Panic Attack Overview
A panic attack can creep on you suddenly and can be a truly terrifying experience, especially if you have never had one before.
It is a sudden onset of a strong wave of fear which triggers an instinctive “fight or flight” response of the body.
Panic attacks can cause severe physical reactions, which can often be mistaken for heart attacks, a feeling of a total loss of control, and even of dying.
The most common symptoms include a thumping or racing heart, trouble breathing, and an intense fear of dying or going crazy.
While some people may experience panic attacks once or just a few times in their lives as a result of stressful events, others may suffer from recurring attacks, which almost always leads to constant fear and anticipation of the next one. The latter may start suffering from panic disorder.
Panic attacks can occur even when one is fully relaxed, and sometimes happen while a person is sleeping.
First and foremost, it is vital to understand that panic attacks are not life-threatening.
At the same time, a panic attack can be a very frightening experience, and is very likely to affect one’s quality of life, especially if you have panic disorder.
Often, when people suffer from recurrent panic attacks, there is a specific panic-inducing event or situation which seems to trigger them. This can include making a public speech, traveling on an airplane, and many others.
Such panic-inducing events and situations can trigger the “fight or flight” response, and make you feel like you are trapped and that you need to escape.
Some people, who suffer from such recurrent panic episodes, may have underlying conditions such as social phobia, panic disorder, or depression.
Thankfully, there are ways to treat panic attacks and panic disorder through therapy and medication.
There are also ways to control and stop your panic attacks when they strike out without warning and to regain control over your life.
Read on to find out everything you need to know about the symptoms, causes, prevention, treatment, complications as well as ways to control and manage panic attacks.
Panic attack symptoms
The symptoms of a panic attack can appear at any time, any place, and in any situation, which is one of the reasons why they are so frightening.
Although the symptoms may vary, they usually peak within about 10 minutes and end in up to 20-30 minutes.
The problem is that a panic attack can strike while you are driving, in the middle of a presentation, in the subway, or even while you are asleep.
Usually, people feel worn and fatigued after the attack subsides.
The most common symptoms of a panic attack include the following:
- Pounding and thumping heart and a racing heart rate
- Unexplained sweating
- Shaking and trembling
- Difficulty breathing, hyperventilation, shortness of breath,
- A tight throat and feeling of choking
- Hot flashes or chills
- A sense of danger, doom, and even dying
- Dizziness, faintness or lightheadedness
- Abdominal cramps
- Pain or discomfort in the chest
- Tingling or numbness in the limbs
- A feeling of being detached from reality and the surroundings
- Intense fear of going crazy, losing control and even dying
The symptoms are quite scary and unpleasant, which is why so many people suffer from a constant anxiety of suffering another panic attack and going through the terrifying experience again. This causes many to avoid situations that may trigger the attacks, which can lead to isolation, anxiety, and depression.
Since the majority of the symptoms of a panic attack are physical and can be so severe, you may have the feeling that you are having a heart attack and that you are dying. This is the reason why so many people end up in the emergency room because of panic attacks.
Of course, any underlying medical reasons for the worrying symptoms like heart palpitations, chest pains, and difficulty breathing must be ruled out, but usually, the panic is overlooked as a cause.
Symptoms and signs that you may have panic disorder
While the majority of the people will go through a panic attack just once or twice in their lifetimes, others can develop panic disorder.
Panic disorder is caused by or can cause repeated panic attacks and, in most cases, an overall change of the behavior of the person affected, or continuous anxiety and fear of having another attack.
Some of the signs that you may have panic disorder include:
- You experience panic attacks frequently and without any obvious trigger or cause
- You spend a lot of time worrying about suffering another panic attack
- You are avoiding going to places, or doing things which are related to previous panic attacks
Even though the actual episode usually lasts for a few minutes, the terrifying experience can leave a long-lasting imprint on a person’s psyche.
If you have panic disorder, suffering frequent panic attacks can seriously affect your emotional wellbeing, your self-confidence, and can cause significant disruption to your everyday life.
