Panic attacks can be extremely frightening and debilitating events. During a panic attack, a person experiences an overwhelming sense of fear and anxiety that can include physical symptoms like a racing heartbeat, hyperventilation, dizziness, and trembling. These attacks often strike suddenly and without warning, leaving the sufferer feeling helpless and terrified. While many people experience isolated panic attacks at some point, recurrent and untreated panic attacks can develop into a more serious anxiety disorder called panic disorder. Panic disorder affects around 2-3% of adults at some point in their lives. The good news is that panic disorder is highly treatable, especially when addressed early. But what happens if panic attacks are allowed to continue untreated?
More Frequent and Severe Attacks
If left untreated, panic attacks tend to increase in both frequency and severity over time. The first panic attack often strikes “out of the blue,” catching the person completely off guard. After the initial attack, it’s common to experience more panic attacks in situations or places that remind the person of that first attack. For example, if the first attack happened in a crowded area, future attacks may repeatedly happen in crowded or public spaces. This process can create an escalating cycle of fear about having more attacks, followed by increased anxiety and tension that actually triggers more attacks.
Why Attacks Get Worse
There are several reasons why panic attacks tend to worsen when untreated:
- Fear of having another attack can heighten anxiety and stress, which are triggers for panic attacks.
- Hypervigilance about physical symptoms and irrational fear of what they might mean (like a racing heart) can increase panic.
- Avoiding situations, places, activities, or even memories associated with panic makes the fear worse over time.
- Loss of confidence and perceived control over panic creates a sense of helplessness.
All of these factors can interact to create a vicious cycle where fear of panic leads to more panic. Left untreated, panic attacks often increase in frequency, such as from once a month to once a week or even daily. Severity can also increase, from attacks lasting a few minutes to persisting for an hour or more.
Development of Panic Disorder
If panic attacks become frequent and disabling enough, the person may be diagnosed with panic disorder. This disorder is characterized by recurrent, unexpected panic attacks along with persistent worry or anxiety about having more attacks. People with panic disorder often experience significant anxiety and fear between attacks as well, worrying when the next one will strike. Other common symptoms of panic disorder include:
- Avoiding places, situations, or activities where panic attacks have happened before.
- Distress when confronted with physical sensations or feelings associated with panic.
- Major, negative impacts on daily functioning and quality of life.
Around 1 in 3 people with recurring panic attacks will eventually develop panic disorder if untreated. The actual risk depends on many factors like genetics, temperament, and life stress. But in general, the more frequent and intense the attacks, the more likely the development of panic disorder.
Diagnosing Panic Disorder
Panic disorder is diagnosed when a person experiences:
- Recurrent, unexpected panic attacks.
- At least one month of persistent worry or anxiety about having more attacks.
- Significant behavior change related to the attacks like avoidance of certain places and situations.
- Impairment or distress due to the attacks.
These symptoms cannot be better explained by another mental health disorder. Seeking an accurate diagnosis from a mental health professional is important for effective treatment.
Agoraphobia
For around one-third of people with panic disorder, the condition progresses to agoraphobia when left untreated. Agoraphobia is an intense fear and avoidance of situations where escape might be difficult or help unavailable if a panic attack occurs. Common agoraphobic situations include:
- Being alone outside of the home
- Traveling in cars, planes, or public transportation
- Standing in line or crowded spaces
- Being in enclosed spaces like stores, theaters, or bridges
People with agoraphobia often arrange their lives to avoid these situations and may be completely homebound in severe cases. Without treatment, agoraphobia can severely restrict daily activities and quality of life.
When Panic Disorder Progresses
Panic disorder may progress to agoraphobia when:
- Panic attacks have been recurring and untreated for an extended period.
- Attacks begin happening frequently outside of the person’s home, like in public, crowded places.
- The person starts avoiding more and more situations for fear of panic attacks.
This avoidance behavior rewards the anxiety short-term by preventing attacks. But long-term it reinforces the fear and makes agoraphobic avoidance worse. Getting treatment early for panic attacks can prevent this consequence.
General Anxiety
In addition to spontaneous panic attacks, untreated panic attacks often create an ongoing background sense of anxiety, nervousness, tension, and hypervigilance toward possible attack cues. People may feel “on edge” much of the time, tense, irritable, and always alert for signs of impending panic.
This chronic anxiety tends to drain mental energy and make it difficult to relax and feel calm. General anxiety levels may gradually increase over time as panic attacks become more frequent and less predictable.
Effects of General Anxiety
Higher general anxiety due to untreated panic attacks can cause:
- Fatigue from constant tension and stress.
- Trouble fully relaxing or sleeping well.
- Difficulty concentrating.
- A feeling of being “on edge” frequently.
Anxiety may also contribute to stress-related health issues like headaches, muscle pain, irritable bowel problems, and high blood pressure down the line.
Depression
Another potential consequence of uncontrolled panic attacks is developing depression. The extreme fear, restriction on life activities, lost opportunities, and reduced quality of life due to panic can understandably lead to feelings of sadness, helplessness, and hopelessness in some people.
Estimates suggest around half of people with panic disorder also suffer from clinical depression. The social isolation resulting from agoraphobia also contributes to depression risk.
Some key signs that panic attacks may be progressing to depression include:
- Loss of interest in normal activities.
- Loss of motivation.
- Fatigue and lack of energy.
- Sleep and appetite changes.
- Feelings of worthlessness or guilt.
- Trouble concentrating or thinking clearly.
- Thoughts of death or suicide.
Getting a professional assessment is important, as untreated depression can worsen panic symptoms. The two conditions may require concurrent treatment.
Depression Ups Panic Severity
Research indicates that having both depression and panic attacks can worsen outcomes. Effects of concurrent depression may include:
- More severe and debilitating panic attacks.
