As a young adult Jan rode the subway to work in Chicago. One day the train stopped underground between stations with only emergency lighting. Although the delay lasted only 15 minutes and the train moved on without any problems, Jan’s reaction was one that would derail her for the next decade.

The emergency stop triggered Jan’s first panic attack. Her heart pounded wildly, she began gasping for breath and was overwhelmed by nausea and a feeling of impending doom. Strangers came to her aid, but it was difficult for her to explain what was wrong.

After that day Jan refused to ride the subway and had to take a series of buses to get to work. Then panic attacks began to occur in other places, and she became increasingly fearful of venturing out for fear of losing control in public. Eventually she quit her job and moved in with her parents in the suburbs. It was her mother who convinced her to see a physician for an evaluation.

There’s no specific diagnostic test for panic disorder, but Jan’s symptoms in an otherwise healthy young woman made a diagnosis of panic disorder relatively straightforward. Symptoms of panic disorder include: rapid heartbeat, shortness of breath, palpitations, nausea, sweating, shaking, feelings of doom and altered reality, fear of having a heart attack or stroke and fear of death. Symptoms are so acute that many people having a panic attack go to the emergency room.

Although Jan felt isolated and ashamed because of her panic attacks, she is far from alone. An estimated three percent of Americans suffer from panic attacks, which seriously erode quality of life, personal relationships and the ability to work productively.

Panic attacks are a form of anxiety disorder, that occur twice as often in women as in men. They typically begin around 25 years of age but can occur at any age.

Panic reactions often develop into a range of phobias–from agoraphobia (fear of being in public places, which Jan developed), to acrophobia (fear of heights), fear of spiders, snakes, germs, and a whole host of other phobias.

Most of us have a healthy fear of snakes, although not necessarily a phobia. But even a phobic fear of snakes isn’t a huge burden to a city dweller who can easily avoid exposure. Fear of elevators for an urban dweller would impose more of a burden.

Panic disorder can be treated successfully, usually involving medication, psychological therapy or a combination of the two.

Cognitive behavioral therapy has been used with some success to treat anxiety-related disorders. This type of therapy can help patients identify and correct negative thought patterns that either trigger or intensify panic attacks. Patients learn to recognize how they overestimate danger, overreact to external situations and obsess about ‘what if’ situations that are extremely improbable.

Exposure therapy is also used, sometimes with the help of virtual reality technology. Virtual reality helmets can create the illusion of being at a great height or of taking off in a plane while the patient sits in the therapist’s office and practices calming, coping and rationalizing strategies.

The class of drugs known as benzodiazepines were at one time used alone to treat anxiety. Benzodiazepines work on GABA (gamma-aminobutyric acid) which is present in most areas of the brain and has a calming effect, minimizing the effects of stress.

The antidepressant classes of SSRIs (selective serotonin reuptake inhibitors) and SNRIs (selective norepinephrine reuptake inhibitors) are now often used as first line drugs for anxiety. Physicians often prescribe an antidepressant in combination with a benzodiazepine.

Other drugs that may be prescribed either alone or in combination include Tiagabine (Gabitril), which increases transmission of GABA in a different way than a benzodiazepine, and the medications gabapentin and pregabalin, which diminish the release of glutamate, a chemical that increases anxiety in the brain.

By using drugs that work in different and complementary ways a physician can improve control of symptoms and sometimes achieve full control for a patient.

As scientists learn more about the biology of fear, our ability to treat panic disorder can only improve. Rather than allowing panic to shrink their social, family and working lives, those who suffer panic attacks need to seek help from a physician or psychiatrist experienced in treating the disorder.