Panic Attack: Causes, Symptoms and Treatment

What Is A Panic Attack?

Do you experience episodes of intense fear accompanied by breathlessness, nausea, chest pain, and trembling? It may be a panic attack!

Panic attacks are sudden and brief episodes of intense fear and anxiety. They are more severe than anxiety and can cause various symptoms, including shortness of breath, racing heartbeat, and nausea. Most panic attacks are a blend of emotional, psychological, and biological reactions. Some people may also experience excessive sweating, trembling, headache, and dizziness and require medical attention.

Panic attacks are common in people who go through long periods of stress or experience a traumatic incident in life, and each episode may last for a few minutes. However, the post-panic attack symptoms, such as fatigue, muscle soreness, body pain, sleeplessness, and dizziness, may last longer. Although scary, panic attacks are not life-threatening. Seeking timely treatment and taking the prescribed medications can help.

Causes of Panic Attacks

While the exact reason behind experiencing a panic attack is still unclear, it can be caused by various factors including:

1. Stressful life events

Extreme and prolonged stress, such as having a stressful job, or major life changes, or traumatic experiences can trigger panic attacks.

2. Medical Conditions

Having a medical condition like asthma, diabetes, sleep apnoea, or hyperthyroidism can increase the likelihood of panic attacks.

3. Genetics

Family history can play a role in predisposing and increasing the risk to panic disorder.

4. Phobias

Specific phobias or agoraphobia i.e. fear of places or situations where escape might be difficult, can lead to panic attacks.

5. Biological factors

Changes in brain function or imbalances in neurotransmitters (such as serotonin or norepinephrine) can contribute.

6. Substance use

Smoking tobacco & consuming alcohol or withdrawal from it can provoke panic attacks.

Understanding these triggers can help in managing and treating panic attacks effectively.

Signs and symptoms of panic attacks

The signs and symptoms experienced of a panic attack can vary from person to person, but it commonly includes:

• Sudden & Intense distress or fear: A feeling of anxiety or overwhelming fear that comes out of nowhere
• Chest pain or discomfort: A feeling of contraction or pain in the chest, which may make you feel like you’re having a heart attack
• Shortness of breath: Feeling of choking, difficulty breathing, or feeling like you cant get enough air
• Rapid Heartbeat (Palpitations) : Heart palpitations or a pounding heart
• Excessive sweating: Sweating profusely, even when its not hot
• Hot flashes or chills: Feeling unusually hot or cold, even in normal temperature environments
• Trembling or shaking: Entire body or your hands may shake uncontrollably
• Numbness or tingling sensations: One can experience this in the hands, feet, or face
• Headache, Nausea and dizziness: Feeling dizzy, lightheaded, unsteady, or feeling like you might pass out
• Tense muscles & dry mouth: One can experience tightness in the throat along with dry mouth
• Fear of losing control or going crazy: It is feeling like you’re losing control or are detached from reality
• Fear of dying: This is a sense of impending doom or fear of dying
• Feeling of Unreality or Detachment: Feeling detached from oneself or from surroundings, like things are not real or they don’t exist

These symptoms can be extremely stressful and may aggravate quickly, usually peaking within few minutes

Diagnosis of Panic Attacks

Diagnosing panic attacks involves a thorough assessment by a medical professional, usually a psychiatrist or a psychologist. Key steps involved in diagnosing panic attacks are:

1. Clinical Assessment

The healthcare provider will conduct a detailed evaluation and interview to gather information about the symptoms experienced, individual’s medical and family history, and any potential triggers or stressors.

2. Diagnostic Criteria

The practitioner will assess whether the individual meets the diagnostic criteria for a panic attack as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), according to which a panic attack is characterized by the sudden onset of intense fear which reaches a peak within few minutes along with at least 4 of the specific symptoms mentioned above.

3. Differential Diagnosis

The doctor will rule out the possibility of other medical conditions or substances that could mimic or contribute to panic-like symptoms, such as cardiovascualr issues, thyroid disorders, or substance use.

4. Medical Evaluation

In order to rule out any underlying medical conditions that could be causing or contributing to the symptoms, doctor may recommend conducting additional medical tests like blood tests or an ECG.

5. Psychological Evaluation

The healthcare practitioner may conduct a psychological assessment for other mental health conditions such as generalized anxiety disorder (GAD), agoraphobia, or depression, that common co-occur with panic disorders.

6. Frequency of the panic attacks

The practitioner will evaluate the frequency and impact of the panic attacks on an individuals’ daily life and functioning as recurrent attacks may indicate a diagnosis of panic disorder.

How to treat panic attacks?

Once a thorough assessment is completed, the healthcare provider can make a diagnosis and discuss appropriate treatment options. Treating panic attacks typically involves a combination of approaches tailored to an individual’s need and severity of their symptoms.

If panic attacks are linked to a health condition, such as asthma, sleep apnoea, or heart disease, healthcare practitioners will focus on treating the illness to prevent recurrent panic attacks. However, if panic attacks are related to stress, anxiety, or traumatic events, here are some common treatment strategies:

1. Therapy (Psychotherapy)

• Cognitive Behavioural Therapy (CBT)

This form of therapy focuses on changing wrong and negative thoughts, feelings and behaviours. It helps individuals identify and change negative thought patterns and behaviours that contribute to panic attacks. Techniques such as cognitive restructuring and exposure therapy may be used.

• Exposure Therapy

This is a type of cognitive behavioural therapy in which the therapist exposes you to your fears to help you get rid of them for good. Gradual and controlled exposure to situations or sensations that trigger panic attacks can help reduce fear and anxiety over time.

• Mindfulness-Based Therapies

Practices such as mindfulness meditation or acceptance and commitment therapy (ACT) can help individuals develop skills to manage anxiety and cope with panic attacks.

