Understanding panic attacks: Symptoms and treatment

What are panic attacks?

Panic attacks are unmistakable. You're involved in some ordinary aspect of life when suddenly your heart begins to pound and you hyperventilate, sweat, and tremble. You fear you are having a heart attack, or even dying. Then, 10 minutes or so later, it's gone. What just happened?

Unfortunately, there is no clear answer. You may have had a panic attack.  Panic attacks are fairly common, usually beginning between ages 15 and 25. If you have recurrent panic attacks - and for some sufferers, they recur again and again - and if a persistent fear of subsequent attacks occurs or if you change your behaviour significantly because of such attacks, you have panic disorder. Between attacks, sufferers live in dread of the next one.

Many people with panic disorder relate an attack to what they were doing when it occurred. They may assume that the restaurant, lift, or classroom caused the attack, and decide to avoid that situation. In these cases, panic disorder may lead to agoraphobia -- the fear of leaving home or being in public places -- though the relationship between the two conditions is unclear.

What causes panic attacks?

The underlying cause of panic attacks and panic disorder is not clear. There is evidence of both a genetic and a biochemical basis. There is also an association with phobias, such as school phobia or agoraphobia, as well as with depression, alcohol or cigarette abuse, suicide risk, and seasonal affective disorder - a type of depression that occurs during winter months.  

The sudden feeling of terror or doom often brings on hyperventilation - uncontrollable, rapid, shallow breathing. This in itself can cause many of the other physical symptoms by upsetting the balance of oxygen and carbon dioxide in the bloodstream.  

Panic disorder may begin after a serious illness or accident, the death of a close friend, separation from the family, or the birth of a baby. Attacks may also accompany the use of mind-altering drugs. Most often, however, a panic attack comes "out of the blue". It may even begin during sleep.  

Some medical problems and medications can cause panic attacks, including some antidepressants at high dosage. Panic disorder that begins after age 40 suggests depression or another underlying medical health disorder.

What are the symptoms of a panic attack?

If you have four or more of the following symptoms, you may be having a panic attack:

• Sudden high level of anxiety - with or without a cause
• Heart palpitations
• Sweating
• Shaking
• A ‘smothering’ sensation
• A feeling of choking
• Chest pain or discomfort
• Nausea
• Dizziness or faintness
• A sense of unreality
• A fear of dying
• Numbness or tingling
• Chills or hot flushes

An isolated panic attack, while extremely unpleasant, is not uncommon or life-threatening. Panic disorder and panic attacks are not the same thing. All panic disorders have panic attacks as a symptom but having a panic attack does not mean you have panic disorders. Panic attacks can be a symptom of other anxiety disorders as well.

You may think you're having a heart attack -- and it's true that the symptoms can be similar. However, most people having a panic attack have had one before, triggered by a similar event or situation.

The chest pain of a panic attack usually stays in the mid-chest area (the pain of a heart attack commonly moves toward the left arm). It is often accompanied by rapid breathing, rapid heartbeat, and fear. A panic attack usually lasts only a few minutes, comes suddenly and leaves suddenly, but leaves one exhausted.

What are the treatments for panic attacks?

The cause of most panic attacks is not clear, so treatment may be different for each person. Typically, it involves psychotherapy, cognitive-behavioural therapy, and/or medication. Alternative treatments like meditation and relaxation therapy are often used to help relax the body and relieve anxiety.

If you’re in the middle of a panic attack, some relief can come from taking anti-anxiety medications, at least in the beginning of medical therapy.

For preventive or maintenance care, psychotherapy offers support and helps minimise fear. In some cases, psychotherapy alone can clear up the disorder.

Cognitive-behavioural therapy helps people learn to deal with panic symptoms, using techniques like muscle and breathing relaxation. Patients also gain reassurance that panic will not lead to the catastrophic events they fear, since many people fear they are having a heart attack or going mad.

Antidepressants often help reduce anxiety and the frequency and severity of panic attacks. Even more frequently used medications are the selective serotonin reuptake inhibitors (SSRIs). This group of medications is often considered the first line of treatment for panic disorders.

How can I prevent panic attacks?

You can take steps to lessen the chance of having panic attacks and learn to manage them better. Learn to recognise a panic attack. When you sense the first symptoms, know that other symptoms may follow. You have survived them before and can do so again. Try slow, deep breaths.  

• Take your time. It's important not to hope for a quick cure. Therapy takes time, and improvement comes in small steps.  
• Go easy on yourself. People who feel panic tend to be overly critical of themselves.  
• Learn to lower your level of everyday anxiety through a variety of techniques, including meditation and exercise.
• Learn other relaxation techniques, like deep breathing or guided imagery.
• Avoid stimulants, such as nicotine and caffeine, which can be found not only in coffee, but many teas, colas and chocolate.