This can lead to the following symptoms of panic disorder:
- Anticipatory anxiety – a constant feeling of dread and tenseness in between panic attacks, caused by the intense fear of another upcoming attack. This is the so-called “fear of fear” and can be pretty disturbing and incapacitating.
- Phobic avoidance – avoidance of any place, event, or situation associated with a previous panic attack, as well as avoidance of places and situations which do not allow for an easy escape, where it will be embarrassing, or where you won’t have available help in case of a panic attack. In extreme cases, phobic avoidance can turn into debilitating agoraphobia. People suffering from this type of phobia can start avoiding all kinds of crowded places, transportation, traveling, some types of drinks and foods, physical exercise, or going anywhere without a “safety” person – everything which they associate with or fear could trigger another panic attack.
Panic attack causes
The exact causes of panic attacks are not clear, but there is a tendency that they are hereditary. So if somebody from your family has panic attacks, it is more likely that you would suffer attacks too.
There also seems to be a connection between panic attacks and certain significant milestones and transitions in life, including graduation, starting a new job, getting married, having a child, and others.
Panic attacks can also be caused by major stress, like getting fired, getting divorced, or losing a loved one.
Also, some people who have more sensitive temperaments and are prone to experiencing negative emotions are more likely to suffer from panic attacks.
A change in the brain’s chemical balance and the false triggering of the “fight or flight” reaction is another potential explanation for experiencing panic attacks.
In some cases, panic attacks may have an underlying medical condition causing them, including:
- An overactive thyroid gland (hypothyroidism)
- Low blood sugar levels (hypoglycemia)
- Withdrawal from medication, alcohol, nicotine, or drugs
- Use of stimulants like amphetamines, cocaine or caffeine
- A mitral valve prolapse of the heart
Who is at risk of suffering from panic attacks or panic disorders?
Statistics show that women and more prone to panic attacks than men, and that the onset of panic disorder is more likely to occur in late teenage years and early adulthood.
There are some other factors which can increase the risk of having panic attacks or developing panic disorder, including:
- Genetics – a family history of people with panic attacks or panic disorder
- Severe stress – significant life stress like a serious illness or the death of a loved one, divorce, and others
- Traumatic event – accidents, sexual assault, childhood abuse, and others
- Major transition – marriage, having a baby, starting new work
- Excessive caffeine intake, smoking, drinking, illegal drugs
Although panic attacks are not life-threatening, when left untreated, especially in the case of panic disorders, they may upset your normal life.
They can cause:
- Development of phobias, like agoraphobia
- Avoidance of friends and social events
- Problems at school or work
- Frequent visits to the emergency room
- Anxiety, depression, and psychiatric disorders
- Suicidal thoughts and increased risk of suicide
- Alcohol or substance abuse
- Financial woes
Preventing panic attacks
While there is no way to prevent panic attacks and panic disorder, there are ways to minimize the risk of their recurrence, including:
- Getting proper treatment on time
- Sticking to the treatment plan
- Engaging in regular physical exercise
Diagnosis of panic attacks and panic disorder
The first step for diagnosing whether you have panic attacks, suffer from panic disorder, or have an underlying condition causing them or resembling panic attacks includes:
- Getting a thorough physical examination
- A blood test for thyroid or other conditions
- An ECG or EKG to determine an underlying heart condition
- A psychological evaluation
- Discussing your alcohol and other substance use
You may be diagnosed with panic disorder if:
- You have sudden and frequent panic attacks
- At least one of them was followed by a month or more of worrying about a next attack
- A significant change in the behavior and continued fear of suffering another panic attack
- Your frequent panic attacks are not caused by underlying medical conditions or substance abuse
It is essential to seek treatment even if you have suffered only one or two panic attacks and do not have the abovementioned symptoms of panic disorder, to avoid developing one or developing a phobia.
How are panic attacks and panic disorders treated?
