment, improvement can be expected.
Keldsen Family Clinic is a family-friendly clinic offering both Psychosomatic Medicine and Internal Medicine, a 1-minute walk from ‘Oizumi Yubinkyoku’ bus stop, accessible by Seibu Bus from Oizumi-Gakuen Station. Open on weekends and holidays, we also offer Telemedicine. If taking that first step toward getting help feels a little intimidating, we are here to walk that path with you.
About Anxiety Disorders
Anxiety disorders are a group of conditions characterized by excessive anxiety or fear that persists over a long period of time and interferes with daily life. Common examples include panic disorder, generalized anxiety disorder, social anxiety disorder, and obsessive-compulsive disorder.
Among the anxiety disorders, panic disorder is notable for the sudden onset of its attacks, and the impact of these episodes can severely restrict daily activities. It is thought to arise from a state in which the brain’s circuits for processing anxiety and fear become hypersensitive — it is not something caused by willpower or attitude.
With appropriate treatment, symptom improvement can be expected for many individuals. Recognizing the signs early and receiving proper care is the most direct path to recovery.
A distinguishing feature of panic disorder is how anticipatory anxiety — the fear that “the next attack could happen at any time” — progressively narrows the range of daily activities. If everyday actions such as taking the train, commuting, or going out begin to feel burdensome, we recommend seeking help early.
What Is Panic Disorder?
Panic disorder is a condition characterized by three key features: panic attacks, anticipatory anxiety, and agoraphobia.
Panic attacks are sudden, intense episodes of anxiety that strike without warning. Symptoms such as palpitations, shortness of breath, dizziness, sweating, trembling, nausea, and chest pain may occur simultaneously. Although the attacks are accompanied by an overwhelming fear — such as “I’m going to die” or “I’m going to lose my mind” — they typically subside on their own within 10 to 30 minutes.
Anticipatory anxiety is a persistent state of dread about having another attack — “What if it happens again?” This anxiety continues even when no attack is occurring and can lead to ongoing tension and physical discomfort.
Agoraphobia involves avoiding places or situations where escape may be difficult or help may be unavailable if a panic attack occurs. Common examples include trains, buses, airplanes, hair salons, movie theaters, crowded places, and going out alone.
The 12-month prevalence of panic disorder in Japan is reported to be approximately 0.5%. Onset most commonly occurs in the early 20s, and the condition is reported to be approximately twice as common in women as in men. Because the physical symptoms — such as palpitations and shortness of breath — are so prominent, many people first visit an internist or cardiologist.
The symptoms of panic attacks can also resemble those of physical conditions such as hyperthyroidism, arrhythmia, hypoglycemia, and asthma. For this reason, when attacks recur, it is important to have a thorough physical evaluation as well.
At Keldsen Family Clinic, we offer both Psychosomatic Medicine and Internal Medicine under one roof, enabling smooth differential diagnosis between panic disorder and physical conditions.
Characteristics and Symptoms of Panic Disorder
The symptoms of panic disorder manifest in three areas: the attacks themselves, anxiety between attacks, and the impact on daily life.
Specific Symptom Examples
Symptoms of a Panic Attack
- Palpitations or increased heart rate
- Shortness of breath or hyperventilation
- Dizziness, lightheadedness, or faintness
- Sweating or trembling in the hands and feet
- Chest pain or tightness
- Nausea or abdominal discomfort
- An intense fear of “dying”
- A sensation of “losing one’s mind”
- Numbness or cold sensations in the hands and feet
- Derealization (feeling as though you are not yourself)
Symptoms of Anticipatory Anxiety
- Constantly worrying “What if I have another attack?”
- Repeatedly recalling the place where an attack occurred
- Experiencing strong anxiety before going out
- Constantly monitoring physical sensations
- Being unable to relax, even on days off
Impact on Daily Life (Agoraphobia)
- Being unable to ride trains, buses, or airplanes
- Avoiding hair salons, dental offices, or movie theaters
- Being unable to go to crowded places
- Being unable to go out alone
- Hesitating to travel or take trips
- Finding it difficult to go to work or school
Understanding that “while the attacks are frightening, they are not a life-threatening physical illness” can be an important first step toward recovery.
Treatment and Management of Panic Disorder
The standard treatment for panic disorder involves a combination of medication and cognitive behavioral therapy. When treatment is started early, remission (a state in which symptoms are nearly absent) can often be achieved within six months to one year.
1. Medication
The first-line treatment is an SSRI (selective serotonin reuptake inhibitor). SSRIs can help reduce the frequency and severity of attacks and alleviate anticipatory anxiety. Because it typically takes 2 to 6 weeks for the effects to become apparent, it is important to continue treatment patiently.
When initial anxiety is severe or when a rapid reduction in attack frequency is desired, anti-anxiety medications may be used as a supplementary measure. However, due to the risk of dependence, long-term continuous use is generally avoided, and short-term use is the norm.
Discontinuing medication on your own can lead to a recurrence of attacks, so any dose reduction or discontinuation should always be discussed with your doctor.
2. Psychosocial Support
- Cognitive behavioral therapy (CBT): A method for gradually re-examining fear of the attacks themselves and patterns of avoidance behavior. This may include exposure therapy — a process of gradually becoming accustomed to feared situations.
- Supportive psychotherapy: A therapeutic relationship in which patients can talk about their situation and have their feelings acknowledged, helping to organize their anxiety.
- Relaxation techniques: Methods for relieving physical tension, such as breathing exercises and progressive muscle relaxation.
At Keldsen Family Clinic, we listen carefully during each consultation and, when appropriate, suggest a psychotherapy approach tailored to your needs.
3. Strategies for Work and School
- Consider commuting or school routes that minimize stress
- Identify a place where you can temporarily step away if an attack occurs
- Share your situation with a trusted supervisor, colleague, or teacher
- When necessary, consider taking a leave of absence or requesting a change in duties
A medical certificate can serve as an important tool for communicating your situation to your workplace or school.
4. Strategies for Home
- During an attack, stay calm and offer quiet reassurance: “It’s okay, you’re safe”
- Avoid dismissing the attack or blaming the person
- Offer to accompany the person on outings to help reduce their burden
- Family members should also find someone they can talk to about their own feelings
5. Self-Care for Daily Life
- Breathing exercises: Slow exhalation can help regulate the autonomic nervous system
- Exercise: Light aerobic activities such as walking can be effective in reducing anxiety
- Sleep: Maintain a consistent sleep schedule and ensure adequate rest
- Limit caffeine and alcohol: These can worsen palpitations and anxiety
- Attack diary: Recording the circumstances, timing, and details of attacks can be helpful during consultations
Panic disorder is a condition from which recovery can be expected with treatment. Rather than struggling alone, please feel free to reach out to Keldsen Family Clinic. We are a 1-minute walk from ‘Oizumi Yubinkyoku’ bus stop, accessible by Seibu Bus from Oizumi-Gakuen Station, open on weekends and holidays, and offer Telemedicine.