Understanding Panic Disorder
Panic disorder is characterized by recurrent, unexpected panic attacks — sudden surges of intense fear peaking within minutes — accompanied by persistent concern about future attacks or significant behavioral changes (like avoidance). Panic attacks involve physical symptoms (racing heart, shortness of breath, chest pain, dizziness, tingling) so intense that many patients initially present to emergency rooms believing they are having a heart attack.
Signs & Symptoms
- Recurrent unexpected panic attacks
- Racing heart, palpitations, pounding heart
- Shortness of breath or choking sensation
- Chest pain or discomfort
- Dizziness, lightheadedness, or faintness
- Fear of losing control or "going crazy"
- Fear of dying
- Agoraphobia — avoidance of situations where escape might be difficult
How Dr. Agresti Treats This Condition
Panic disorder responds very well to treatment. Cognitive Behavioral Therapy (CBT) — particularly interoceptive exposure (learning that physical sensations are not dangerous) — is highly effective. SSRIs and SNRIs are first-line medications. Benzodiazepines can provide acute relief during high-frequency attacks but are not a long-term solution. Dr. Agresti's direct access means that acute panic episodes can be addressed quickly rather than waiting weeks for an appointment.
Medication Options
- SSRIs: Paxil (paroxetine), Zoloft (sertraline), Lexapro (escitalopram)
- SNRIs: Effexor XR (venlafaxine)
- Benzodiazepines: Klonopin (clonazepam), Xanax (alprazolam) — for acute use, used cautiously
- Beta-blockers for situational panic (presentations, flights)
The Concierge Advantage
With Dr. Agresti's concierge model, medication adjustments happen quickly when you need them — not at your next appointment weeks away. Text him directly if symptoms worsen. Get same-day refills. Reach him directly when you're having a difficult day. This level of access makes a meaningful difference in psychiatric treatment outcomes.
Frequently Asked Questions
Panic attacks are not physically dangerous, though they feel extremely threatening. The physical symptoms are real — triggered by the sympathetic nervous system — but they do not cause harm. Understanding this is part of CBT for panic disorder: learning that the sensations, however terrifying, are not signs of medical emergency.
Benzodiazepines (Xanax, Klonopin) provide rapid relief from panic attacks, but regular use can lead to dependence and may interfere with CBT by preventing the processing of fear. Dr. Agresti may prescribe them for short-term acute use while establishing longer-term treatment.
Many patients with panic disorder achieve lasting remission after a course of treatment — particularly those who also complete CBT. Medications can often be tapered after a period of stability. The goal is always to develop skills and achieve stability so that ongoing medication is optional, not mandatory.
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