“They would happen randomly: sometimes in the street, sometimes while I was in the house getting ready to go out or, like the first one and most inconveniently of all, in the middle of meals” Lee, Kynaston, a victim of panic disorder (Mooney 7). Kynaston is experiencing is a panic attack. Panic attacks may lead to panic disorder. Panic disorder is a severe mental health problem, one of multiple mental health problems referred to as anxiety disorders. There are many factors that play a role in panic disorder, including gender, heredity, biochemistry, and one’s environment. Specifically, there is extensive evidence to support the fact that genetics are a major cause of panic disorder. Many studies have been done that have identified specific genes that are associated with panic disorder. It is imperative for the general public to understand the role of genetics in panic disorder to be more sympathetic with the victims of the disorder, and possibly even contribute to the research to cure the disorder, making life better for society as a whole. Firstly, there is a clear distinction between panic disorder and normal feelings of alarm and uneasiness. When one is afraid, a physical response is initiated. “This innate reaction activates certain areas of the brain that release chemicals to increase heart rate, blood pressure, and breathing rate. These physical changes are designed to ensure survival by preparing the body to either fight or flee eminent danger” (Mooney 11). It is normal and helpful to a person when their body responds to real danger with a fight-or-flight reaction. This reaction is able to assist a person in being alert or to take action for his or her own safety. However, the flight-or-fight response may be initiated in circumstances where no true danger is present. Panic attacks result in these situations. One with panic disorder sufferers these abrupt and chronic episodes of anxious concern (Mooney 11). Understanding panic disorder is the first step in finding a cure for it. Secondly, When one has a panic attack, they suffer a number of autonomic nervous system signs, including discomfort in the chest, trouble breathing, and irregular and fast heart beats. During a panic attack, one might feel like they are dying. A panic attack is usually ten to thirty minutes long. Several of those who have panic disorder later begin to suffer from agoraphobia, in which panic attacks are triggered in specific environments, such as in large assemblies of people. About 20% of those with panic disorder who do not receive medical assistance recover (Mossner, Freitag, Gutknecht, Reif, Tauber and Franke). Despite the fact that experts do not know exactly what triggers panic disorder, they have learned much about what causes it. The majority of researchers maintain that panic disorder is not triggered by one particular influence, but rather by multiple causes, including biology, genetics, and environmental factors. A plethora of research indicates that genes may play a role in panic disorder. Studies done by the University of Maryland Medical Center have indicated that as many as half of people with panic disorder have a family member with the disorder. Scientists have indicated which genes they think cause panic disorder. Many studies have shown scientists how these genes cause panic disorder, and these studies have been done by a variety of organizations. For example, in 2011, research published in the journal Biological Psychiatry indicated that a substance in cells that may help to operate clusters of genes that cause panic disorder. Ribonucleic acid, or RNA, is synthesized in cells in the body. Every cell’s nucleus contains deoxyribonucleic acid, or DNA, which contains genetic information. RNA is utilized to replicate the DNA, which contains information about how the other organelles in the cell need to operate, and deliver it wherever it needs to so that the entire cell can survive. MicroRNAs (miRNAs) are portions of RNA that attach to DNA and regulate which genes are activated. Scientists who researched about miRNA discovered that four or more kinds could be related to panic disorder. Additional research has indicated that these miRNAs inactivate many genes that scientists believe might play a role in the brain’s control of anxiety (Mooney). According to John Krystal, reviser of Biological Psychiatry, “Variation in genes coding for miRNAs may coordinate the involvement of a number of risk genes and thereby contribute to the development of panic disorder” (Mooney). In addition, in 2013, scientists from the Centre for Genomic Regulation (CRG) in Spain promulgated that they had learned of a gene, NTRK3, that could cause panic disorder. NTRK3 produces proteins with instructions required for the development of the brain, allowing neurons to continue to function, and creating neural networks, which connect all of the neurons in the brain. Normally, the body is able to control whether NTRK3 genes are activated or deactivated at the proper times (Mooney). “However, when NTRK3 is deregulated and the controls that turn it on and off are not in place, this gene appears to increase a person’s perception of fear, which makes them more likely to overestimate danger and heave a heightened sense of alarm and anxiety” (Mooney 27). If NTRK3 is not controlled correctly, the brain’s fear memory system is altered. The system is more susceptible to causes of panic and allows a person to remember more situations in which they were afraid. Despite the fact that scientists have improved their comprehension of the role of genetics in panic disorder, there is much more for them to learn about this subject. Family studies have been an additional indication of the genetic causes of panic disorder. “Researchers conducted family studies to examine whether a certain phenotype aggregates in some families, by comparing the phenotype prevalence among affected probands’ relatives with that of unaffected controls’ relatives” (Na, Kang, Lee, and Yu). Initially in the investigation of the role of genetics in panic disorder, these studies were often