Panic attacks are sudden episodes of fear and anxiety that usually last for between 10 and 30 minutes and cause symptoms such as a racing heartbeat, heavy perspiration and shortness of breath. Although panic attacks are usually medically harmless, they can be extremely frightening, and often feel like a heart attack. Therefore, many people seek emergency medical care for their symptoms.
The exact cause of panic attacks is not understood, although stress, various biochemical factors and heredity are all believed to contribute to attacks. In some cases, panic attacks may be the result of an associated mental condition or disorder. For instance, anxiety disorders, such as phobias and post-traumatic stress disorder, can cause panic attacks. Patients should notify their physician if panic attacks occur frequently or interfere with daily functioning. A person who has four or more panic attacks on a monthly basis is usually diagnosed with a condition called panic disorder. Both panic attacks and panic disorder are highly treatable conditions that usually respond to a combination of medicine and psychotherapy. Various relaxation techniques and other stress-relieving measures can help prevent panic attacks.
About panic attacks
Panic attacks are sudden episodes of fear and anxiety that trigger symptoms such as a racing heartbeat, heavy perspiration and shortness of breath. Panic attacks provoke an overwhelming stress response that is greater than a situation would typically warrant. People who have panic attacks often feel as though they are having a heart attack or are losing control of their thoughts, and it is common for them to seek emergency medical treatment for these symptoms. According to some estimates, up to 30 percent of adults will experience at least one panic attack in their lifetime.
Panic attacks often begin suddenly and without warning. Once they start, they tend to peak within 10 minutes and last for a total of about 30 minutes. However, no two panic attacks are exactly alike, and some patients have reported panic attacks that last for several hours or even an entire day. Panic attacks can strike at any time during waking or sleeping hours, and a high percentage of patients report that these attacks awaken them in the middle of the night.
Although panic attacks themselves are relatively similar, they may occur under three sets of circumstances, according to the Anxiety Disorders Association of America(ADAA):
- Unexpected. An attack that occurs without any warning and for no obvious reason.
- Situational. An attack that occurs in a given set of circumstances. For example, patients may experience symptoms whenever they are in a large crowd of people.
- Situationally predisposed. Situations in which a person sometimes has a panic attack, and other times does not.
Although panic attacks are frightening for many patients, they tend to be medically harmless. Many people have just one or two attacks during their lifetime. However, patients who experience repeated panic attacks may be diagnosed with panic disorder, which usually involves at least four panic attacks a month. Patients with panic disorder find themselves avoiding situations that tend to induce attacks. For example, a person who experienced a panic attack while driving across a bridge may avoid all bridges. Such avoidance can leave people isolated and adversely affect their quality of life, leading to increased risk of depression, substance abuse and even suicide. People who regularly suffer panic attacks have a high risk of developing agoraphobia, which is an inability to venture beyond comfortable surroundings (e.g., one’s home) due to intense anxiety.
People who experience repeated panic attacks or long-lasting attacks should seek medical care. Conditions such as impending heart attack or overactive thyroid gland (hyperthyroidism) can cause symptoms similar to those of a panic attack, as can other lung, intestinal or nervous system disorders.
Potential causes of panic attacks
Although the exact cause of panic attacks is not yet understood, stress and various biochemical factors are believed to contribute to the attacks. Because panic attacks are more likely in people with a family history of such attacks, heredity may also play a role. In some cases, panic attacks may be associated with another psychological condition, such as agoraphobia, post-traumatic stress disorder(PTSD) or phobias (e.g., social phobias, specific phobias).
Some experts have speculated that panic attacks may be related to the body’s “fight or flight” response. This response occurs in the sympathetic nervous system when the body faces danger. Adrenaline (a chemical secreted by the adrenal medulla in response to stress that is also known as epinephrine) and other hormones are released, allowing the body to either fight the danger or flee from it. Researchers believe that during panic attacks, an unknown trigger activates this response despite the fact that no danger is actually present. Other researchers have cited a similar “suffocation alarm” in the body that falsely indicates that death is imminent, triggering an attack.
In addition, several physical factors may increase the risk of panic attacks. These include:
- Low blood sugar (hypoglycemia).
- Irregular heartbeat.
- Mitral valve prolapse. Disorder in which the heart’s mitral valve does not properly close.
