Panic Disorder
During peri- and post-menopause, an increased level of anxiety and higher numbers of panic attacks are commonly reported. When a woman experiences an overwhelming feeling of panic or the inability to think clearly and process her circumstances, she may be experiencing symptoms of panic disorder. Panic attacks are often accompanied by physical symptoms such as hyperventilating, shortness of breath, a racing heart, and sudden sweating or a clammy feeling. Women with a previous history of panic attacks may experience the continuation of their condition during menopause, and new-onset panic disorder is also possible and common.
Among women 45 – 54 years old, 23% have reported panic attacks
During menopause, there is often an overlap of symptoms and diagnoses. Panic attacks are closely associated with anxiety and other mood-based disorders. It is possible for psychosomatic symptoms to start suddenly and they may increase or recede without obvious cause. As these types of symptoms are sometimes privately felt and not discussed, a woman may feel confused or disoriented as her emotions and circumstantial responses shift unpredictably.
If you are experiencing times of acute panic, if you are feeling “frozen” in social circumstances, or have feelings of an inability to cope or respond, you may be suffering from clinical levels of panic. It is important to receive an accurate diagnosis, as it is possible that your sensations are related to other mood-based disorders, such as clinical anxiety, social phobia, or depression. Take comfort in the fact that your symptoms are likely temporary in nature and related to your menopausal transition. Effective treatment options are available once an accurate diagnosis has been determined.
Why is this happening?
The endocrine system changes during menopause, as the biological processes controlling hormone releasing glands are altered by fluctuating hormone levels. The interrelationship of the endocrine system with a woman’s nervous system (her hypothalamic-pituitary system) is how physiological wellness is maintained. During menopause, hormone changes mean that symptoms of physiological imbalance can manifest. Imbalances in hormones and their regulatory functions stem from estrogen, progesterone, and serotonin levels.
Progesterone and GABA levels affected by menopause may interfere with neurotransmissions, resulting in mood-based dysfunctions. During peri-menopause, progesterone levels are declining and can lead to changes in a woman’s sense of emotional stability. When progesterone is metabolized, it produces GABA (a receptor agonist called Gamma-Aminobutyric acid) in order to regulate emotions, moods, and sleep. During times of lowered progesterone and GABA, anxiety, depression, and sleep disorders may increase.
Among women 45 – 54 years old, 23% reported panic attacks within the previous six-month period. In a survey of post-menopausal women, panic attacks were reported to be most commonly experienced during the menopausal transition years (peri-menopause, as opposed to pre- or post-menopause). In addition, panic attacks most often occur in association with negative life experiences, cognitive impairment, or the presence of another medical condition at the same time. A small clinical study indicated that 18% of women aged 40 - 60 exhibited significantly high levels of measurable panic disorder related indicators.
If your feelings of panic are interfering with your daily life, your job, your relationships, or are causing you to self-medicate through use of alcohol and other substances, it is important to consult with a medical professional. Diagnosis and treatment are available and the symptoms you are experiencing are common.
Other impacted areas
Other menopausal symptoms that are often inter-related with panic disorder are:
- Mood swings
- Anxiety
- Depression
- Irritability
- Fatigue
- Sleep disturbance
- “Brain fog” & difficulty concentrating
- Decreased libido
Diagnosis
Although specific testing for panic disorder is not available, self-reported symptoms can be analyzed by medical professionals. Standardized diagnostic tools, based on the DSM-V (Diagnostic and Statistical Manual of Mental Disorders), are used to determine if and what type of treatment is necessary.
Possible triggers or risk factors
Triggers for panic attacks can include:
- Negative life circumstances
- Stress
- Fatigue or cognitive impairment
- High levels of anxiety
- Excessive rumination or worry
- Feelings of hopelessness or uncertainty
Want to speak with a Menopause doctor?
Treatments & remedies
In addition to the supplement and pharmaceutical alternatives described below, other forms of therapy have excellent efficacy rates, either in isolation or combination. Cognitive Behavior Therapy (CBT) and forms of counseling, intentional reductions of stress points, and proactive engagement in self-care activities should be considered as additional treatment options.
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Nutrition
Maintaining a healthy diet and weight is essential for optimal health at every stage of life.
- If possible reduce intake of over-processed foods, concentrating on a high-fibre diet with significant vitamin, mineral, Omega-3 fats, and probiotic components.
- Alcohol, drugs, and smoking should be reduced or eliminated.
- There is a strong positive correlation between a plant-based Mediterranean diet and a lower risk of mood-based disorders such as anxiety and depression. A Mediterranean diet focuses on whole grains, fruits, vegetables, seafood, beans, and nuts. It avoids processed meat, pre-packaged meals with high sodium levels, refined grains, butter, and hydrogenated oil.
