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Panic Attacks

A panic attack is a sudden rush of overwhelming fear that comes often without warning and without any obvious reason. Intense anxiety may develop between attacks because of their unpredictable nature. This persistent fear is a symptom of panic disorder.

A panic attack is a common symptom of many anxiety disorders.

A panic attack can be very frightening but is not dangerous.
The symptoms often include a sense of unreality, feelings of impending doom or fear of dying.

Panic attacks arise most commonly between the ages of 15 and 25, but it can develop at any age. Twice as many women as men are affected by panic disorder. At least 1 in 10 people have occasional panic attacks. Incidence of chronic panic disorder is approximately 2%.

Without treatment panic disorder and panic attacks may lead to phobias, depression or substance abuse.

Panic attacks can occur with or without agoraphobia. Recurrent panic attacks i.e. panic disorder, may become associated with the places in which they occur. As the individual attempts to avoid these situations agoraphobia may develop.

Symptoms

Panic attacks can happen anywhere and at anytime. Symptoms include several of the following:

  • dizziness or feeling faint,
  • palpitations, increased heart rate,
  • sweating, trembling or shaking,
  • difficulty breathing,
  • feeling of choking or nausea,
  • chest pain,
  • numbness or tingling sensations,
  • chills or hot flushes,
  • feelings of unreality and detachment,
  • fear of losing control,
  • fear of dying, and
  • a sense of great danger and an urge to escape.

The symptoms of a panic attack can last anywhere from several seconds to about ten minutes. Occasionally the symptoms come in 'waves' for up to 2 hours.

Causes

The exact causes are unclear.

There does seem to be a connection with major life changes, for example going to college, getting married etc.

Studies have found that panic disorder tends to run in families. However, it is unknown whether this is due to genetic and/or environmental influence.

A biochemical cause is suggested, in which there are abnormalities in neurotransmitters (chemical messengers in the brain) that trigger an inappropriate response to danger.

It has also been suggested that the individual may have learned inappropriate responses to the physiological symptoms of anxiety. For example, interpreting normal feelings of anxiety as critical or disastrous.

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) provide the following list of the criteria for panic disorder.

Panic disorder is characterised by unexpected and recurrent panic attacks (a distinct period of intense fear, in which four (or more) of the symptoms mentioned above developed abruptly), together with one or more of the following:

  • severe concerns about having more panic attacks,
  • concerns about the meaning or consequences, for example dying, or having a heart attack, and
  • changes in behaviour patterns related to the panic attacks. For example avoiding things/situations for fear of having an attack.

Treatment

Many people experience a very occasional panic attack and do not seek medical help. However often people with panic disorder will seek help from their GP who will refer them to specialist physiatrist or psychotherapist.

Cognitive behavioural therapy, drugs or a combination of both, will prevent panic attacks or reduce their frequency and severity in many people.

Drugs have been shown to be effective in the treatment of panic disorder. The tricyclic antidepressants (TCAs) were the first medications shown to have a beneficial effect against panic disorder. Selective serotonin reuptake inhibitors (SSRIs) are now the most commonly prescribed drugs. Significant improvement is usually seen within 6 to 8 weeks. TCAs and SSRIs are equally effective, and choice is determined by side effects.

SSRIs should not generally be prescribed to the under 18s, although fluoxetine can be prescribed if specialist advice is obtained. TCAs are avoided if the patient is thought to be at risk of suicide. Following initial presentation, 30 -75% patients relapse when medication is stopped and some patients may require repeated episodes of drug treatment or require long-term maintenance treatment.

Benzodiazepines produce almost instant symptom relief, but they are addictive, which limits their usefulness. Diazepam (a Benzodiazepine) is usually the drug of choice, given in single doses for very short or short courses (up to four weeks).

Cognitive behaviour therapy (CBT) combines two types of psychotherapy cognitive therapy and behaviour therapy. It is based on the theory that most emotional and behavioural responses are learned and the goal is to unlearn unwanted responses and learn new ways of reacting to the situation. CBT aims to change an individual's thinking patterns that lead to feelings of intense anxiety and feelings of panic.

Behaviour therapy aims to gradually reduce the fear of the individual by gradual exposure to the cause of anxiety. Combination psychological and drug therapy may be more effective both in the short and long-term than either treatment alone, although more data on this is required.

Research has shown that panic disorder exists together with other disorders, most commonly agoraphobia, depression and drug and alcohol abuse. Appropriate diagnosis and treatment of co- existing disorders is important to successful treatment of panic disorder.

The information shown here is Crown copyright and has been reproduced with the permission of NHS Direct. Last updated June 2007.