Panic attacks are sudden periods of intense fear that may include palpitations, sweating, shaking, shortness of breath, numbness, or a feeling that something really bad is going to happen. [1][2] The maximum degree of symptoms occurs within minutes. There may be a fear of losing control or chest pain. [2] Panic attacks themselves are not dangerous. [3] They are distinguished from other forms of anxiety by their intensity and their sudden, episodic nature. [5] They are often experienced in conjunction with anxiety disorders and other psychological conditions, although panic attacks are not generally indicative of a mental disorder.
Panic attacks can occur as part of a number of mental health conditions, including panic disorder, social anxiety disorder, post-traumatic stress disorder, drug use, depression, and a number of medical problems. [2][4] They can either be triggered or occur unexpectedly. Often people are not aware of a specific trigger or the underlying issues, feelings and emotions that may contribute to a panic attack. To uncover these deeper issues is an important part of therapy. An awareness of them usually makes the panic attacks subside.
Common risk factors include smoking and psychological stress. Similar symptoms to panic attacks can be caused hyperthyroidism, hyperparathyroidism, heart disease, lung disease, and drug use. [2]
In Europe about 3% of the population has a panic attack in a given year while in the United States they affect about 11%. They are more common in females than males. They often begin during puberty or early adulthood. Children and older people are less commonly affected. [2]
Symptoms
People with panic attacks often report a fear of dying or heart attack, flashing vision, faintness or nausea, numbness throughout the body, heavy breathing and hyperventilation, or loss of bodily control. Some people also suffer from tunnel vision, mostly due to blood flow leaving the head to more critical parts of the body in defense. These feelings may provoke a strong urge to escape or flee the place where the attack began (a consequence of the “fight-or-flight response”, in which the hormone causing this response is released in significant amounts). This response floods the body with hormones, particularly epinephrine (adrenaline), which aid it in defending against harm. [5]
A panic attack is a response of the sympathetic nervous system (SNS). The most common symptoms include trembling, dyspnea (shortness of breath), heart palpitations, chest pain (or chest tightness), hot flashes, cold flashes, burning sensations (particularly in the facial or neck area), sweating, nausea, dizziness (or slight vertigo), light-headedness, hyperventilation, paresthesias (tingling sensations), sensations of choking or smothering, difficulty moving, and derealization. These physical symptoms are interpreted with alarm in people prone to panic attacks. This results in increased anxiety and forms a positive feedback loop. [6]
Often, the onset of shortness of breath and chest pain are the predominant symptoms. Shallow and rapid breathing can change the pH level in one’s blood, which leads to even more symptoms of a panic attack. To break this vicious cycle is difficult once the panic attack has started.
However, since the symptoms of a panic attack are similar to symptoms of severe physical illnesses, they should always be investigated for somatic sources.
Treatment of Panic attacks
Psychotherapy should always be a part of treatment.
Medication can be added to prevent the occurrence of panic attacks for a while. This lowers the anxiety of having another panic attack, which in itself lowers the likelihood of having a panic attack. First line treatment is usually an antidepressant from the group of serotonin reuptake inhibitors (SSRIs) for the long-term in combination with a benzodiazepine, such as Alprazolam (Xanax(R)) or Lorazepam (Temesta(R)), as a one-off when a panic attack might be coming on. The disadvantage of the benzodiazepines is that they take up to an hour to have an effect, work only for up to a couple of hours and, if they are taken regularly, they can be addictive. However, many patients find it useful to carry a tablet of Xanax(R) or Temesta(R) with them. This already often lowers the fear of having a panic attack.
References
[1] “Anxiety Disorders”. NIMH. March 2016.
[2] American Psychiatric Association (2013), Diagnostic and Statistical Manual of Mental Disorders (5th ed.), Arlington: American Psychiatric Publishing, pp. 214–217, 938, ISBN 0890425558
[3] Geddes, John; Price, Jonathan; McKnight, Rebecca (2012). Psychiatry. OUP Oxford. p. 298. ISBN 9780199233960.
[4] Craske, MG; Stein, MB (24 June 2016). “Anxiety.”. Lancet (London, England). PMID 27349358.
[5] Bourne, E. (2005). The Anxiety and Phobia Workbook, 4th Edition: New Harbinger Press.
[6] Klerman, Gerald L.; Hirschfeld, Robert M. A.; Weissman, Myrna M. (1993). Panic Anxiety and Its Treatments: Report of the World Psychiatric Association Presidential Educational Program Task Force. American Psychiatric Association. p. 44. ISBN 978-0-88048-684-2.
© Dr Christian Jonathan Haverkampf. All rights reserved.
Psychotherapy & Counselling, Communication, Medicine (Psychiatry); Dublin, Ireland
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