By Dr Ritesh Kohli, MD (Internal Medicine Specialist)
All of a sudden, I felt a tremendous wave of fear for no reason at all. My heart was pounding, my chest hurt, and it was getting harder to breathe. I thought I was going to die.
I’m so afraid. Every time I start to go out, I get that awful feeling in the pit of my stomach and I’m terrified that another panic attack is coming or that some other, unknown terrible thing is going to happen.
What is a panic attack?
A panic attack is a severe attack of anxiety and fear which occurs suddenly, often without warning, and for no apparent reason. In addition to the anxiety, various other symptoms may also occur during a panic attack. These include one or more of the following:
– Palpitations or a thumping heart
– Sweating and trembling
– Hot flushes or chills
– Feeling short of breath, sometimes with choking sensations
– Chest pains
– Feeling sick
– Feeling dizzy, or faint
– Fear of dying or going crazy
– Numbness or pins and needles
– Feelings of unreality, or being detached from yourself
The physical symptoms that occur with panic attacks do not mean there is a physical problem with the heart, chest, etc. The symptoms mainly occur because of an ‘overdrive’ of nervous impulses from the brain to various parts of the body during a panic attack.
During a panic attack you tend to over-breathe (hyperventilate). If you over-breathe you ‘blow out’ too much carbon dioxide which changes the acidity in the blood. This can then cause more symptoms such as confusion and cramps, and make palpitations, dizziness, and pins and needles worse. This can make the attack seem even more frightening, and make you over-breathe even more, and so on.
A panic attack usually lasts 5-10 minutes, but sometimes they come in ‘waves’ for up to two hours.
What causes panic attacks?
Panic attacks usually occur for no apparent reason. The cause is not clear. Slight abnormalities in the balance of some brain chemicals (neurotransmitters) may play a role. This is probably why medicines used for treatment work well. Anyone can have a panic attack, but they also tend to run in some families. Stressful life events such as bereavement may sometimes trigger a panic attack. According to one theory of panic disorder, the body’s normal ‘alarm system,’ the set of mental and physical mechanisms that allow a person to respond to a threat, tend to be triggered unnecessarily, when there is no danger. We don’t know exactly why this happens or why some people are more susceptible to the problem than others.
Dealing with a panic attack
To ease a panic attack, or to prevent one from getting worse:
Breathe as slowly and as deeply as you can. Concentrate on breathing.
Breathe into a paper bag. By doing this you re-breathe your own carbon dioxide. This helps to correct the blood acid level that had been upset by over-breathing which makes symptoms worse (described above).
What is the treatment for panic attacks and panic disorder?
No treatment is needed if you have just an occasional panic attack. It may help if you understand about panic attacks. This may reassure you that any physical symptoms you get during a panic attack are not due to a physical disease.
Treatment can help if you have recurring attacks (panic disorder). The main aim of treatment is to reduce the number and severity of panic attacks.
An anti-depressant medicine is the usual treatment. These usually work well to prevent panic attacks in more than half of cases. Anti-depressants do not work straight away. It takes 2-4 weeks before their effect builds up and may take up to eight weeks to work fully. A common problem is that some people stop the medicine after a week or so as they feel that it is doing no good. You need to give them time to work.
There is also cognitive-behaviour therapy (CBT). This is a type of specialist ‘talking’ treatment. It is probably the most effective treatment. Studies show that it works well for over half of people with panic disorder. Cognitive therapy is based on the idea that certain ways of thinking can trigger, or ‘fuel,’ certain mental health problems such as panic attacks. The aim is then to change your ways of thinking to avoid these ideas. Also to help your thought patterns to be more realistic and helpful.
Behaviour therapy aims to change behaviours which are harmful or not helpful.
Cognitive-behaviour therapy (CBT) is a mixture of the two where you may benefit from changing both thoughts and behaviours.
A combination of CBT and antidepressants may work better than either treatment alone.
Self-help tips for panic attacks and panic disorder
When it comes to panic attacks, professional treatment and therapy can make a big difference. But there are many things you can do to help yourself, too:
Learn about panic. Simply knowing more about panic can go a long way towards relieving your distress. So read up on anxiety, panic disorder, and the fight-or-flight response experienced during a panic attack. You’ll learn that the sensations and feelings you have when you panic are normal and that you aren’t going crazy.
Avoid smoking and caffeine. Smoking and caffeine can provoke panic attacks in people who are susceptible.
Learn how to control your breathing. Deep breathing, on the other hand, can relieve the symptoms of panic. By learning to control your breathing, you develop a coping skill that you can use to calm yourself down when you begin to feel anxious.
Practice relaxation techniques. When practised regularly, activities such as yoga, meditation, and progressive muscle relaxation strengthen the body’s relaxation response – the opposite of the stress response involved in anxiety and panic. And not only do these relaxation practices promote relaxation, but they also increase feelings of joy and equanimity. So make time for them in your daily routine.