Expert Telehealth Care for Panic Disorders in New York
Panic disorder affects approximately 6 million American adults — about 2.7% of the population — according to the Anxiety and Depression Association of America. Panic attacks are among the most frightening experiences a person can have, frequently mimicking the symptoms of a heart attack or serious medical emergency. For many people, the fear of having another attack becomes so consuming that it begins to reshape their entire life — driving avoidance, shrinking their world, and creating a secondary layer of anxiety on top of the original condition.
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At Strong Enough Mental Health, Salvatore Marchica, PMHNP-BC, provides expert, compassionate telehealth evaluation and treatment for panic disorder for adolescents and adults across New York State. With the right care, panic disorder is highly treatable — and recovery is absolutely possible.
What is Panic Disorders?
Panic disorder is characterized by recurrent, unexpected panic attacks — sudden, intense surges of fear or discomfort that peak within minutes — along with persistent worry about future attacks and/or significant behavioral changes made to avoid triggering them. A panic attack itself is not medically dangerous, but it is intensely distressing, and the behavioral changes that develop around preventing future attacks — avoidance, dependence on others, inability to travel alone — can become profoundly limiting.
Panic disorder is also frequently associated with agoraphobia — avoidance of places or situations where escape might be difficult or where help would be unavailable during an attack. This can include public transportation, crowds, shopping centers, or simply being outside the home alone.
What Are The Signs And Symptoms of Panic Disorder?
Physical Symptoms of a Panic Attack
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Racing or pounding heartbeat (palpitations)
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Shortness of breath or feeling smothered or choked
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Chest pain or pressure
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Dizziness, lightheadedness, or feeling faint
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Sweating, trembling, or shaking
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Nausea or abdominal distress
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Numbness or tingling sensations (paresthesias)
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Chills or hot flushes
Cognitive and Emotional Symptoms
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Intense fear of dying — most commonly fear of having a heart attack
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Fear of losing control, going crazy, or doing something embarrassing
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Derealization — the world feeling unreal, dreamlike, or distant
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Depersonalization — feeling detached from one's body or thoughts
Behavioral Symptoms (developing after repeated attacks)
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Persistent worry and anticipatory anxiety about having another panic attack
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Avoidance of situations or places associated with previous attacks
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Need to always know where the nearest exit is
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Difficulty being alone or away from home
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Avoiding exercise or physical exertion out of fear of triggering physical sensations similar to panic
How is Panic Disorder Diagnosed?
Panic disorder is diagnosed through a clinical evaluation confirming recurrent unexpected panic attacks, assessing the behavioral changes they have produced, and ruling out medical conditions — such as cardiac arrhythmias, hyperthyroidism, or hypoglycemia — that can produce similar symptoms. At Strong Enough Mental Health, Salvatore conducts a thorough evaluation to ensure an accurate diagnosis before developing a treatment plan tailored to your specific presentation.
What Are Possible Treatments For Panic Disorder?
Medication for Panic Disorder
Panic disorder responds well to pharmacological treatment, and the combination of medication and Cognitive Behavioral Therapy (CBT) — particularly with interoceptive exposure and situational exposure — produces the best outcomes. At Strong Enough Mental Health, we manage the medication component and facilitate referrals to CBT specialists when appropriate.
Selective Serotonin Reuptake Inhibitors (SSRIs) — First-Line Long-Term Treatment
SSRIs are the first-line long-term treatment for panic disorder. They reduce both the frequency and severity of panic attacks and decrease anticipatory anxiety over time. Full effect typically takes 4–8 weeks. An important caution: SSRIs can temporarily increase anxiety or trigger panic symptoms in the early weeks of treatment — starting at a very low dose and increasing slowly minimizes this, something we manage carefully at Strong Enough Mental Health.
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Sertraline (Zoloft) — FDA-approved for panic disorder
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Paroxetine (Paxil, Paxil CR) — FDA-approved for panic disorder
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Fluoxetine (Prozac) — Widely used for panic disorder
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Escitalopram (Lexapro)
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Venlafaxine XR (Effexor XR) — FDA-approved for panic disorder
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Duloxetine (Cymbalta) — Used off-label with good clinical evidence
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
Benzodiazepines — Acute and Bridge Use
Benzodiazepines can provide rapid relief from acute panic and are sometimes used as a short-term bridge while SSRIs build to full effect. Long-term use requires careful clinical judgment due to dependence and withdrawal considerations.
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Clonazepam (Klonopin) — Longer-acting; sometimes used on a scheduled basis for ongoing panic management
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Lorazepam (Ativan) — Used as-needed for acute panic episodes
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Alprazolam (Xanax) — Rapid-acting; typically prescribed for short-term or as-needed use only
TCAs are effective for panic disorder but are typically reserved for cases where SSRIs and SNRIs have not provided sufficient relief, due to their side effect profile.
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Imipramine (Tofranil) — Strong clinical evidence for panic disorder
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Clomipramine (Anafranil)