Panic Attacks

Panic attack is a sudden surge of overwhelming anxiety and fear. Your heart pounds and you can’t breathe. You may even feel like you’re dying or going crazy. Panic attacks often occur in people who are diagnosed with Panic Disorder. They may even cause you to withdraw from normal activities. But panic attacks can be cured and the sooner you seek help, the better. With treatment, you can reduce or eliminate the symptoms of panic and regain

control of your life.

Childhood panic disorder facts include that about 0.7% of children suffer from panic disorder or generalized anxiety disorder and that although panic is found to occur twice as often in women compared to men, boys and girls tend to experience this disorder at an equal frequency.

Causes

• Long-term, predisposing causes: The onset of panic disorder usually occurs in early adulthood, although it may appear at any age. It occurs more frequently in women and often in people with above average intelligence. Various twin studies where one identical twin has an anxiety disorder have reported an incidence ranging from 31 to 88 percent of the other twin also having an anxiety disorder diagnosis. Environmental factors such as an overly cautious view of the world expressed by parents and cumulative stress over time have been found to be correlated with panic attacks.
• Biological causes: obsessive compulsive disorder, post traumatic stress disorder, hypoglycemia, hyperthyroidism, Wilson's disease, mitral valve prolapse, pheochromocytoma, and inner ear disturbances (labyrinthitis)
• Phobias: People will often experience panic attacks as a direct result of exposure to a phobic object or situation.
• Short-term triggering causes: Significant personal loss, including an emotional attachment to a romantic partner, life transitions, significant life change.
• Maintaining causes: Avoidance of panic-provoking situations or environments, anxious/negative self-talk ("what-if" thinking), mistaken beliefs ("these symptoms are harmful and/or dangerous"), withheld feelings.
• Lack of assertiveness: A growing body of evidence supports the idea that those who suffer from panic attacks engage in a passive style of communication or interactions with others. This communication style, while polite and respectful, is also characteristically un-assertive. This un-assertive way of communicating seems to contribute to panic attacks while being frequently present in people who experience them.
• Hyperventilation syndrome: Breathing from the chest may cause overbreathing, exhaling excessive carbon dioxide in relation to the amount of oxygen in one's bloodstream. Hyperventilation syndrome can cause respiratory alkalosis and hypocapnia. This syndrome often involves prominent mouth breathing as well. This causes a cluster of symptoms including rapid heart beat, dizziness, and lightheadedness which can trigger panic attacks.
• Situationally bound panic attacks: Associating certain situations with panic attacks, due to experiencing one in that particular situation, can create a cognitive or behavioral predisposition to having panic attacks in certain situations (situationally bound panic attacks).
• Chronic and/or serious illness: Cardiac conditions that can cause sudden death such as long QT syndrome; catecholaminergic polymorphic ventricular tachycardia or Wolff-Parkinson-White syndrome can also result in panic attacks. This is particularly difficult to manage as the anxiety relates to events that may occur such as cardiac arrest, or if an implantable cardioverter-defibrillator is in situ, the possibility of having a shock delivered. It can be difficult for someone with a cardiac condition to distinguish between symptoms of cardiac dysfunction and anxiety. In CPVT, anxiety itself can and does trigger arrythmia. Current management of panic attacks secondary to cardiac conditions appears to rely heavily on benzodiazepines, selective serotonin reuptake inhibitors However, people in this group often experience multiple and unavoidable hospitalisations; in people with these types of diagnoses, it can be difficult to differentiate between symptoms of a panic attack versus cardiac symptoms without an electrocardiogram.

Symptoms

Panic attacks typically begin suddenly, without warning. They can strike at almost any time — when you're driving the car, at the mall, sound asleep or in the middle of a business meeting. Panic attacks have many variations, but symptoms usually peak within 10 minutes. You may feel fatigued and worn out after a panic attack subsides.

Panic attacks typically include a few or many of these symptoms:

• Sense of impending doom or danger
• Fear of loss of control or death
• Rapid heart rate
• Sweating
• Trembling
• Shortness of breath
• Hyperventilation
• Chills
• Hot flashes
• Nausea
• Abdominal cramping
• Chest pain
• Headache
• Dizziness
• Faintness
• Tightness in your throat
• Trouble swallowing

One of the worst things about panic attacks is the intense fear that you'll have another one. You may fear having a panic attack so much that you avoid situations where they may occur. You may even feel unable to leave your home (agoraphobia) because no place feels safe.

Diagnosis

Some practitioners will administer a self-test of screening questions to individuals whom they suspect may be suffering from panic disorder. In addition to looking for symptoms of repeated panic attacks by asking detailed questions about the sufferer's history and conducting a mental-status examination, mental-health professionals will explore the possibility that the individual's symptoms are caused by another emotional illness instead of or in addition to the diagnosis of panic disorder. For example, people with an addiction often experience panic attacks, but those symptom characteristics generally only occur when the person is either intoxicated or withdrawing from the substance. The practitioner will also likely ensure that a physical examination and any other appropriate tests have been done recently to explore whether there is any medical problem that could be contributing to the occurrence of panic attacks.

Treatment

The goal of treatment is to eliminate all of your panic attack symptoms. With effective treatment, most people are eventually able to resume everyday activities.