Exercise
Exercise is essential for proper physical and mental wellbeing. Studies show the positive relationship between an active lifestyle and the ability to regulate moods and emotions. Acute panic attacks are our body’s response to stress, danger, over-tiredness, or anxiety, and these negative symptoms can be reduced by mild to moderate aerobic activity.
A 10-minute walk has been shown to be effective in reducing a woman’s self-reported level of anxiety for several hours. Active people report lower levels of anxiety than sedentary individuals, and researchers found that women who get regular, aerobic exercise are 25% less likely to develop symptoms related to heightened anxiety.
Mindset
The ability to avoid highly stressful or panic-initiating circumstances is often related to mental wellness. There are many therapy alternatives available to you regarding lifestyle decisions, including:
- Counseling and psychological support
- Discussing your symptoms with trusted professionals and your support base
- Focusing on daily stress reductions
- Employing self-awareness techniques such as daily journaling
- Maintaining positive and frequent social contact
Supplements
- Preliminary studies suggest that chamomile extract might be helpful in managing generalized anxiety disorder including panic attacks, but as the clinical evidence is limited a conclusive answer to its efficacy cannot be given.
- A recent study (2020) looking at the effectiveness of Melatonin as a possible alternative to conventional anxiety-reducing drugs had promising short-term results, but the long-term effects are unclear.
- Passionflower and valerian have been used to treat anxiety and panic disorders but have insufficient clinical research to support the claimed efficacy.
- Even though some women have reported positive benefits from taking additional supplements of Vitamin B in order to reduce stress levels, there is no clinical proof tying increased levels of Vitamin B to reductions in anxiety and panic attacks.
OTC Products
There are no effective over-the-counter pharmaceutical products available for the treatment of panic disorder.
Prescription
Antidepressants are commonly prescribed for clinical depression and anxiety, and it is important to discuss treatment options with your doctor. Your healthcare provider will indicate whether antidepressants should be considered given the extent of your symptoms.
Hormone Treatment
The medical community is ambivalent regarding the effectiveness of HRT for menopausal panic and anxiety disorders. Research indicates mixed and conflicting results. Generally, there are less invasive forms of stress management that should be considered in order to reduce the likelihood of overwhelming emotions.
Holistic Treatment
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FAQ
What are the symptoms of Menopause?
There are roughly 34 symptoms of Menopause with the most commonly experienced being:
- Irregular periods
- Vaginal dryness
- Hot flashes
- Night sweats
- Fatigue
- Sleep problems
- Mood changes and irritability
- Weight gain
- Thinning hair and dry skin
Medically reviewed and detailed symptom fact sheets can be found here, and a general overview of what (peri) menopause is and entails can be found here.
References
Akhondzadeh S, Naghavi HR, Vazirian M, Shayeganpour A, Rashidi H, Khani M. Passionflower in the treatment of generalized anxiety: a pilot double-blind randomized controlled trial with oxazepam. J Clin Pharm Ther. 2001 Oct;26(5):363-7. doi: 10.1046/j.1365-2710.2001.00367.x. PMID: 11679026.
Freeman EW. Depression in the menopause transition: risks in the changing hormone milieu as observed in the general population. Womens Midlife Health. 2015 Aug 11;1:2. doi: 10.1186/s40695-015-0002-y. PMID: 30766689; PMCID: PMC6214217.
Joffe H, de Wit A, Coborn J, Crawford S, Freeman M, Wiley A, Athappilly G, Kim S, Sullivan KA, Cohen LS, Hall JE. Impact of Estradiol Variability and Progesterone on Mood in Perimenopausal Women With Depressive Symptoms. J Clin Endocrinol Metab. 2020 Mar 1;105(3):e642–50. doi: 10.1210/clinem/dgz181. PMID: 31693131; PMCID: PMC7075107.
Kai Y, Nagamatsu T, Kitabatake Y, Sensui H. Effects of stretching on menopausal and depressive symptoms in middle-aged women: a randomized controlled trial. Menopause. 2016;23(8):827-832. doi:10.1097/GME.0000000000000651
Maki PM, Kornstein SG, Joffe H, Bromberger JT, Freeman EW, Athappilly G, Bobo WV, Rubin LH, Koleva HK, Cohen LS, Soares CN; Board of Trustees for The North American Menopause Society (NAMS) and the Women and Mood Disorders Task Force of the National Network of Depression Centers. Guidelines for the evaluation and treatment of perimenopausal depression: summary and recommendations. Menopause. 2018 Oct;25(10):1069-1085. doi: 10.1097/GME.0000000000001174. PMID: 30179986.
