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Panic Attack


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Panic attack

Central nervous system

A panic attack is a feeling of intense, overwhelming fear that starts suddenly without warning and without any obvious cause in seemingly harmless situations. Usually, a panic attack lasts for just a few minutes and then gradually goes away. Some people experience a series of panic attacks, each of relatively short duration, but together lasting for periods of up to one or two hours.

A panic attack is not dangerous, but it can be extremely distressing for the person concerned. The panic attacks can create such a strong feeling of being out of control that they can lead to the development of other conditions such as anxiety, phobias and depression.

Panic attacks are very common. They often first develop in teenagers and young adults, but can affect anyone at any age. Women are more likely to get panic attacks than men.

The exact cause of panic attacks is not known. Some suggest that there may be a genetic reason because in some people panic attacks tend to run in families. However, many people who experience panic attacks have no other relatives with the condition. In these cases, it would appear that there is some physical or psychological event such as pain, worry or fear of failure that triggers a normal emotional response to which the person over-reacts.

Whatever the causes may be, once a panic attack starts its intensity and duration is maintained by a vicious cycle of physical symptoms, thoughts and behaviour. As the panic attack starts there is a strong sense of fear. Fear normally acts as a protective mechanism for the body because it prepares the body for action. This is termed the ‘fight or flight’ response as the body is preparing to either fight or run away from danger. A chemical called adrenaline is released in the body which stimulates the heart and increases the breathing rate to prepare the body for physical activity (fighting or running away). The sensation of the fast heart rate and fast breathing rate feeds back to the brain, reinforcing the sensation of fear which leads to the release of further amounts of adrenaline, establishing a cycle of events that leads to the panic attack.

When a person has a panic attack, the heart beat races and the breathing rate changes. The person may feel short of breath and feel the need to gulp for air, or breathing may become very rapid. The person may experience chest pain and lose feeling in fingers and toes. Some people feel that they cannot swallow and feel sick, faint and dizzy. Another common symptom is sweating and feelings of terror and unreality. Many think that they are going mad or suffering a heart attack. Symptoms may last for a few seconds or for 5 to 10 minutes. Attacks may occur singly or one after another.

Most doctors agree that a combination of cognitive and behavioural therapies is the best treatment for repeated panic attacks, or so called panic disorder. These therapies help people identify the things that trigger the attacks and, once recognised, to learn to control their emotional and behavioural responses. The therapies help people accept that the panic attacks will not cause harm.

In some cases doctors may prescribe a medicine to help. Antidepressants called SSRIs (selective serotonin reuptake inhibitors) such as citalopram, escitalopram and paroxetine are the most widely used. Improvement in symptoms is usually seen in 6 to 8 weeks, but they may have to be continued for several months to ensure that symptoms are fully controlled.

Other drugs called benzodiazepines, such as diazepam, help control anxiety that may lead to a panic attack. However, benzodiazepines are addictive and so should only be used for a few weeks.

Other drugs such as beta-blockers, that are normally used to control high blood pressure or angina, may be used to slow the heart rate and by doing so interrupt the vicious cycle that intensifies the panic attack.

When to see your pharmacist
If you suffer an occasional panic attack and would prefer to manage the condition by yourself, talk to your pharmacist. Your pharmacist is able to supply a number of herbal medicines that may help you relax and cope with everyday worries that may be causing your panic attacks.

If your pharmacist considers that your panic attacks are affecting your life style, you will be advised to see your doctor.

When to see your doctor
If you think you or a relative's life is being affected by panic attacks you should make an appointment to see a doctor. Your doctor may decide to prescribe one of the medicines described above or refer you to a specialist in cognitive and behavioural therapy.

Living with panic attacks
Although it may seem impossible at first, accepting that the panic attack will not cause any harm is key to breaking the cycle and stopping the attacks. Understanding how the symptoms of a panic attack create a vicious circle of events will help you break the cycle.

Learning relaxation techniques and controlled breathing can help during panic attacks. Relaxing should help if you start to feel anxious. Some people find yoga classes useful as a method of learning to relax, others find listening to relaxing music helpful. Practising breathing techniques when you are not having a panic attack should help breathing during an attack. This means taking long, slow breaths in and very slowly exhaling.

If you do experience a panic attack, try and distract yourself by talking to someone or counting backwards. Try and think positive, reassuring thoughts. As you begin to realise that you are controlling the panic attacks, rather than they are controlling you, you will find that the number and intensity of attacks will fall.

Useful Tips
  • Try and reduce stress in your life

  • Learn a relaxation technique such as yoga

  • Do not drink alcohol to try and relax

  • If you smoke, try to stop - see give up smoking section

Reviewed on 12 April 2011