2. Medications

Medicines can help calm the mind and ease the symptoms of a panic attack. The healthcare provider may prescribe antidepressants to reduce the frequency and severity of panic attacks. They may also prescribe benzodiazepines for acute symptoms relief but they are not generally recommended for long-term use due to the risk of dependence. The doctor may also prescribe medications to help manage physical symptoms of anxiety, such as rapid heartbeat and trembling.

3. Lifestyle Modifications

• Manage Stress

Practising stress-reduction techniques such as deep breathing exercises, progressive muscles relaxation, or yoga can help alleviate anxiety and prevent panic attacks.

• Exercising Regularly

Engaging in regular physical activity can help reduce overall anxiety levels and improve mood.

• Get Adequate Restful Sleep

Ensuring healthy sleep habits can contribute to better emotional resilience.

4. Education & Support

Understanding the nature of panic attacks and learning coping strategies can empower individuals to manage their symptoms more effectively. Connecting with other people who have had similar experiences can provide validation, encouragement, and practical tips for managing panic attacks.

5. Avoidance of Triggers

Identifying and avoiding triggers that can lead to panic attacks can help reduce the frequency of episodes.

6. Combination Therapy

Depending on the severity of symptoms, for some people a combination of psychotherapy and medication may be the most effective approach.

Treatment for panic attacks should be personalized based on the symptoms experienced, preferences, and if there are any co-existing conditions. Early intervention and consistent treatment adherence can significantly improve outcomes and quality of life for individuals.

Living with panic attacks – Tips for management

If you get panic attacks often, doing the following can help you manage the symptoms —

1. Deep breathing

Panic attacks can make your breaths fast and shallow. Therefore, when you feel overly anxious, breathing deeply can help relax your mind and body. You can also practice the 4-7-8 breathing technique. This technique involves —

• breathing in or inhaling for 4 seconds
• holding your breath for the next 7 seconds
• slowly exhaling and exhaling for 8 seconds

2. Remind yourself that this is temporary

Most panic attacks last for a few minutes to half an hour. Therefore, if you find yourself in the situation, remind yourself that it will be over soon. You can also tell yourself that although the symptoms are uncomfortable, you can deal with them like you have done before.

3. Sit in a quiet place

When you have a panic attack, you may feel uncomfortable in a crowded and noisy place. Therefore, it is wise to find a quiet place to sit and focus on your thoughts and breathing.

4. Be mindful of the present

Concentrate on the present moment to defeat negative and traumatic thoughts. You can also concentrate on a nearby object for a few minutes or until you feel better. This simple exercise can settle the mind and calm you down.

5. Chant a mantra

Chanting a simple mantra can stop negative thoughts and ease stress and anxiety. You can chant anything that makes you feel better and positive about things, like “All is well” or “This too shall pass”. This simple practice can also slow down your physical responses, normalise breathing, and relax the muscles.

6. Be active

When you walk, jog, dance, exercise, or play a sport, your body releases endorphins – one of the feel-good hormones that help ease stress and pain and improve mood. Therefore, walking and engaging in other physical activities can help manage panic attacks.

7. Listen to music

When you are feeling stressed or anxious, listening to music can relax your mind, normalise blood pressure, and ease the symptoms of a panic attack.

8. Talk to you loved one or a friend

Talking things over with a loved one or a friend can calm you down and make you feel better.

How to prevent panic attacks?

The following measures may help prevent episodes of panic attacks —

1. Identify & Avoid Triggers

If there is something that triggers panic attacks, stay away from it consciously. For example, some people panic in enclosed spaces, while others feel anxious and suffocated during arguments. Smoking cigarettes or drinking alcohol and caffeinated beverages can also trigger panic attacks.

2. Take the prescribed medication

Medications are quite effective in easing symptoms of panic attacks. If your doctor has prescribed medications for panic attack treatment, make sure you take them as directed. It is also important to stick to the treatment plan unless your healthcare practitioner tells you otherwise.

3. Manage stress

Stress is a significant contributor to panic attacks. Implementing stress management techniques such as deep breathing, progressive muscle relaxation, mindfulness meditation, or yoga can help reduce overall stress levels. Developing a hobby, reading books, going for nature walks, and talking to your loved ones can also help.

4. Exercise regularly

Exercising and staying active will help release feel-good hormones and lower the risk of panic attacks. Aim for at least 30 minutes of moderate exercise most days of the week.

5. Consume a healthy diet

Your diet is important to prevent nutritional deficiencies and maintain good physical and mental health. Eat regular, nutritious meals to maintain stable blood sugar levels & avoid skipping meals as low blood sugar can contribute to feelings of anxiety.

6. Limit Stimulants

Reduce or eliminate substances that can increase anxiety, such as caffeine and nicotine, as these substances can trigger or exacerbate panic attacks.

7. Limit Alcohol & Drug Use

Avoid excessive alcohol consumption and drugs, as they can increase anxiety and trigger panic attacks.

8. Regular check-up with Healthcare Provider

Regular follow-up appointments with your doctor can help monitor your progress and adjust treatment, if needed.

Conclusion

To sum up, if you experience panic attacks often, seek professional help without delay. A healthcare provider can suggest ways to manage triggers and prescribe medications to ease the symptoms. By implementing preventive strategies consistently and with proactively managing stress and triggers, you can significantly reduce the frequency and intensity of panic attacks.

It’s important to note that experiencing a panic attack does not necessarily mean a person has panic disorder; however recurrent and unexpected panic attacks may be indicative of a panic disorder.

Source: my.clevelandclinic, betterhealth, medicalnewstoday, healthline, mind.org.uk, mayoclinic