Thankfully, both panic attacks and panic disorder can be treated successfully with psychotherapy sometimes combined with medications.
Proper treatment can help the frequency and the intensity of the panic attacks and can help get your life back to normal.
Your doctor will decide which type of treatment is most suitable for your specific case.
Therapy is considered the most effective treatment for panic attacks and disorders. The goal of the different types of psychotherapy is to help you understand the panic attacks better, to learn how to cope with them, and to learn how to face your fears.
An experienced cognitive therapist will help you recreate your panic attack symptoms repetitively and safely, to help you learn and realize that the symptoms are not dangerous and life-threatening.
Cognitive therapy can help reduce the feeling of fear from the physical symptoms of panic attacks, and thus help resolve them, and also help you overcome the fear of specific settings and situations which you have been avoiding due to this fear.
Usually, the results of cognitive therapy will become evident within a few weeks as the panic attack symptoms decrease. In a few months of therapy, the symptoms may decrease significantly or go away altogether.
This type of psychotherapy is suitable for treating panic disorder as well as agoraphobia caused by panic disorder.
During these sessions, the therapist will ask you to do certain exercises and things that cause sensations that are very similar to the symptoms of a panic attack. You may be asked to hold your breath, hyperventilate, shake your head and others. The goal is to mimic some of the symptoms of a real panic attack and allow you to get to know these sensations, fear them less, and thus develop a feeling of greater control over them.
If you suffer from panic disorder and agoraphobia, the exposure therapy may include you facing a specific feared situation under controlled circumstances, until the panic and fear subside.
Medications are an excellent choice for temporarily reducing or controlling certain symptoms of panic attacks and disorders.
They can be instrumental in some severe cases but should be combined with therapy and with some lifestyle changes.
There are several types of medications which are used for relieving the symptoms of panic attacks and panic disorders, including:
Antidepressants can help suppress the symptoms and improve the control over the panic attacks, but they need to be administered for several weeks before they start working.
Your doctor may prescribe one of the following types of antidepressants:
- SSRIs (Selective serotonin reuptake inhibitors) – these are considered to be generally safe, and have a low risk of any adverse effects. They are usually the first choice when it comes to prescribing medications for panic attacks. Some of the FDA approved SSRIs used for panic attacks include sertraline (Zoloft), fluoxetine (Prozac), and paroxetine (Pexeva, Paxil).
- SNRIs (Serotonin and norepinephrine reuptake inhibitors) – the most common FDA approved SNRI for panic disorder is venlafaxine (Effexor XR).
Benzodiazepines are quick-acting medications that can help relieve the symptoms of a panic attack when taken prior to or at the onset of the attack.
These anti-anxiety medications act within 30 to 60 minutes from taking them. They are sedatives that depress the central nervous system.
Some of the most commonly used benzodiazepines, approved by the FDA are alprazolam (Xanax) and clonazepam (Klonopin).
Unfortunately, benzodiazepines are also highly addictive and can cause mental as well as physical dependence. They can interact with other medications and substances you are taking, so they should be used with caution. They also should also be administered on a short-term basis because tolerance to them can be developed.
It is crucial that you work closely with your doctor when taking any medication for your panic attacks or panic disorders.