Modabbernia A, Akhondzadeh S. Saffron, passionflower, valerian and sage for mental health. Psychiatr Clin North Am. 2013 Mar;36(1):85-91. doi: 10.1016/j.psc.2012.12.007. PMID: 23538079.
Pacchierotti Claudia, Castrogiovanni Andrea, Cavicchioli Chiara, Luisi Stefano, Morgante Giuseppe, De Leo Vincenzo, Petraglia Felice, Castrogiovanni Paolo, Panic disorder in menopause: a case control study Maturitas, Volume 48, Issue 2, 2004, Pages 147-154
Rabijewski M, Papierska L, Binkowska M, Maksym R, Jankowska K, Skrzypulec-Plinta W, Zgliczynski W. Supplementation of dehydroepiandrosterone (DHEA) in pre- and postmenopausal women - position statement of expert panel of Polish Menopause and Andropause Society. Ginekol Pol. 2020;91(9):554-562. doi: 10.5603/GP.2020.0091. PMID: 33030737.
Smoller JW, Pollack MH, Wassertheil-Smoller S, et al. Prevalence and Correlates of Panic Attacks in Postmenopausal Women: Results From an Ancillary Study to the Women's Health Initiative. Arch Intern Med. 2003;163(17):2041–2050. doi:10.1001/archinte.163.17.2041
Ventriglio, A., Sancassiani, F., Contu, M. P., Latorre, M., Di Slavatore, M., Fornaro, M., & Bhugra, D. (2020). Mediterranean Diet and its Benefits on Health and Mental Health: A Literature Review. Clinical Practice & Epidemiology in Mental Health, 16(1), 156–164.
Young, L. M., Pipingas, A., White, D. J., Gauci, S., & Scholey, A. (2019). A Systematic Review and Meta-Analysis of B Vitamin Supplementation on Depressive Symptoms, Anxiety, and Stress: Effects on Healthy and ‘At-Risk’ Individuals. Nutrients, 11(9), 2232.Harvard Health Publishing. (2014, February). 8 principles of low-glycemic eating.
As Menopause Nears, Be Aware It Can Trigger Depression And Anxiety, Too. (2020, January 16). NPR.
https://psychiatry.org/patients-families/depression/what-is-depression
http://www.menopause.org/docs/default-source/agm/roussos-ross-k-2017-slides.pdf
https://www.aafp.org/afp/2018/1015/p508.html
https://www.menopause.org/for-women/menopauseflashes/mental-health-at-menopause/depression-menopause
https://www.medicalnewstoday.com/articles/anxiety-hot-flashes
Panic Disorder
During peri- and post-menopause, an increased level of anxiety and higher numbers of panic attacks are commonly reported. When a woman experiences an overwhelming feeling of panic or the inability to think clearly and process her circumstances, she may be experiencing symptoms of panic disorder. Panic attacks are often accompanied by physical symptoms such as hyperventilating, shortness of breath, a racing heart, and sudden sweating or a clammy feeling. Women with a previous history of panic attacks may experience the continuation of their condition during menopause, and new-onset panic disorder is also possible and common.
Among women 45 – 54 years old, 23% have reported panic attacks
During menopause, there is often an overlap of symptoms and diagnoses. Panic attacks are closely associated with anxiety and other mood-based disorders. It is possible for psychosomatic symptoms to start suddenly and they may increase or recede without obvious cause. As these types of symptoms are sometimes privately felt and not discussed, a woman may feel confused or disoriented as her emotions and circumstantial responses shift unpredictably.
If you are experiencing times of acute panic, if you are feeling “frozen” in social circumstances, or have feelings of an inability to cope or respond, you may be suffering from clinical levels of panic. It is important to receive an accurate diagnosis, as it is possible that your sensations are related to other mood-based disorders, such as clinical anxiety, social phobia, or depression. Take comfort in the fact that your symptoms are likely temporary in nature and related to your menopausal transition. Effective treatment options are available once an accurate diagnosis has been determined.
Dr. June Tan Sheren
Why this is happening
The endocrine system changes during menopause, as the biological processes controlling hormone releasing glands are altered by fluctuating hormone levels. The interrelationship of the endocrine system with a woman’s nervous system (her hypothalamic-pituitary system) is how physiological wellness is maintained. During menopause, hormone changes mean that symptoms of physiological imbalance can manifest. Imbalances in hormones and their regulatory functions stem from estrogen, progesterone, and serotonin levels.
