Panic Attack (Specifier)

Panic attack symptoms typically appear abruptly and peak within minutes. To be considered a panic attack, the person must experience at least four of the following symptoms:

• Pounding heart, accelerated heart rate, or palpitations
• Sweating
• Shaking or trembling
• Feeling short of breath or as if they are being smothered
• Feeling as if they are choking
• Experiencing chest pain or discomfort
• Having nausea or abdominal distress
• Feeling faint, unsteady, light-headed, or dizzy
• Having chills or sensations of heat
• Experiencing paresthesia (feeling tingling or numbness)
• Having depersonalization (feeling detached from oneself) or derealization (feeling disconnected from reality)
• Feeling as if they are going crazy or losing control
• Having a fear of dying

Some people experience limited-symptom panic attacks, which have fewer than four of the symptoms mentioned above.

These symptoms are similar to the body’s fight-or-flight response, which we typically only experience when in danger. However, for people experiencing a panic attack, the symptoms can seemingly appear out of nowhere. The level of fear may be entirely out of proportion to the situation. Symptoms generally resolve in a few minutes as the body cannot sustain the “fight or flight” response for very long, but repeated attacks can occur.

Panic attacks are a defining characteristic of panic disorder, which researchers believe may result from both physical and psychological causes. 

There may be a genetic predisposition to panic attacks. Some people with panic disorder and panic attacks report that they have close family members with either panic disorder or another emotional disorder, like anxiety or depression. 

Stressful life events may trigger panic disorders and panic attacks. With the addition of more and more stress, some people may develop a lower resistance to it, which may lead to a physical response that triggers a panic attack.

Another possible cause for panic attacks may be that the person experiencing them brings them on by responding to various stimuli in a particular way. For example, someone who experiences panic attacks may have a higher heart rate for another reason, like exercising or drinking coffee, but then interpret the physical sensation of their heart racing as the beginning of an attack. This interpretation can increase their anxiety, which may be enough to bring on a panic attack. Focusing on the multiple causes of panic attacks may help the person reduce their frequency and severity.

Panic attacks are highly treatable. Some of the options for treatment include:

Medication

Several medications have been used to manage panic disorder. The FDA approved medications for panic disorder include:

• Selective serotonin reuptake inhibitors (SSRIs): SSRIs are prescribed for panic disorder, and include medications such as fluoxetine, paroxetine, and sertraline.
• Serotonin and norepinephrine reuptake inhibitor (SNRI):  Venlafaxine is approved for the treatment of panic disorder. 
• Benzodiazepines: During a panic attack, a fast-acting benzodiazepine, like lorazepam or clonazepam, may help. These medications may be prescribed for a short period for the patient to take on an as-needed basis. These medications are habit-forming, have serious side effects, and can interact with other medications and substances such as alcohol.

It is important to consult with a doctor or medical professional before beginning or changing any medication plan. The information provided in this article is not intended as medical advice; please consult a qualified healthcare professional for personalized guidance.   

Self-care

Self-care can have a significant impact on both physical and mental health. Below are some tips to get started with self-care:

• Get regular exercise.
• Eat regular healthy meals.
• Stay hydrated.
• Prioritize sleep. 
• Make time for something relaxing, like breathing exercises, meditation, yoga, or journaling.
• Stay positive. Recognize and challenge negative thoughts. 
• Stay connected to friends and family.
• Reach out for support when needed.

Relaxation techniques may help someone get through a panic attack. These techniques tend to engage the body’s relaxation response, which can slow breathing, lower blood pressure, and lower heart rate, counteracting the physical manifestations of the episode. As those physical processes slow down and relax, the perception of panic also tends to decrease.

Some relaxation techniques that may be useful during a panic attack include the following: 

• Progressive relaxation, the controlled tensing and releasing of different muscles in the body 
• Guided imagery (also called visualization), the process of picturing scenes, events, or images that bring about feelings of calmness or relaxation to relax the body
• Breathing exercises, which can consist of deep breathing, box breathing, or other paced exercises

Therapy can be an effective way to help people learn to cope with their panic attacks and work through any underlying concerns contributing to panic attacks. For those whose fear of panic attacks makes it difficult to leave home, online therapy may be an effective option. Online therapy with BetterHelp allows you to choose how to communicate with a therapist, whether by audio, video, live chat, or a combination of these methods. 

Also, the Anxiety and Depression Association of America (ADAA) has multiple resources available for people who may be experiencing panic attacks, including links to online seminars and lectures, blog posts, and first-hand accounts. You can also visit the ADAA’s website to find virtual or local in-person support groups.

Further, if you’re looking for ideas for relaxation techniques and where to begin, Harvard Medical School has a great list of six techniques to get you started.

One recent study looked at the effects of caffeine on people with panic disorder and found that the amount of caffeine in five cups of coffee induced panic attacks in a large portion of participants. The researchers believe that caffeine-induced changes in the body’s homeostasis and brain-mediated processes led to increased anxiety and panic attacks and suggested that future studies should look at other mechanisms in the body that may be affected by caffeine.

Another recent study looking at data about panic attacks concluded that recurrent panic attacks were associated with the onset of other mental disorders. This research proposes that a single panic attack may be protective. In contrast, recurrent panic attacks were associated with worse outcomes and were correlated with increased rates of major depression, bipolar disorder, anxiety disorders, impulse control disorders, and substance use disorders.³ 

• One recent study found that the lifetime prevalence of panic attacks was 13.2%. Of these, 12.8% occurred in people who met the criteria for a diagnosis of panic disorder.
• Between 70% and 80% of people experiencing panic attacks go to their primary care physician for help. 
• According to the National Comorbidity Survey Replication (NCS-R), the past-year prevalence of panic disorder among U.S. adults was 2.7%. 
• Panic disorder is highly treatable. Pharmacological therapy and cognitive behavioral therapy⁴ are effective for about 80% of people.

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