Prodrome Aug 24, 2026

By Joo Jin-won, Doctor of Korean Medicine · Kyung Hee Barun Clinic

Panic attacks don't
come out of nowhere

Before an attack, the body signals. The signals are usually missed — not because they are hidden, but because they are familiar. And because they never get said out loud.

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A first attack feels sudden. So does a relapse. Almost always, it wasn't.

The body had been signalling for weeks. The signals were missed — and where they weren't missed, they went unmentioned.

Those signals have a name: prodromal symptoms.

Why they get missed

They are small. A mild tightness in the chest. A heart rate that climbs from very little effort. A moment of lightheadedness.

And they are familiar. You have met all of them before. So they get waved off.

Going back to a doctor over this feels like too much — you are tired of going back. Searching online returns nothing sharp. So the conclusion gets reached alone:

“Maybe I'm just being oversensitive. Health anxiety again.”

That conclusion isn't simply wrong. Health anxiety is real, and it is common after panic.

But health anxiety and a prodrome are not the same thing.

What separates them is the background

Health anxiety is a problem of interpretation — the same palpitation read as danger.

A prodrome is different. It doesn't arrive for no reason. Behind it there is almost always a disturbance in daily rhythm:

So the test is not your character. It is what changed in the last few weeks. And that is checkable. “Am I oversensitive?” has no answer. “What time have I been going to bed?” has one.

The question isn't “am I being oversensitive?”
It is “what changed in the last few weeks?” The first question has no answer. The second one does.

And a prodrome grows out of residual symptoms

Residual symptoms are what remains after an attack settles — subclinical, below the threshold of any test, but unmistakably there.

You sleep fine. You eat three meals. Nothing especially stressful is happening. And still:

You can live with these. That is exactly the problem — living with them doesn't make them go away.

Let daily rhythm slip on top of that baseline, and residual symptoms turn into prodromal ones. Let the prodrome run unaddressed, and an attack follows.

The same road, drawn out

This pattern has a name in the literature: the rollback phenomenon. It was described by Detre and Jarecki in 1971, and developed for mood and anxiety disorders by Giovanni Fava and colleagues, whose work on staging and residual symptoms gave it clinical shape.

The core observation: a disorder recedes in the reverse of the order it arrived — and when it returns, it retraces that order forward.

The rollback phenomenon
  1. Pre-onset Subclinical &
    prodromal symptoms
  2. Acute phase Panic attack
  3. Recovery Residual symptoms
  4. Pre-relapse Residual turns back
    into prodromal
  5. Relapse Acute attack returns

What pushes ③ into ④
accumulated stress · short sleep · irregular meals · more caffeine

How illness travels → Rhythm slips on top of a residual baseline; residual becomes prodromal; left alone, prodromal becomes an attack.
← How treatment travels Backwards, most recent symptom first. Settle the prodrome, then work on what was residual underneath it.

Put stages ① and ④ side by side. They are the same symptoms. The illness leaves and returns through the same door.

Which changes what treatment is aiming at

This is where the idea earns its keep.

Treating panic disorder is not aimed at the attack itself. The attack is the event at the end of the sequence. Hold onto the end alone, and everything that built up to it stays in place.

The order these researchers propose runs the other way: work backwards, starting from the most recent discomfort.

  1. Settle the prodrome first — which means starting with the daily rhythm underneath it: sleep, meals, caffeine, load.
  2. Then address what was residual — the symptoms that were tolerable enough to be ignored, and that tolerating never removed.

The order matters. Residual symptoms are slow work. Trying to do that slow work while a prodrome is building loses both. Put the fire out first; then repair where it started.

What you can do now

1. Name your own prodrome. Think back to the weeks before your first attack — not the attack itself. What was different? Two or three specifics is enough, and that short list will beat any general checklist. Relapse announces itself in your own handwriting.

2. Record the rhythm alongside the symptoms. Symptoms alone end in “maybe I'm oversensitive again.” Sleep, meals, caffeine and workload written beside them make the background visible — and the background is the part you can act on.

3. Treat drift as notice, not as failure. If your list starts filling in again, the illness hasn't won. The earliest possible notice has arrived, while there is still room to act.

The part worth keeping

Look at the diagram once more. Stage ④ has to happen before stage ⑤ can.

That stage is not decoration. It is time — real time, usually weeks. And it is legible, because it is written in symptoms you have already met once.

Panic that returned without warning would be a genuinely frightening illness. Panic that returns through a door you recognise is a different thing. Still hard. But not unpredictable, and not something you stand in front of empty-handed.