- Increased phobias and avoidance behaviors.
- Higher risk of alcohol or drug abuse as a coping mechanism.
- Greater likelihood of suicidal behaviors.
- Poorer functioning and quality of life.
Treating depression may improve panic symptoms and overall treatment success.
Increased Self-Medication
Experiencing severe, repeated panic attacks often drives people to attempt controlling or escaping the symptoms in unhealthy ways. These negative coping methods provide short-term relief but worsen the problem over the long-term.
Common unhealthy coping behaviors include:
- Alcohol or drug abuse – Many people abuse alcohol or drugs like sedatives to try to numb, reduce anxiety, and prevent or escape from panic attacks.
- Safety behaviors – This involves rigid rituals or escapes meant to ensure safety, like keeping “safety items” or a loved one nearby, sitting near exits, etc. Safety behaviors reinforce panic.
- Anger and conflict – Panic sufferers may unintentionally take out their suffering on loved ones.
- Avoidance – Avoiding treatment, social activities, and facing fears maintains anxiety.
Using these maladaptive coping methods tends to increase reliance on the “quick fix” they provide and worsens long-term functioning. Getting effective professional treatment is a much healthier option.
When Self-Medication Becomes Addiction
Without treatment, using substances or negative behaviors to control panic may lead to:
- Increased alcohol/drug abuse and addiction.
- Worsening anxiety from withdrawal between uses.
- Damage to health and relationships.
- Inability to cope without the unhealthy strategy.
Addiction represents an extreme loss of healthy control and coping abilities, requiring intensive treatment to reverse.
Overall Lower Quality of Life
The combined effects of more severe and frequent panic attacks, increased anxiety between episodes, phobias, depression, and unhealthy coping behaviors contribute to a drastically lowered quality of life when panic goes untreated.
Some major ways untreated panic attacks reduce quality of life include:
- Reduced social and family life – Isolation and loneliness increase.
- Declining mental health – Effects accumulate like anxiety, depression, and addiction.
- Impaired work or academic functioning – Concentration suffers and absence increases.
- Lost independence – Can no longer take public transit, travel, do daily tasks alone.
- Increased stress – Constant anxiety, fear, tension, and sadness take their toll.
- Poor physical health – Lack of activity and stress effects increase risks.
Over time, untreated panic attacks can make it very difficult to maintain normal life activities, happiness, and functioning. Prioritizing getting professional help is key to averting this and regaining quality of life.
Getting Effective Professional Treatment
The good news is that with proper, evidence-based treatment from a mental health professional, most people with panic attacks and panic disorder can achieve full recovery. Early intervention delivers the best results, preventing escalation and long-term consequences.
There are two main effective treatment approaches for panic attacks – psychotherapy and medications. A combination approach is often ideal.
Proven-Effective Psychotherapy
Cognitive behavioral therapy (CBT) is the frontline psychotherapy treatment for panic. CBT helps patients:
- Recognize panic attack triggers and patterns.
- Identify and modify fearful thoughts.
- Develop skills to prevent and better cope with attacks.
- Face feared situations in a gradual, controlled way.
Numerous studies support CBT’s effectiveness in reducing panic attack frequency, severity, anxiety levels, and phobic avoidance while improving functioning. With a trained CBT therapist, the vast majority of panic disorder patients see long-term improvement.
Medication Options
Antidepressant and anti-anxiety medications are also commonly prescribed for panic attacks when needed. Options may include:
- Selective serotonin reuptake inhibitors (SSRIs) like sertraline, paroxetine, fluoxetine
- Serotonin-norepinephrine reuptake inhibitors (SNRIs) like venlafaxine, duloxetine.
- Tricyclic antidepressants like imipramine, clomipramine
- Benzodiazepines like clonazepam, lorazepam, alprazolam
These medications reduce panic symptoms like fear, anxiety, heart racing, shaking, and depersonalization. SSRIs and SNRIs take several weeks to achieve full effect, but have fewer side effects than benzodiazepines and are not habit-forming.
Some patients benefit from starting medication when beginning psychotherapy to quickly help control severe symptoms. The medication can be discontinued later on for many patients once CBT takes effect. This combined approach optimizes treatment.
Outlook Is Good with Proper Treatment
Though debilitating, panic attacks and panic disorder respond very well to psychotherapy and medication interventions. Make seeing a mental health professional the priority when experiencing distressing or disabling panic attacks. The sooner treatment begins, the faster improvement happens and negative long-term consequences can be prevented.
With professional help, the vast majority of those suffering from panic attacks will decrease their frequency and severity substantially or eliminate them completely within 12-16 weeks. This allows normal life functioning and quality of life to be restored.
Ongoing Self-Help Strategies
In addition to professional treatment, these self-help strategies can help manage panic:
- Learn calming techniques like deep breathing, muscle relaxation, and meditation.
- Cut back on caffeine.
- Improve sleep quality through sleep hygiene habits.
- Stay active and exercise regularly.
- Reduce alcohol intake.
- Seek support from loved ones.
- Keep a journal to identify attack triggers.
Implementing positive lifestyle changes and self-care can assist in overcoming panic attacks when combined with professional treatment. The outlook for controlling this condition is excellent.
Conclusion
Panic attacks that continue uncontrolled can progress in frequency and severity and lead to complications like panic disorder, agoraphobia, depression, and reduced quality of life. The good news is that cognitive behavioral therapy and medications are extremely effective for the vast majority of those suffering from panic attacks when accessed early. With proper treatment, normal functioning can be restored and the risk of complications reduced. Seeking help swiftly is key to preventing worsening of panic symptoms, so meet with a mental health professional if recurring panic attacks are interfering with your life. Consistently implementing what you learn through therapy, along with positive lifestyle changes, offers the best chance for overcoming panic and enjoying life to the fullest again.