utilized to explain the genetic origin of panic disorder. After psychiatrists discovered that panic disorder was a family illness, many family studies have indicated a heightened likelihood (by 5.7%-17.3%) of developing panic disorder for those whose family members were victims of the disorder. Also, a group of researchers at the University of California, San Francisco, through a study, observed that one’s likelihood of developing panic disorder was seventeen times as great when they had an immediate family member with the illness if the family member developed the illness before age twenty. However, the thereas the study indicated that one’s likelihood of developing panic disorder was only six times as great if they had an immediate family member who developed the illness after turning twenty. Despite the fact that family studies have plainly reported that panic disorder runs in families, these studies are not concrete, as they do not differentiate genetic causes from environmental influences (Na, Kang, Lee, and Yu). In addition to family studies, twin studies are a source of additional insight into genetic on one’s risk for panic disorder (PD). “Twin studies of PD have demonstrated this phenotype is moderately heritable and that the concordance rate for monozygotic twins is higher than that for dizygotic twins. These findings indicate genetic factors contribute to PD’s pathogenesis with an estimated heritability of 30%-40%” (Na, Kang, Lee, and Yu). Experts concluded, from several twin studies by the Virginia Institute for Psychiatric and Behavioral Genetics, that the likelihood of inheriting panic disorder is about 43%. A later study, done by the Virginia Adult Twin Study of Psychiatric and Substance Use Disorders, involving over than 5,000 twins, indicated that the likelihood of inheriting panic disorder is about 28%. From these studies, it is obvious that genes play a role in panic disorder, although environmental causes are significant as well. Since twins have the exact same genes, if only one twin has panic disorder, the other must have the genes for panic disorder, but they must have been turned off by environmental factors. Therefore, genes cannot be the only cause of panic disorder and research must be done to find out what environmental conditions turn off genes for panic disorder. Doing so may allow experts to expose one to these environmental conditions to cure them of the disorder (Na, Kang, Lee, and Yu). Also, research done by the University of Iowa involving lymphocytes (white blood cells) is another indication of the genetic causes of panic disorder (Jessen). “University of Iowa researchers recently used lymphocytes and their derived lymphoblast cell lines as an alternative tissue source, citing a number of studies that have demonstrated that gene expression differences found in either lymphoblasts or lymphoblast cell lines are predictive of complex “medical” illnesses including hyperlipidemia, hypertension and arthritis” (Jessen). Because almost 82% of genes expressed in the central nervous system are expressed in the blood, the researchers believe that blood can be used to to study diseases of the central nervous system. Since, it is much easier to sample blood than to sample brain tissue, blood is an attractive avenue to study mental illnesses, including panic disorder. Also, it is imperative that researchers specifically study white blood cells, because white blood cells have a nucleus and DNA, so they could contain genes for panic disorder, while red blood cells don’t have a nucleus or DNA, so they could not (Jessen). In addition, the university utilized lymphoblasts from sixteen patients who had panic disorder and seventeen patients who did not. Patients who had panic disorder and patients who did not had very unlike gene expression in their lymphoblasts (Jessen).”Interestingly, almost 7 times more genes were found to be activated than repressed in patients with panic disorder” (Jessen). However, there were several issues with the study. For example, panic disorder is an illness in brain tissue, but the researchers studied genes from lymphoblasts. The researchers presume that in order to have panic disorder, certain genes and an environmental trigger is required and variations in gene expression in lymphoblasts will indicate whether or not someone has panic disorder. This has not been proven. In addition, fourteen of the sixteen patients with panic disorder were taking mental health medicine during the study, which could have invalidated their results. Furthermore, the researchers noted many genes that controlled calcium channels (which allow calcium atoms to diffuse in and out of cells) that were not controlled in individuals who had panic disorder. Calcium has been considered a possible cause of various types of anxiety for several decades, but minimal inquiry has not allowed much to be concluded from the research. However, since variations in lymphoblast gene expression in individuals who have and do not have panic disorder provides hope for later research (Jessen). A study done in 2015 and discussed in the journal Biological Psychiatry suggests a specific molecule, microRNA, is the main cause of panic disorder. MicroRNA molecules are tiny segments of RNA that attach to DNA and regulates the expression of different genes. Many miRNAs have a wide variety of impacts on gene expression (Nauert). “Through case-control studies in three different populations, from Spain, Finland and Estonia, the research team found that at least four miRNAs may be involved in the pathophysiology of panic disorder” (Nauert). Later research indicated that the microRNA (miRNA) molecules inactivate many candidate (potential) genes for panic disorder and help to control neural pathways that cause anxiety (Nauert). “These data provide important new evidence that variation in genes coding for miRNAs may coordinate the involvement of a number of risk genes and thereby contribute to the development of panic disorder,” Dr. John Krystal, Editor of Biological Psychiatry said (Nauert). Other studies done have