Lifestyle changes and home remedies for managing the panic attacks symptoms
While it is always recommended that you seek professional treatment for panic attacks and panic disorders, there are some lifestyle changes and home remedies which can help alleviate the symptoms, and manage the panic attacks better, including:
- Educate yourself about panic attacks – the more you know about panic attacks, panic disorder, and anxiety, as well as the fight or flight response of the body, the better you will learn to understand and accept your symptoms, without fearing death or going crazy
- Avoid alcohol, smoking or caffeine – these are all stimulants which can induce panic attacks in susceptible people
- Learn breathing control – hyperventilating can cause panic attack symptoms, while deep breathing can help alleviate them. Take the time to exercise and learn how to control your breathing to lessen the symptoms and to calm yourself when panic strikes
- Get enough sleep – sleep is essential for everyone’s wellbeing and health, and not getting enough restful sleep can worsen the symptoms of panic disorder and anxiety, so make sure you get 7-9 hours of sleep per night
- Use relaxation techniques – activities like meditation, yoga or muscle relaxation can help train the body to relax in response to anxiety and panic
- Exercise – physical exercise has been proven to relieve stress and anxiety. Try to have at least 30 minutes of movement or exercise every day. You can resort to walking, running, swimming, aerobic workouts, dancing and others
- See your friends and family – panic disorder can lead to isolation and agoraphobia, which may make your symptoms even worse. So, make sure you meet your friends, or create new supportive friendships, and reach out to them on a regular basis
- Join a support group – finding people who have the same problems and fears as you can help you cope with your panic attacks or disorder much easier
Alternative medicines for panic attacks and panic disorder
Although there have been some studies of treating panic disorder with herbs and dietary supplements, there is not sufficient proof that they can actually help subdue the symptoms. Plus, the benefits and risks have not been researched enough yet.
Since herbal and other dietary supplements are not regulated by the FDA, in the same way as medications, you should always speak to your doctor before taking any of the advertised dietary supplements or herbal remedies for your panic attacks or panic disorder. This is especially important if you are already on prescription medication in order to avoid harmful and potentially dangerous interactions.
When is it time to see a doctor?
Although panic attacks are not dangerous or life-threatening, it is essential to seek medical advice or help if you experience such episodes. This will help you get better control over the symptoms and avoid the development of more serious problems like panic disorder, anxiety, depression, agoraphobia and other conditions.
Also, in some cases, the symptoms of panic attacks can resemble the symptoms of other underlying medical conditions that need to be addressed and ruled out.
Preparing for your doctor’s appointment
Before you see your primary medical care provider regarding your panic attack symptoms, you can make a list that will help with your diagnosis and assessment.
Here are some key points to include in your list:
- List your symptoms, how often they occur, and when they first appeared
- Describe any stressful or traumatic event or situation which may have triggered your panic attack
- Include any other relevant medical information and your medical history
- List all medications you take, including your prescriptions, OTC medications, supplements, and vitamins, as well as their dosages
- Add the questions which you would like to ask your doctor or the mental health expert you have been referred to
Questions which you may expect to be asked by your doctor
- When did you first experience the symptoms, and what type of symptoms do you have?
- How often do they occur, and how long do they tend to last?
- Have you noticed anything specific triggering the attacks and the symptoms?
- How often do you worry about suffering another panic attack?
- Do you avoid certain places, events, and experiences in order to prevent potential panic attacks?
- Do your symptoms affect your family, relationships, school, or work, and if so – how?
- Have you experienced any significant stress or trauma shortly before your first panic attack?
- Do you have any traumatic experiences from the past – including accidents, military action, sexual abuse, or other?
- Describe your childhood and your relationship with your parents.
- Do you have a close relative who suffers from panic attacks, panic disorder or has another mental health issue?
- Do you suffer from any other medical conditions?
- What kinds of medications, supplements, and vitamins are you taking?
- Do you smoke, drink or use recreational drugs, and if so – how often?
- Do you exercise or engage in another physical activity regularly?
If necessary, your doctor may ask additional or follow-up questions. But it helps to be prepared with the answers to the basic ones so that you can provide all the information pertinent for proper diagnosis of your condition.
How to help someone who is having a panic attack?
Being present when a relative, friend, or loved one has a panic attack can be quite a frightening experience.
Watching a person, you care about experience problems breathing, feeling dizzy, trembling, sweating, being nauseous and having a racing heart, thinking he or she is having a heart attack is stressful for anyone.
Even if you are sure that the person is experiencing a panic attack, you shouldn’t dismiss the situation by telling them to calm down.
It is important to stay calm and help the person get through this frightening experience. This will not only help in the specific situation but can also help the person feel less threatened and fearful of another upcoming panic attack in the future.
