This page provides a comprehensive overview of panic attacks and how to heal them.  It describes panic symptoms and includes information from the National Institute of Mental Health on “Clinical Panic Disorder.”

General Description of Panic
The Function of Panic
Ways to Decrease Panic Attacks
Blog Posts to Help With Panic Attacks
Assessment Tools for Panic Disorder
Overview of “Clinical Panic Disorder” from the National Institute of Mental Health (NIMH)

General Description of Panic

Panic is a sudden, uncontrollable feeling of fear or terror. It is accompanied by the physical sensations that help us fight or flee real, life threatening situations. Panic occurs when we are faced with true danger, but when it occurs in the absence of real danger, it is considered a panic attack or episode. It is much more severe than having fear or anxiety about stressful life events.

Below are the symptoms of a panic attack:

• Palpitations, heart pounding or a rapid pulse
• Sweating
• Trembling or shaking
• Breathing problems, such as shortness of breath or feeling smothered
• Feeling of choking
• Chest pain or chest discomfort

• Abdominal discomfort, upset stomach or nausea
• Feeling faint, dizzy, light-headed or unsteady on your feet
• Feeling unreal or detached from yourself
• Fear of losing control
• Fear of dying
• Numbness or tingling in arms, legs or other parts of the body
• Chills or hot flushes

Between panic attacks, someone with panic disorder usually has persistent worries that a new attack will occur. These worries may cause the person to dramatically change his or her behavior or lifestyle to avoid the embarrassment of “losing control” while with other people

If you have felt panic like this in the absence of a real threat, and fear having an attack again, you may have experienced a panic attack (see NIMH description below for clinical definition of Panic Disorder).   It is especially important to seek help right away if fear of having a panic attack is preventing you from engaging in normal daily activities or causing you to avoid places or situations.

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The Function of Panic

When humans are faced with a real (or even perceived) threat, their sympathetic nervous system prepares them to fight or flee the danger. The adrenal glands release two powerful neurotransmitters, adrenaline and norepinephrine, which increases heart rate and breathing, constricting blood vessels and tightening muscles. The sudden presence of these neurotransmitters at receptor sites in the brain allow the body to rely on spontaneous or intuitive behaviors related to combat or escape.

Panic is a survival mechanism, evolved over centuries to assist us in life threatening situations.   If you see a fire and need to flee or are confronted by a criminal, these neurotransmitters can mean the difference between life and death. However, in the absence of real threats, repeated episodes of panic can be debilitating.

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Ways to Decrease Panic Attacks

1. Rule out any medical issues – Many medical diagnoses cause the same physical symptoms of panic attacks. It is very important to first see a doctor to rule out heart issues, asthma or breathing problems, hormone imbalances, and infections. Overuse of caffeine and use of alcohol, marijuana, amphetamines, cocaine and other drugs can also either produce panic-like symptoms or trigger panic attacks.

2. Psychotherapy, especially Cognitive Behavioral Therapy – Psychotherapy is often the first recommended treatment for panic. It is important to identify the thoughts that can both trigger and exacerbate panic. Changing these thoughts can often reduce the intense emotional and physical response that occurs when a panic episode begins. A psychotherapist can also help in confronting situations that trigger panic attacks, helping one to face the feared situation in the presence of a supported other. This is called exposure therapy.

3. Relaxation – Calm Breathing and Muscle Relaxation techniques can be done in a therapy office or at home. Many psychologists believe that when you take away the physical response to fear, the psychological experience of fear disappears. That is why relaxation is almost always part of any treatment for panic and anxiety.

4. Self Help – There are many online self help strategies and books that give helpful tools for developing strategies to reduce panic attacks. Since shame, embarrassment and isolation can often accompany panic disorder, this is a good first step for anyone reluctant to see a professional for help. One of the most acclaimed methods that you can do at home is the Linden Method, which also provides free phone support. This method has solid research to back it up and a number of testimonials from people who have successfully cured anxiety and panic symptoms using the method. See here for a good review on this method. Another highly recommended book to help cope with panic attacks is the Panic Attacks Workbook.

5. Medication – Depending on the frequency and severity of the panic attacks, many SSRI antidepressants can be helpful in reducing panic attacks. Since psychotherapy can take longer, a person’s decision to use medication in addition to or instead of psychotherapy may depend on how much the panic attacks are interfering with work, relationships and other normal routines.

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Blog Posts to Help With Panic Attacks

Overcoming Panic Attacks-A Five Step Response

Calming the Rush of Panic: A Mindfulness Based Stress Reduction Guide to Freeing Yourself from Panic Attacks

What is Exposure Therapy?

Treatment of Anxiety Disorders and Panic Attacks

Personal Stories about Panic and Anxiety

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Assessment Tools for Panic Disorder

1.) Screening for Panic Disorder (Anxiety and Depression Association of America (ADAA)

2.) Panic Disorder Self Assessment Tool

Overview of “Clinical Panic Disorder” from the National Institute of Mental Health (NIMH)

Note: the information presented below is from The National Institute of Mental Health (NIMH) and represents information related to clinical level panic attacks/symptoms.

“What is Panic Disorder?
People with panic disorder have sudden and repeated attacks of fear that last for several minutes. Sometimes symptoms may last longer. These are called panic attacks. Panic attacks are characterized by a fear of disaster or of losing control even when there is no real danger. A person may also have a strong physical reaction during a panic attack. It may feel like having a heart attack. Panic attacks can occur at any time, and many people with panic disorder worry about and dread the possibility of having another attack.

A person with panic disorder may become discouraged and feel ashamed because he or she cannot carry out normal routines like going to the grocery store or driving. Having panic disorder can also interfere with school or work.

