Condition Basics

What are panic attacks and panic disorder?

A panic attack is a sudden, intense fear or anxiety. It may make you short of breath or dizzy or make your heart pound. You may feel out of control. Some people believe that they're having a heart attack or are about to die. An attack usually lasts from 5 to 20 minutes. But it may last longer, up to a few hours. If these attacks happen often, they are called a panic disorder.

Panic attacks can be scary and so bad that they get in the way of your daily activities. Treatment can help most people have fewer symptoms or even stop the attacks.

What causes them?

Experts aren't sure what causes panic attacks and panic disorder. Attacks occur when you feel stressed or sense danger even though there is none. They may be more likely if you have a family history of panic disorder. They may be triggered by things such as depression, high stress levels, and heavy alcohol use.

What are the symptoms of a panic attack and panic disorder?

A panic attack may cause a feeling of intense fear, terror, or anxiety. Other symptoms include trouble breathing, chest pain or tightness, and a fast or irregular heartbeat.

When you have panic disorder, you have repeated, unexpected panic attacks. And you may worry that you'll have another attack. Because of this fear, you may change your daily activities to avoid situations that may trigger it.

How are they diagnosed?

Your doctor will ask about your health and symptoms and do a physical exam. You may get blood tests to rule out other causes of your symptoms. You may have panic disorder if you have at least two unexpected panic attacks, worry about having another attack, and avoid situations that may trigger it.

How are they treated?

Treatment for panic attacks and panic disorder includes counselling, such as cognitive behavioural therapy (CBT). Medicines, such as antidepressants, may also help. Treatment can help most people control or even stop attacks. But symptoms can come back, especially if you stop treatment too soon.

Cause

Experts aren't sure what causes panic attacks and panic disorder. The body has a natural response when you're stressed or in danger. It's called the fight-or-flight response. It speeds up your heart, makes you breathe faster, and gives you a burst of energy. It gets you ready to deal with or run away from danger. If this response happens when there's no danger, it's called a panic attack.

Panic attacks and panic disorder may be more likely if you have a family history of panic disorder. They sometimes have no clear cause.

Panic attacks may also be brought on by:

• A health problem, such as an overactive thyroid (hyperthyroidism), or heart or breathing problems.
• Depression or another mood disorder.
• Heavy alcohol use.
• Having too much nicotine or too much caffeine.
• Certain medicines, such as ones used to treat asthma and heart problems.
• Using drugs.
• Having high levels of stress for a long time.

Symptoms

Symptoms of a panic attack may include:

• A feeling of intense fear, terror, or anxiety.
• Trouble breathing or very fast breathing.
• Chest pain or tightness.
• A heartbeat that races or isn't regular.
• Sweating.
• Nausea or an upset stomach.
• Dizziness and shaking.
• Numbness or tingling.
• Fear that you are going to die, lose control, or "go crazy."

Symptoms of panic disorder may include:

• Repeated, unexpected panic attacks.
• Worry that you'll have another attack. Because of this fear, you may change your daily activities to avoid situations that may trigger it.

Some people have a fear of being in crowds, standing in line, or going into shopping malls. They are afraid of having another panic attack or of not being able to escape. This problem is called agoraphobia. It can be so bad for some people that they never leave their homes.

People who have panic disorder often have depression at the same time.

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What Happens

A first panic attack often starts without warning during an everyday activity such as shopping or walking down the street.

• You may become confused and think you are "going crazy." You may feel like something bad is going to happen.
• You may feel a strong need to leave the area and go to a place that feels safe, such as your car or home.
• You may also have physical symptoms. This may include shortness of breath, a pounding heart, or chest pain. It's common to think that you're having a heart attack and to seek treatment in a hospital emergency room.

For many people, the first panic attack may occur at a stressful time. It may happen during a serious illness or injury, the loss of a relationship, or separation from family. A woman may have her first panic attack after she gives birth.

It's also possible for a first panic attack to be caused by a drug reaction or a reaction to nicotine or caffeine.

Panic disorder

If panic attacks happen often, they are called a panic disorder. People with panic disorder may:

• Feel exhausted from lack of sleep.
• Use drugs or alcohol. This may help them numb their fears or give them a false sense of courage to face feared situations.
• Have depression.
• Have extreme fears (phobias).
• Have other anxiety disorders, such as post-traumatic stress disorder.
• Have trouble relating to other people in social settings because of intense feelings of anxiety.