By remaining calm, non-judging, and understanding, you can help the symptoms of the panic attack subside faster.
Help the person focus on their breathing
If possible, get the person to sit in a quiet place and help him or her take control over their breathing by taking deep and slow breaths for several minutes until the hyperventilation stops.
Try getting the person to do some exercises with you
By engaging the person who is having a panic attack with physical activity like lifting the arms or legs, clapping, or stumping their feet along with you, you can help reduce some of the stress and help them relax.
Try to distract your friend from the fear
You may try to ask your panicking friend about specific things you know interests him or her, or simply play a little game and ask them to name five things they can see four things they can touch, something that they can taste, or just about anything that can help distract them from the fear they are thinking about at the moment.
Reassure and encourage the person
Show your full support for your loved one once the panic attack is over, and encourage them to seek help for their condition. Make sure to reassure them that everything is OK and there is nothing to be embarrassed about.
Useful ways to stop or control a panic attack
Panic attacks come suddenly and at any given moment, and can be one of the most terrifying experiences you can have.
Thankfully, there are ways to control your symptoms and try to stop the panic attack as soon as you feel that it is about to start.
1. Control your breathing
Hyperventilating, which is shallow and quick breathing, can bring upon more symptoms and make the existing symptoms of a panic attack worse.
This is why getting control over your breathing is essential for subduing the symptoms.
Try to focus on breathing deeply when you feel the onset of a panic attack.
Close your eyes concentrate on your breathing, and take deep breaths.
Place your hand between the ribs and your belly button and feel how your belly rises and falls as you inhale through your nose deeply and slowly, and then allow the air to exhale through the mouth slowly.
Count from 1 to 4 each while you inhale and hold your breath for a second, then count to four as you exhale. Your hand on your belly will help you keep the tempo slow and controlled.
Within a few minutes, your symptoms should start subsiding.
2. Recognize the panic attack
Since the fear associated with the sudden onset of a panic attack is mainly due to the physical symptoms, which sometimes can feel very similar to having a heart attack, you must learn to recognize when you are experiencing a panic attack, or when you are about to experience one.
Once you recognize that you are in fact having a panic attack which is not life-threatening and which usually subsides in a matter of minutes, it will be much easier to assure yourself that it will pass and that you are not going to die, and will be OK in just several minutes.
By removing the overwhelming fear of death and doom, you can move on to the other techniques which will help alleviate the symptoms.
3. Keep your eyes closed
This is especially important if you are in a setting where there is fast movement, and a lot of visual stimuli that can trigger and feed the panic attack.
By eliminating the visual stimuli, you can focus on calming yourself down, recognizing that you are not dying, and on controlling your breathing.
4. Use mindfulness
Practicing mindfulness can be especially useful if you are prone to panic attacks. Since the panic attack usually causes a feeling of separation from reality and your surroundings, mindfulness can help fight this feeling, and bring you back to the reality of what is actually happening. It is a good idea to focus on specific sensations like feeling the texture of your clothes if you sense that a panic attack is coming up.
5. Focus on something specific
People with panic disorder may find it useful to focus their entire attention on a specific object nearby, and then start trying to notice every single detail about it. By examining the object and taking note of all the details, all of your energy will be focused on this task, and the panic symptoms may subside.
6. Relax your muscles
Muscle relaxation is very useful for controlling the response of the body during a panic attack. If you feel an impending attack, try to tense one muscle at a time, and then relax it, do it with as many muscles as you can, so that your whole body relaxes. You can start with the fingers or toes and start moving up or down your body.
It is useful to practice this technique before you have an actual panic attack so that you know how to act as soon as the symptoms start appearing.
7. Imagine your most relaxed and happy place
Think about the place where you feel or have felt the most comfortable. This can be the countryside, the beach, the mountain, your couch or anywhere else you can think of.
Imagine you are there and try feeling the sensations which you felt there – smells, sounds, tastes, and textures.