Causes
Panic disorder sometimes runs in families, but no one knows for sure why some people have it while others don’t. Researchers have found that several parts of the brain are involved in fear and anxiety. By learning more about fear and anxiety in the brain, scientists may be able to create better treatments. Researchers are also looking for ways in which stress and environmental factors may play a role.

Signs & Symptoms
People with panic disorder may have:

• Sudden and repeated attacks of fear
• A feeling of being out of control during a panic attack
• An intense worry about when the next attack will happen
• A fear or avoidance of places where panic attacks have occurred in the past
• Physical symptoms during an attack, such as a pounding or racing heart, sweating, breathing problems, weakness or dizziness, feeling hot or a cold chill, tingly or numb hands, chest pain, or stomach pain.

Who Is At Risk?
Panic disorder affects about 6 million American adults and is twice as common in women as men. Panic attacks often begin in late adolescence or early adulthood, but not everyone who experiences panic attacks will develop panic disorder. Many people have just one attack and never have another. The tendency to develop panic attacks appears to be inherited.

Diagnosis
Panic attacks can occur at any time, even during sleep. An attack usually peaks within 10 minutes, but some symptoms may last much longer.

People who have full-blown, repeated panic attacks can become very disabled by their condition and should seek treatment before they start to avoid places or situations where panic attacks have occurred. For example, if a panic attack happened in an elevator, someone with panic disorder may develop a fear of elevators that could affect the choice of a job or an apartment, and restrict where that person can seek medical attention or enjoy entertainment.

Some people’s lives become so restricted that they avoid normal activities, such as grocery shopping or driving. About one-third become housebound or are able to confront a feared situation only when accompanied by a spouse or other trusted person.  When the condition progresses this far, it is called agoraphobia, or fear of open spaces.

Early treatment can often prevent agoraphobia, but people with panic disorder may sometimes go from doctor to doctor for years and visit the emergency room repeatedly before someone correctly diagnoses their condition. This is unfortunate, because panic disorder is one of the most treatable of all the anxiety disorders, responding in most cases to certain kinds of medication or certain kinds of cognitive psychotherapy, which help change thinking patterns that lead to fear and anxiety.

Panic disorder is often accompanied by other serious problems, such as depression, drug abuse, or alcoholism. These conditions need to be treated separately. Symptoms of depression include feelings of sadness or hopelessness, changes in appetite or sleep patterns, low energy, and difficulty concentrating. Most people with depression can be effectively treated with antidepressant medications, certain types of psychotherapy, or a combination of the two.

First, talk to your doctor about your symptoms. Your doctor should do an exam to make sure that another physical problem isn’t causing the symptoms. The doctor may refer you to a mental health specialist.

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Treatments
Panic disorder is generally treated with psychotherapy, medication, or both.

Psychotherapy. A type of psychotherapy called cognitive behavior therapy is especially useful for treating panic disorder. It teaches a person different ways of thinking, behaving, and reacting to situations that help him or her feel less anxious and fearful.

Medication. Doctors also may prescribe medication to help treat panic disorder. The most commonly prescribed medications for panic disorder are anti-anxiety medications and antidepressants. Anti-anxiety medications are powerful and there are different types. Many types begin working right away, but they generally should not be taken for long periods.

Antidepressants are used to treat depression, but they also are helpful for panic disorder. They may take several weeks to start working. Some of these medications may cause side effects such as headache, nausea, or difficulty sleeping. These side effects are usually not a problem for most people, especially if the dose starts off low and is increased slowly over time. Talk to your doctor about any side effects you may have.

It’s important to know that although antidepressants can be safe and effective for many people, they may be risky for some, especially children, teens, and young adults. A “black box”—the most serious type of warning that a prescription drug can have—has been added to the labels of antidepressant medications. These labels warn people that antidepressants may cause some people to have suicidal thoughts or make suicide attempts. Anyone taking antidepressants should be monitored closely, especially when they first start treatment with medications.

Another type of medication called beta-blockers can help control some of the physical symptoms of panic disorder such as excessive sweating, a pounding heart, or dizziness. Although beta blockers are not commonly prescribed, they may be helpful in certain situations that bring on a panic attack.

Some people do better with cognitive behavior therapy, while others do better with medication. Still others do best with a combination of the two. Talk with your doctor about the best treatment for you.

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Living With Panic Disorder
“One day, without any warning or reason, I felt terrified. I was so afraid, I thought I was going to die. My heart was pounding and my head was spinning. I would get these feelings every couple of weeks. I thought I was losing my mind.”

“The more attacks I had, the more afraid I got. I was always living in fear. I didn’t know when I might have another attack. I became so afraid that I didn’t want to leave my house.”

“My friend saw how afraid I was and told me to call my doctor for help. My doctor told me I was physically healthy but that I have panic disorder. My doctor gave me medicine that helps me feel less afraid. I’ve also been working with a counselor learning ways to cope with my fear. I had to work hard, but after a few months of medicine and therapy, I’m starting to feel like myself again.”

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Clinical Trials on Panic Disorder
NIMH supports research studies on mental health and disorders. See also: A Participant’s Guide to Mental Health Clinical Research.

Participate, refer a patient or learn about results of studies in ClinicalTrials.gov , the NIH/National Library of Medicine’s registry of federally and privately funded clinical trials for all disease.

Find NIH-funded studies currently recruiting participants with panic disorder .

Science News About Panic Disorder

• Bullying Exerts Psychiatric Effects Into Adulthood
• Light Switches Brain Pathway On-and-Off to Dissect How Anxiety Works
• Nurturing Newborn Neurons Sharpens Minds in Mice

Join A Study

• Panic Disorder Studies for Adults“

End Source: The National Institute of Mental Health (NIMH) is part of the National Institutes of Health (NIH), a component of the U.S. Department of Health and Human Services.

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