The main treatment options for panic attacks are psychotherapy and medications. Both are effective. Your doctor likely will recommend one or both types of treatment, depending on your preference, your history, the severity of your panic disorder and whether there are therapists with special training in panic disorders in your area.

Psychotherapy

Psychotherapy, also called talk or behavior therapy, is considered an effective first choice treatment for panic attacks and panic disorder. Psychotherapy can help you understand panic attacks and panic disorder and learn how to cope with them.

Cognitive behavioral therapy can help you learn through your own experience that panic symptoms are not dangerous. During therapy sessions, your therapist will help you gradually re-create the symptoms of a panic attack in a safe, supportive setting. Once the physical sensations of panic no longer seem threatening, the attacks begin to resolve. Successful treatment can also help you overcome fears of situations that you've been avoiding because of panic attacks.

Your therapist may suggest weekly meetings when you begin psychotherapy. You may start to see improvements in panic attack symptoms within several weeks, and often symptoms decrease significantly or go away within several months.

As your symptoms improve, you and your therapist will develop a plan to taper off therapy. You may agree to schedule occasional maintenance visits to help ensure that your panic attacks remain under control.

Medications

Medications can help reduce symptoms associated with panic attacks as well as depression if that's an issue for you. Several types of medication have been shown to be effective in managing symptoms of panic attacks, including:

• Selective serotonin reuptake inhibitors (SSRIs). Generally safe with a low risk of serious side effects, SSRI antidepressants are typically recommended as the first choice of medications to treat panic attacks. SSRIs approved by the Food and Drug Administration (FDA) for the treatment of panic disorder include fluoxetine (Prozac), paroxetine (Paxil, Pexeva) and sertraline (Zoloft).
• Serotonin and norepinephrine reuptake inhibitors (SNRIs). These medications are another class of antidepressants. The SNRI drug called venlafaxine hydrochloride (Effexor XR) is FDA approved for the treatment of panic disorder.
• Benzodiazepines. These mild sedatives belong to a group of medicines called central nervous system depressants. Benzodiazepines may be habit-forming (causing mental or physical dependence), especially when taken for a long time or in high doses. Benzodiazepines approved by the FDA for the treatment of panic disorder include alprazolam (Niravam, Xanax), clonazepam (Klonopin) and lorazepam (Ativan). If you seek care in an emergency room for signs and symptoms of a panic attack, you may be given a benzodiazepine to help stop the attack.

If one medication doesn't work well for you, your doctor may recommend switching to another or combining certain medications to boost effectiveness. Keep in mind that it can take several weeks after first starting a medication to notice an improvement in symptoms. All medications have a risk of side effects, and some may not be recommended in certain situations, such as pregnancy. Talk with your doctor about the possible side effects and risks.

Self-Help

Taking care of panic attacks at home is possible, but be careful not to mistake another serious illness (such as a heart attack) for a panic attack. In fact, this is the dilemma that doctors face when people experiencing panic are brought to a hospital's emergency department or the clinic.

There are things that people with panic disorder can do to assist with their own recovery. Since substances like caffeine, alcohol, and illicit drugs can worsen panic attacks, those things should be avoided. Other tips for managing panic attacks include engaging in aerobic exercise and stress-management techniques like deep breathing and yoga on a regular basis, since these activities have also been found to help decrease panic attacks.

Although many people breathe into a paper bag in an attempt to alleviate the hyperventilation that can be associated with panic, the benefit received may be the result of the individual thinking it will help. Unfortunately, breathing into a paper bag while having trouble breathing can worsen symptoms when the hyperventilation is caused by a condition associated with oxygen deprivation, like an asthma attack or a heart attack.

If a person has been diagnosed with panic attacks in the past and is familiar with the signs and symptoms, the following techniques may help the person stop the attack. You may also try these tips for overcoming the symptoms of a panic attack.

• First, relax your shoulders and become conscious of any tension that you may be feeling in your muscles.
• Then, with gentle reassurance, progressively tense and relax all the large muscle groups. Tighten your left leg while taking a deep breath in, for example, hold it, then release the leg muscles and the breath. Move on to the other leg. Move up the body, one muscle group at a time.
• Slow down your breathing. This may best be done by blowing out every breath through pursed lips as if blowing out a candle. Also, place your hands on your stomach to feel the rapidity of your breathing. This may allow you to further control your symptoms.
• Tell yourself (or someone else if you are trying this technique with someone) that you are not "going crazy." If you are concerned about not being able to breathe, remember that if you are able to talk, you are able to breathe.

If a person is diagnosed with any medical illness, especially heart disease, home treatment is not appropriate. Even if the person has a history of panic attacks, home care is not appropriate if there is any new or otherwise worrisome symptom.

Prognosis

Many people being treated for panic attacks begin to experience limited symptom attacks. These panic attacks are less comprehensive, with fewer than 4 bodily symptoms being experienced.

It is not unusual to experience only one or two symptoms at a time, such as vibrations in their legs, or shortness of breath, or an intense wave of heat traveling up their bodies which is not similar to hot flushes due to estrogen shortage. Some symptoms, such as vibrations in the legs are sufficiently different from any normal sensation that they clearly indicate panic disorder. 

Other symptoms on the list can occur in people who may or may not have panic disorder. Panic disorder does not require four or more symptoms to all be present at the same time. Causeless panic and racing heartbeat are sufficient to indicate a panic attack.