Progesterone and GABA levels affected by menopause may interfere with neurotransmissions, resulting in mood-based dysfunctions. During peri-menopause, progesterone levels are declining and can lead to changes in a woman’s sense of emotional stability. When progesterone is metabolized, it produces GABA (a receptor agonist called Gamma-Aminobutyric acid) in order to regulate emotions, moods, and sleep. During times of lowered progesterone and GABA, anxiety, depression, and sleep disorders may increase.
Among women 45 – 54 years old, 23% reported panic attacks within the previous six-month period. In a survey of post-menopausal women, panic attacks were reported to be most commonly experienced during the menopausal transition years (peri-menopause, as opposed to pre- or post-menopause). In addition, panic attacks most often occur in association with negative life experiences, cognitive impairment, or the presence of another medical condition at the same time. A small clinical study indicated that 18% of women aged 40 - 60 exhibited significantly high levels of measurable panic disorder related indicators.
If your feelings of panic are interfering with your daily life, your job, your relationships, or are causing you to self-medicate through use of alcohol and other substances, it is important to consult with a medical professional. Diagnosis and treatment are available and the symptoms you are experiencing are common.
Other impacted areas
Other menopausal symptoms that are often inter-related with panic disorder are:
- Mood swings
- Anxiety
- Depression
- Irritability
- Fatigue
- Sleep disturbance
- “Brain fog” & difficulty concentrating
- Decreased libido
Diagnosis
Although specific testing for panic disorder is not available, self-reported symptoms can be analyzed by medical professionals. Standardized diagnostic tools, based on the DSM-V (Diagnostic and Statistical Manual of Mental Disorders), are used to determine if and what type of treatment is necessary.
Possible triggers or risk factors
Triggers for panic attacks can include:
- Negative life circumstances
- Stress
- Fatigue or cognitive impairment
- High levels of anxiety
- Excessive rumination or worry
- Feelings of hopelessness or uncertainty
Treatments & Remedies
In addition to the supplement and pharmaceutical alternatives described below, other forms of therapy have excellent efficacy rates, either in isolation or combination. Cognitive Behavior Therapy (CBT) and forms of counseling, intentional reductions of stress points, and proactive engagement in self-care activities should be considered as additional treatment options.
Products
- Preliminary studies suggest that chamomile extract might be helpful in managing generalized anxiety disorder including panic attacks, but as the clinical evidence is limited a conclusive answer to its efficacy cannot be given.
- A recent study (2020) looking at the effectiveness of Melatonin as a possible alternative to conventional anxiety-reducing drugs had promising short-term results, but the long-term effects are unclear.
- Passionflower and valerian have been used to treat anxiety and panic disorders but have insufficient clinical research to support the claimed efficacy.
- Even though some women have reported positive benefits from taking additional supplements of Vitamin B in order to reduce stress levels, there is no clinical proof tying increased levels of Vitamin B to reductions in anxiety and panic attacks.
There are no effective over-the-counter pharmaceutical products available for the treatment of panic disorder.
Antidepressants are commonly prescribed for clinical depression and anxiety, and it is important to discuss treatment options with your doctor. Your healthcare provider will indicate whether antidepressants should be considered given the extent of your symptoms.
Lifestyle
Maintaining a healthy diet and weight is essential for optimal health at every stage of life.
- If possible reduce intake of over-processed foods, concentrating on a high-fibre diet with significant vitamin, mineral, Omega-3 fats, and probiotic components.
- Alcohol, drugs, and smoking should be reduced or eliminated.
- There is a strong positive correlation between a plant-based Mediterranean diet and a lower risk of mood-based disorders such as anxiety and depression. A Mediterranean diet focuses on whole grains, fruits, vegetables, seafood, beans, and nuts. It avoids processed meat, pre-packaged meals with high sodium levels, refined grains, butter, and hydrogenated oil.
Exercise is essential for proper physical and mental wellbeing. Studies show the positive relationship between an active lifestyle and the ability to regulate moods and emotions. Acute panic attacks are our body’s response to stress, danger, over-tiredness, or anxiety, and these negative symptoms can be reduced by mild to moderate aerobic activity.
A 10-minute walk has been shown to be effective in reducing a woman’s self-reported level of anxiety for several hours. Active people report lower levels of anxiety than sedentary individuals, and researchers found that women who get regular, aerobic exercise are 25% less likely to develop symptoms related to heightened anxiety.
The ability to avoid highly stressful or panic-initiating circumstances is often related to mental wellness. There are many therapy alternatives available to you regarding lifestyle decisions, including:
- Counseling and psychological support
- Discussing your symptoms with trusted professionals and your support base
- Focusing on daily stress reductions
- Employing self-awareness techniques such as daily journaling
- Maintaining positive and frequent social contact
Holistic
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