- Substances such as amphetamines, marijuana and caffeine.
Signs and symptoms of panic attacks
Panic attacks tend to occur suddenly, with symptoms following rapidly and reaching a peak within 10 minutes. The symptoms of panic attacks include:
- Palpitations (rapid or pounding heartbeat)
- Heavy perspiration
- Shortness of breath or feeling of suffocation
- Chest pain
- Dizziness or lightheadedness
- Nausea or abdominal cramping
- Chills or hot flushes
- Tingling and numbness in the hands
- Sensation of choking
- Feelings of unreality or being detached from oneself
- Fear of losing control
- Fear of dying
A person who experiences four or more of these symptoms could be having a panic attack. As these symptoms multiply, the individual may feel an impending sense of doom or a loss of mental control. Gradually, these feelings and symptoms will subside. Once the attack has passed, a feeling of fatigue may set in.
Diagnosis of panic attacks
Although panic attacks are frightening, they do not typically cause physical harm, and many people have just one or two attacks during their lifetime. However, patients should notify their physician when panic attacks occur frequently or interfere with daily functioning.
A physician will perform a complete physical examination and compile a thorough medical history. The physician will also rule out other medical conditions that could be causing symptoms, such as a heart problem or an overactive thyroid. If a panic attack is diagnosed, but does not appear to be debilitating, the patient may be cleared medically and instructed to monitor their condition in case symptoms continue or worsen. Patients whose symptoms are more disruptive may be referred to a psychiatrist or a psychologist.A person who has four or more panic attacks each month may be diagnosed with a condition called panic disorder. This diagnosis also pertains to individuals who have fewer episodes, but experience recurrent fears of another attack. Such patients may develop phobias (irrational fears to ordinary situations) to places or situations where panic attacks have occurred in the past. Both panic disorder and phobias can usually be treated effectively.
Treatment options for panic attacks
Patients who experience panic attacks have several treatment options. In most cases, effective treatment consists of a combination of therapy and medications.
Cognitive behavior therapy(CBT) can help patients learn techniques that will better enable them to handle panic attacks when they occur. Patients learn how to recognize the signs of an impending attack and how to use breathing and relaxation techniques to reduce symptoms. They may also learn how to change their thinking to view the attacks more realistically and understand that they are medically harmless. In addition, patients may be gradually exposed to the stimuli that cause them anxiety so that they can get used to and overcome the source of their fear.
Some antidepressant medications are usually effective in preventing future attacks, even in patients who are not depressed. Anti-anxiety medications may also be prescribed.
The use of antidepressant and anti-anxiety medications should be closely monitored. In addition, certain antidepressants may not be recommended for some patients. The U.S. Food and Drug Administration (FDA) has advised that antidepressants may increase the risk of suicidal thinking in children and adolescents and all people being treated with them should be monitored closely for unusual changes in behavior. Most patients require only short-term therapy and concurrent use of medication to learn to control panic attacks. The right treatment regimen can help reduce or prevent panic attacks for about 70 to 90 percent of patients, according to the National Mental Health Association.
Prevention of panic attacks
Panic attacks cannot always be avoided. However, patients may be able to take steps to reduce the likelihood of their occurrence. Patients who have too much stress in their lives may be at a higher risk for panic attacks. Relaxation techniques such as meditation, muscle relaxation, breathing techniques and guided imagery may help people feel more relaxed.
Taking time to engage in leisure and recreational activities can help restore balance to patients’ lives, leaving them less vulnerable to stress and panic. Finally, eating the proper diet and avoiding certain substances – such as caffeine, amphetamines and marijuana – can reduce the likelihood of panic attacks.
Questions for your doctor about panic attacks
Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions related to panic attacks:
- How can I tell the difference between a panic attack and normal anxiety?
- How can you be certain that my symptoms are caused by panic attacks?
- Do I have any underlying conditions that may cause or contribute to my panic attacks?
- What type of panic attacks do I experience?
- Does having a panic attack mean that I have a panic disorder?
- What are my treatment options?
- How effective are treatments?
- Are there any medications that may benefit me? Which do you recommend? What are the potential side effects?
- What type of therapy might I benefit from? Can you recommend a qualified therapist or support group?
- How can I prevent panic attacks?