Panic attacks may continue for years, especially if you also have agoraphobia (avoiding places where you fear another attack will occur). These attacks can be mild to severe. You may have long periods of time without panic attacks. And you may have other periods of time when attacks occur often.

Panic disorder may last a lifetime. Most people who have panic disorder get better with treatment. But the attacks can come back, especially if treatment is stopped too soon.

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When to Call a Doctor

Call 911, or other emergency services immediately if you have symptoms of a heart attack. These may include:

• Chest pain or pressure, or a strange feeling in the chest.
• Sweating.
• Shortness of breath.
• Nausea or vomiting.
• Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly, or in one or both shoulders or arms.
• Light-headedness or sudden weakness.
• A fast or irregular heartbeat.

After you call 911, the operator may tell you to chew 1 adult-strength or 2 to 4 low-dose aspirin. Wait for an ambulance. Do not try to drive yourself.

Call your doctor if you have:

• Attacks of intense fear or anxiety that seem to come on without a reason.
• A panic attack or worry that you will have another one, and your worrying keeps you from doing your daily activities.
• Physical symptoms now and then (such as shortness of breath and chest pain), and you aren't sure what is causing them.

Watchful waiting

It can be hard to tell the difference between the symptoms of a panic attack (such as shortness of breath and chest pain) and another serious medical problem. If you have symptoms of a panic attack, be sure to get medical care right away so that other medical conditions can be ruled out.

Examinations and Tests

Your doctor will ask about your past health and symptoms. He or she will do a physical exam. The doctor will listen to your heart and check your blood pressure. You may get blood tests to check for other causes of your symptoms. The doctor may need to rule out other health conditions that have symptoms that are similar to panic disorder, such as a heart attack or hyperthyroidism.

You may be diagnosed with panic disorder if you have at least two unexpected panic attacks and worry about having another attack. This includes avoiding situations that may trigger an attack.

Treatment Overview

Treatment may include:

• Counselling. An example is cognitive behavioural therapy (CBT). Exposure therapy is a type of CBT. It helps you confront upsetting situations or thoughts until you feel less fearful of them.
• Medicines. Antidepressants may be used to help with panic attacks and panic disorder. Your doctor may try other types of medicines if antidepressants don't help.
• Home treatment. This includes relaxation exercises.

Treatment can help most people control or even stop attacks. It can help lower the anxiety you feel because of the fear of future attacks. But symptoms can come back, especially if you stop treatment too soon.

Unfortunately, many people don't seek treatment. You may not seek treatment because you think the symptoms aren't bad enough. Or maybe you think that you can work things out on your own. But getting treatment is important. It can prevent other problems related to panic disorder. These problems include depression, anxiety disorders, and substance use disorder.

If your panic attacks get too severe or happen too often, you may need to be treated in the hospital until they are under control.

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Self-Care

Here are steps you can take to decrease the number of panic attacks you have. These steps can also reduce the severity of your symptoms when an attack does occur.

• Reduce anxiety.

  Do tension-reducing activities, and lower the amount of stress in your life.

• Do relaxation exercises.

  These involve 10 to 20 minutes of deep breathing and muscle relaxation each day.

• Change how you think.

  Changing how you think can change how you feel—and that can reduce your anxiety. Noticing negative thoughts and replacing them with helpful ones is one way to do this.

• Get regular exercise.

  Get your breathing and heart rate up several times a week.

• Limit alcohol and caffeine.
• Join a self-help and support group.

  One option is a group organized by Anxiety Canada.

• Eat a balanced diet.

  This means eating fresh, healthy foods and limiting your intake of foods that are high in sugar and fat.

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Medicines

Medicines for panic disorder are used to:

• Control the symptoms of panic attacks.
• Reduce how many attacks you have and how bad they are.
• Reduce the anxiety and fear linked with having another attack.

Your symptoms should start to improve within a few weeks after you start to take medicines. If they don't improve within 6 to 8 weeks, you may need a higher dose. Or you may need another medicine.

Medicines used most often to treat panic attacks and panic disorder include:

• Antidepressants (SSRIs). Examples are citalopram, escitalopram, and sertraline.
• Other types of antidepressants and benzodiazepines.

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