What is a panic attack?
A panic attack is a severe attack of anxiety and fear which occurs suddenly, often without warning, and for no apparent reason. In addition to the anxiety, various other symptoms may also occur during a panic attack.
Panic attack symptoms
- A 'thumping heart' (palpitations).
- Sweating and trembling.
- Dry mouth.
- Hot flushes or chills.
- Feeling short of breath, sometimes with choking sensations.
- Chest pains.
- Feeling sick (nauseated), dizzy, or faint.
- Fear of dying or going crazy.
- Numbness or pins and needles.
- Feelings of unreality, or being detached from yourself.
The physical symptoms that occur with panic attacks do not mean there is a physical problem with the heart, chest, etc. The symptoms mainly occur because of an overdrive of nervous impulses from the brain to various parts of the body during a panic attack. This overdrive of nervous impulses can lead to the body producing hormones which include adrenaline (epinephrine). This is sometimes referred to as a 'fight or flight' response. This kind of reaction is normal in people when they feel they are in danger. During a panic attack the body can react in the same way.
During a panic attack you tend to over-breathe (hyperventilate). If you over-breathe you blow out too much carbon dioxide, which changes the acidity in the blood. This can then cause more symptoms (such as confusion and cramps) and make a 'thumping heart', dizziness and pins and needles worse. This can make the attack seem even more frightening and make you over-breathe even more, and so on. Over-breathing may make you feel very light-headed and even lose consciousness for a brief period. However, losing consciousness when over-breathing is very uncommon.
A panic attack usually lasts 5-10 minutes; however, sometimes panic attacks come in waves for up to two hours.
What is panic disorder?
At least 1 in 10 people have occasional panic attacks. If you have panic disorder it means that you have repeated panic attacks. The frequency of attacks can vary. About 1 in 50 people have panic disorder.
In panic disorder, there may be an initial event which causes panic but then the attacks after that are not always predictable. If you have panic disorder, you also have ongoing worry about having further attacks and/or worry about the symptoms that you have during attacks. For example, you may worry that the 'thumping heart' (palpitations) or chest pains that you have with panic attacks are due to a serious heart problem. Some people worry that they may die during a panic attack.
What causes panic attacks?
Panic attacks usually occur for no apparent reason. The cause is not clear. Slight abnormalities in the balance of some brain chemicals (neurotransmitters) may play a role. This is probably why medicines used for treatment work well. Anyone can have a panic attack but they also tend to run in some families. Stressful life events such as bereavement may sometimes trigger a panic attack.
Panic disorder, agoraphobia and other fears
Some people with panic disorder worry about having a panic attack in a public place where it is difficult to get out of, or where help may not be available, or where it can be embarrassing. This may cause them to develop agoraphobia. About 1 in 3 people with panic disorder also develop agoraphobia. See separate leaflet called Agoraphobia for more details.
If you have agoraphobia you have a number of fears of various places and situations. So, for example, you may be afraid to:
- Be in an open place.
- Enter shops, crowds and public places.
- Travel in trains, buses, or planes.
- Be on a bridge or in a lift.
- Be in a cinema, restaurant, etc, where there is no easy exit.
- Be anywhere far from your home - many people with agoraphobia stay inside their home for most or all of the time.
You may also develop other irrational fears. For example, you may think that exercise or certain foods cause the panic attacks. Because of this you may fear (develop a phobia for) certain foods, or avoid exercise, etc.
Dealing with a panic attack
To ease a panic attack, or to prevent one from becoming worse, breathe as slowly and as deeply as you can. Really focus on your breathing. Learning and using relaxation techniques may help. Many people find that deep-breathing exercises are useful. This means taking a long, slow breath in, and very slowly breathing out. If you do this a few times, and concentrate fully on breathing, you may find it quite relaxing.
Some people find that moving from chest breathing to tummy (abdominal) breathing can be helpful. Sitting quietly, try putting one hand on your chest and the other on your tummy. You should aim to breathe quietly by moving your tummy with your chest moving very little. This encourages the lower chest muscle (diaphragm) to work efficiently and may help you avoid over-breathing.
What is the treatment for panic attacks and panic disorder?
No treatment is needed if you just have an occasional panic attack. It may help if you understand about panic attacks. This may reassure you that any physical symptoms you have during a panic attack are not due to a physical disease. It may help to know how to deal with a panic attack.
Treatment can help if you have repeated attacks (panic disorder). The main aim of treatment is to reduce the number and severity of panic attacks.
Cognitive behavioural therapy (CBT) for panic disorder
CBT is a type of specialist talking treatment. It is probably the most effective treatment. Studies show that it works well for over half of people with panic disorder (and agoraphobia). CBT is a type of therapy that deals with your current thought processes and/or behaviours and aims to change them through creating strategies to deal with negative patterns, which may help you to deal with panic attacks and manage panic disorder more effectively.
Medicines for panic disorder
Antidepressants work well to prevent panic attacks in more than half of cases, even if you are not depressed. Symptoms of panic are thought to be associated with the production of brain chemicals (neurotransmitters) such as serotonin, and antidepressants are believed to interfere with the way these chemicals work. Escitalopram and sertraline are commonly used for panic disorder. They belong to the group of antidepressants known as selective serotonin reuptake inhibitors (SSRIs). If SSRIs do not work, other types of antidepressants such as imipramine or clomipramine are sometimes used.
If it works, it is usual to take an antidepressant for panic disorder for at least a year. At the end of a course of treatment, you should not stop an antidepressant suddenly; rather, you should reduce the dose gradually under the supervision of a doctor. In about half of people who are successfully treated, there is a return of panic attacks when treatment is stopped. An option then is to take an antidepressant long-term. The attacks are less likely to return once you stop antidepressants if you have had a CBT course.
A combination of CBT and antidepressants may work better than either treatment alone.
Further reading and references
Social anxiety disorder: recognition assessment and treatment; NICE Clinical Guideline (May 2013)
Anxiety disorders; NICE Quality Standards, Feb 2014
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