A panic attack is a sudden bout of intense fear or anxiety that causes frightening but not life-threatening symptoms such as a pounding heart, shortness of breath, and the feeling of losing control or dying. Usually from 5 to 20 minutes long, a panic attack may be triggered by stressful circumstances or it may occur unexpectedly.
The body has an automatic fear response that prepares you to either cope with or run away from danger. A panic attack results when this "fight or flight" response either overreacts or becomes activated when it is not needed at all. During a panic attack, your nervous system reacts as if you are facing a life-threatening situation, even though you may not be in danger. This response causes alarming physical symptoms and feelings.
Panic disorder is diagnosed when you have repeated panic attacks, you worry about having another attack, and you avoid places that you think may cause one. It is possible to have panic attacks without developing panic disorder, and panic attacks may occur with other anxiety disorders.
What causes panic attacks and panic disorder?
Although the exact causes of panic attacks and panic disorder are still not clear, several factors may be responsible. These include an imbalance of brain chemicals (neurotransmitters), a family history of panic disorder, ways of thinking that increase your stress or anxiety, and unresolved psychological issues. Panic attacks sometimes occur as a result of a stressful situation or they can happen with no apparent trigger.
Panic attacks can also be caused or triggered by:
Certain medications (such as those used to treat asthma and heart conditions).
Too much nicotine or too much caffeine.
The use of drugs such as methamphetamines, marijuana, cocaine, or lysergic acid diethylamide (LSD).
A health condition such as an overactive thyroid (hyperthyroidism).
What are the symptoms?
During a panic attack, you may have a feeling of intense fear, terror, or anxiety along with difficulty breathing or rapid breathing (hyperventilation), chest pain or tightness, a racing or irregular heartbeat, dizziness, sweating, and shaking.
If you have repeated, unexpected panic attacks and change your behavior because you worry you will have another attack, you may have panic disorder. If you avoid public places because you are afraid that they may cause you to have a panic attack or that it will be difficult to escape if you do, you also may have agoraphobia, a disorder in which you fear and avoid public places or situations from which escape is difficult.
Cultural factors may play a role in the symptoms of panic disorder. African Americans with panic disorder frequently report episodes of feeling that they can't move during sleep (sleep paralysis). In Hispanic cultures, "ataque de nervios" is an anxiety syndrome that has symptoms similar to panic disorder.
How are panic attacks and panic disorder diagnosed?
You may be asked questions and given tests during your examination that will help your health professional decide if your symptoms are caused by heart problems, an overactive thyroid (hyperthyroidism), or another health condition. You also may be given a mental health assessment, an interview during which you may be asked questions in oral or written form.
You may experience panic attacks only a few times throughout your life, or you may have them on a regular basis, such as weekly or even daily. Panic disorder is diagnosed when you have two or more unexpected panic attacks that interfere with daily living, you worry intensely about having another attack, and you change your lifestyle to avoid situations that might trigger a panic attack.
As many as half of people who have panic disorder also have agoraphobia. Panic disorder and depression also frequently occur together.
It is possible for panic attacks or agoraphobia to occur as a result of a mental condition other than panic disorder, such as depression, post-traumatic stress disorder (PTSD), or another anxiety disorder.
How are panic attacks and panic disorder treated?
Treatments for panic attacks and panic disorder are very effective and include counseling and medications. These treatments help minimize or eliminate panic attacks and can help decrease the fear of future attacks. Early diagnosis and treatment of panic attacks is very important and can prevent other conditions associated with panic disorder, such as depression, anxiety disorders, and substance abuse. Most people with panic disorder get better with treatment and are able to resume a normal lifestyle, although relapse can occur, especially if treatment is stopped too soon.
Who has panic attacks and who develops panic disorder?
Panic attacks are very common. As much as 35% of the general population has a panic attack in the course of a year. Women have panic attacks more frequently than men, and women who have recently gone through menopause may be even more likely to have panic attacks.
About 2% of the general population develops panic disorder at some point in life, and some people are more likely than others to develop the condition. It may be passed down through families; your risk of having panic disorder is higher if you had a parent with panic disorder, especially if your parent also had depression or bipolar disorder. It is twice as common in women as in men and may be associated with the menstrual cycle.
Panic disorder can be controlled with medications (such as antidepressants) and professional counseling (such as cognitive-behavioral therapy). Successful treatment reduces the number and frequency of panic attacks, decreases the anxiety that accompanies the fear of future attacks, and improves the quality of your life.
If your panic attacks were caused by a specific trigger, such as a medication reaction, you may not need treatment once the trigger has been removed, which in this case would mean stopping the medication with the help of your health professional. However, sometimes panic attacks caused by outside factors can continue after the trigger has been removed and may develop into panic disorder.
Initial treatment for panic disorder depends upon the severity of your panic attacks, the fear or anxiety you feel about having another attack, and whether you have agoraphobia (avoiding situations or places that might trigger an attack) along with panic disorder.
Generally, initial treatment includes:
Cognitive-behavioral therapy, which focuses on modifying certain thinking and behavior patterns, is the most effective type of therapy for panic disorder.
Exposure therapy is a type of cognitive-behavioral therapy focusing on confronting a feared object or situation. It can be especially helpful in treating agoraphobia or anxiety linked to a particular place or situation.
The most common medications used to treat panic disorder are selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac), sertraline (Zoloft), or paroxetine (Paxil). If these medications are not effective or do not work because of their side effects, other antidepressants may be tried.
Antidepressants with mixed neurotransmitter effects, such as venlafaxine (Effexor) are sometimes used.
Benzodiazepines such as alprazolam (Xanax), diazepam (for example, Valium), lorazepam (Ativan), or clonazepam (Klonopin) sometimes are prescribed either alone or combined with an antidepressant. Benzodiazepines are most commonly used for rapid, short-term relief of symptoms and may also be used as a part of ongoing treatment either alone or combined with an antidepressant.
Less common antidepressants used to treat panic disorder include tricyclic antidepressants (TCAs) such as imipramine (Tofranil), desipramine (Norpramin), or clomipramine (Anafranil) and monoamine oxidase inhibitors (MAOIs) such as isocarboxazid (Marplan), phenelzine (Nardil), or tranylcypromine (Parnate).
Your symptoms of panic disorder may start to improve within a few weeks after beginning medications. If improvement is not seen within 6 to 8 weeks, a higher dose or another medication may be needed