A panic attack is an episode of unreasonable, overwhelming fear which strikes for no particular reason, and at no predictable time.

Symptoms

The features of a panic attack include feeling the sudden onset of four or more of the following symptoms:

• A sense of impending doom.
• Fear of insanity.
• Palpitations, felt as a racing or pounding heartbeat.
• Nausea with chest pain or a feeling of pressure inside the chest.
• Trembling, dry mouth, or sweating.
• Breathing difficulties.
• A feeling of dread or of loss of control.
• Feeling dizzy or fainting.
• Feelings of unreality.
• Feeling that one is about to die.

A panic attack peaks within a few minutes of starting, and lasts up to 15 minutes in most cases. It is rare for an attack to last more than an hour. Following the attack, patients feel worn out and may remain exhausted for a long time. Many attacks may occur over a period of a few hours. However, they may be of different intensity. Attacks during sleep have been reported.

Panic attacks occur twice as often in women as in men. About half of those who suffer panic attacks have the first episode before the age of 24 years. Some have only one attack, while others have repeated bouts.

The sufferer may feel intense anxiety even between attacks because of the inability to predict when and where the next attack will strike, and the fear of being far from help when an attack strikes. This is called anticipatory anxiety. The occurrence of panic attacks is often associated with another phobia called agoraphobia, or the fear of being in open spaces.

Risk factors

Panic attacks are more common with:

• The use of stimulants like caffeine
• Hereditary factors
• Stressful situations
• Chemical imbalances as may occur with hypoglycemia, hyperthyroidism or phaeochromocytomas, or with certain medications.

The fear of experiencing a panic attack when far from help can be disabling.  This so-called ‘anticipatory anxiety’ can make the affected person retreat to the safety of home more and more often, eventually resulting in becoming house-bound. This is why panic attacks need to be treated as early as possible.

Diagnosis and treatment

The presence of these symptoms may signal the presence of other psychological issues. Once a panic disorder is diagnosed, supportive counsel, patience and the willingness to help the victim emerge from it can go a long way.

In established cases, psychotherapy, cognitive-behavioral therapy, and/or psychiatric medication are helpful in treating the disorder. Adopting a regular timetable, ensuring enough sleep, abstaining from alcoholic drinks, avoiding stimulants and eating regularly are also advisable.

Medications include benzodiazepines and SSRIs. Treatment is aimed at relieving the panic attack, as well as preventing anticipatory anxiety, and expanding the zone of activity by helping to overcome avoidance behavior. Many patients respond to treatment by complete cessation of panic attacks, while a large percentage shows impressive reductions in the frequency and intensity of attacks.

References

• https://www.uhs.umich.edu/anxietypanic
• https://www.med.upenn.edu/ctsa/panic_symptoms.html
• http://www.brown.edu/Courses/BI_278/Other/Clerkship/Didactics/Readings/panic.pdf
• https://umm.edu/health/medical/ency/articles/panic-disorder

Further Reading

• All Panic Attack Content
• Panic Attack Symptoms
• Panic Attack Treatment
• Panic Attacks During Menopause
• Panic Attacks in Open Spaces

Written by

Dr. Liji Thomas

Dr. Liji Thomas is an OB-GYN, who graduated from the Government Medical College, University of Calicut, Kerala, in 2001. Liji practiced as a full-time consultant in obstetrics/gynecology in a private hospital for a few years following her graduation. She has counseled hundreds of patients facing issues from pregnancy-related problems and infertility, and has been in charge of over 2,000 deliveries, striving always to achieve a normal delivery rather than operative.