implicated that various chromosomal regions are involved in the transfer of panic disorder. Over 350 candidate genes have been examined to see if they play a role in panic disorder. To know exactly how these genes may cause panic disorder, more investigations must be done into other factors that may play a role in panic disorder, including gender and race and their effect on the brain. Advances in bioinformatics and genotyping, specifically in research of the entire human genome, have provided much information about the causes of panic disorder. Learning more about the nervous system could help scientists in their genetic research for panic disorder and help them find conclusive information (Maron, Hettema, and Shlik). Furthermore, there is an extensive amount of research that indicates that serotonin, an essential can help to prevent panic attacks. Serotonin regulates many emotions, including anger, sadness, and apprehension. In those who experience depression, anxiety, or panic attacks, it is widely believed that serotonin has not been functioning as often in the brain’s neural synapses.One method through which the majority of physicians try to prevent panic attacks uses a type of drugs called selective serotonin reuptake inhibitors (SSRIs), including as Prozac and Zoloft. These drugs cause more serotonin to be made in the synapses and have been proven to be useful for many mental health issues, such as obsessive-compulsive disorder, depression, and panic disorder. Despite the fact that SSRIs can increase the frequency that serotonin functions and minimize anxiety levels, there are serious disadvantages in using them. SSRIs can only be obtained from doctors, they are very costly, and they may have unpleasant side effects, including soreness in the stomach. In addition, they reduce panic attacks, but only after three to six weeks, and before then, they may worsen anxiety and panic attacks. A less risky and cheaper method of increasing the frequency that serotonin functions is to use serotonin messenger “and the immediate precursor in the body’s synthesis of serotonin is 5-HTP” (Life Enhancement Products). It is well absorbed orally, with 70% of the ingested amount ending up in the bloodstream, and it easily crosses the blood-brain barrier. Thus it can effectively increase the amount of serotonin produced in the brain” (Life Enhancement Products). Furthermore, animal studies have revealed the possibility that neuropeptide S (NPS) and its chemoreceptor (NPSR) to play a role in anxiety. In this investigation, there was an attempt to learn more about the contribution of NPS in the cause of anxiety. NPSR was examined for involvement in panic disorder that caused and had not caused agoraphobia (fear of public settings) in two different investigations, “dimensional anxiety traits, autonomic arousal level during a behavioral avoidance test and (4) brain activation correlates of anxiety-related emotional processing in panic disorder” (Domschke et al). The experiment supported the idea that NPSR genes played a part in panic disorder mostly in women and girls possibly by increased involuntary stimulation and poor handling of anxiety. In addition, more studies have supported the idea that panic disorder is more common in men than women, including the National Comorbidity Survey (NCS). The study investigated the occurrence of various types of mental illness, such as depression, general anxiety, and panic disorder in a large group of people from all over the nation. The information gathered from this survey indicated that panic disorder is “2.5 times more prevalent among women than men” (Leskin and Sheikh). There are many possible explanations for why women are more likely to have panic disorder than men. Many experts claim that hormonal variation that occur in women in specific instances in a women’s life makes her more likely to suffer from panic disorder, such as giving birth. These instances may cause women to experience panic attacks, which may lead to panic disorder. Some experts claim that females are more prone to panic attacks and therefore panic disorder due to the fact that they, in particular, experience a lot of anxiety in trying to do favors for other people before taking care of themselves. Other experts claim that females have a higher chance of being identified as victim of panic disorder due to the fact that they are less reluctant to see a doctor and explain their signs of panic disorder to a doctor (Mooney). Anxiety disorders are one of the most frequently occurring issues in the United States and often can lead to recurring health issues that impact multiple organ systems. They also result in medical expenses totaling more than $40 billion annually. Furthermore, on average, one has a 4.7 percent chance of developing panic disorder at some point in their life. Over the past thirty years, there has been a plethora of work done to research the genetics of anxiety disorders, including panic disorder, to learn more about circumstances that heighten one’s risk of developing anxiety disorders (Norrholm and Ressler). This work needs to continue and money needs to be raised for this research to help find a cure for panic disorder for the mental and physical health of its victims, and to save money. Panic disorder is an important mental health issues. Although there are many causes of panic disorder, genetics are one of the most important factors in panic disorder. The general public should be informed of the information gathered from these studies to learn about the influence of genetics on panic disorder to be more understanding of those with the illness and potentially research the illness to find a cure for the illness, improving the lives of its victims and making society as a whole more mentally healthy. Specifically, since medical expenses for panic disorder total about forty billion dollars annually, if panic disorder was cured, this money could be spent researching cures for other health problems, or scientific research, making society as a whole healthier and more knowledgeable of the world around it.