8. Do some light physical exercises
Aerobic exercise and any type of physical activity help lower the stress, thanks to the endorphins that keep the blood circulation normal and help improve the mood. Choose a light exercise if you feel like you are about to have a panic attack. This can be a brief walk, raising and lowering your arms, lifting up each leg one at a time, and so on.
If you are hyperventilating, make sure you start breathing normally first before making it worse with exercise.
9. Breathe lavender essential oil
If you suffer from frequent panic attacks, it helps to have a small bottle of lavender essential oil handy. Lavender is soothing, so you can simply drop a drop on each wrist and breathe in the scent. You can also use an essential oil diffuser if you are at home.
Lavender tea is soothing too, but be cautious when using lavender if you are already taking benzodiazepines because the combination can increase your drowsiness.
10. Have a relaxing mantra
Choose a mantra that soothes you and helps you relax and repeat it to yourself. It can be a simple mantra like “this will pass soon,” “I am in no danger,” or something else which speaks to you on a personal level.
11. Take a benzodiazepine
These medications have an almost immediate effect, so you may take a pill as soon as you feel that a panic attack is coming.
Use a medication like Xanax, or other FDA approved benzodiazepines, but only as prescribed.
Keep in mind that these medicaments are addictive, and can cause both physical and mental withdrawal.
You can also develop a tolerance to them if you overuse them, and thus will need to take more and more for them to have an effect.
It is a good idea to have your prescribed benzodiazepines with you just in case but resort to them only when you feel that you cannot handle your panic attack without them.
12. Go on with your normal life
Of course, nobody wants to have a panic attack, but you should do your best to prevent the fear and anxiety of another panic attack taking control over your entire life.
So, you should try not to avoid specific places, events, and settings that have triggered a previous panic attack. Instead, try to step out of your comfort zone, and if you are there and do have a panic attack, try to stay there without running away. This will help you realize that there is nothing so terrible to worry about.
13. Don’t try to fight the symptoms, acknowledge them instead
It is helpful to accept the symptoms instead of trying to fight them during a panic attack. This will help you teach your mind that even if there is another panic attack in the future – it will pass, and everything will be alright.
14. Observe your surroundings
To keep your feeling of now and of reality, you should try to observe your settings. Try to find five things somewhere within your sight, then pick four which you can touch, three that you can hear, two that you can smell, and one that you can taste.
This will help you keep grounded instead of detached, and will give your mind something better to do than to focus and dwell on the fear.
15. H.A.L.T. the panic attack
H.A.L.T. is an acronym for “hungry, angry, lonely, tired.” These are the four feelings that will bring some of the worst things in just about anyone, including those prone to panic attacks. The reason is, each of them can become a trigger for an attack.
As soon as you start feeling the symptoms, quickly ask yourself whether you are hungry, alone, lonely, or tired. If the answer to one or more of the questions is “yes,” then you can take the necessary steps to fix the situation before it is too late.
16. Forget about “what ifs”
Anxieties and panic attacks go hand to hand with the nagging thought of “what if.” So, stop thinking, “What if I get a panic attack there?” or “what if I embarrass myself at the business presentation” or “what if people laugh at me?”
Instead, try to exchange the question “what if” with the words “so what.”
If you manage to do that, you will make your life so much easier, especially if you have panic disorder, anxiety, or other similar problems.
17. Try putting a number on your fear level
During a panic attack, it helps if you rate the fear you are experiencing every few minutes. Use a scale of 1 to 10. This will not only help you keep your mind in the present, but will also act as a soothing reminder, that the fear is not always 10.
Panic attacks can be terrifying even for the most resilient person, but it is vital that you take timely precautions to avoid the fear of fear taking control over your life.
Left untreated, panic attacks can lead to a more serious panic disorder like agoraphobia or depression, and can seriously affect your life, work, school, relationships, finances, and just about everything that is important to you.
Panic attacks are treatable, and you can learn how to cope with them, control them, ignore them, and eventually get rid of them altogether.