Topic Overview
What are panic attacks and panic disorder?
A panic
attack is a sudden, intense fear or
anxiety that may make you short of breath or dizzy or
make your heart pound. You may feel out of control. Some people believe that they
are having a heart attack or are about to die. An attack usually lasts from 5
to 20 minutes. But it may last even longer, up to a few hours. You have the most
anxiety about 10 minutes after the attack starts. 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.
More women than men get panic attacks.
What causes panic attacks and panic disorder?
Experts aren't sure what causes panic attacks and panic disorder. But the
body has a natural response when you are stressed or in danger. It speeds up
your heart, makes you breathe faster, and gives you a burst of energy. This is
called the
fight-or-flight response. It gets you ready to either
cope with or run away from danger. A panic attack occurs when this response
happens when there is no danger.
Some people are more sensitive to anxiety and panic than others. Panic attacks and panic disorder
may be more likely if you have a family history of panic
disorder. They sometimes happen with 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.
- Alcohol
abuse.
- Using too much nicotine or too much caffeine.
-
Taking certain medicines, such as those used to treat asthma and heart
problems.
- Misusing drugs.
- Living with high levels of stress for a long time.
You have a higher chance of getting panic disorder if you
have a parent with
depression or
bipolar disorder.
What are the 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.
Symptoms of panic disorder may include:
- Repeated panic attacks when there is no
reason for the fight-or-flight response.
- Changing your daily
activities because you worry that you will have another attack.
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.
How are panic attacks and panic disorder diagnosed?
Your doctor will ask about your past health and do a physical exam. The
exam may include listening to your heart, checking your blood pressure, and
ordering blood tests to look for other causes of your problem.
How are they treated?
Treatment for panic attacks
and panic disorder includes
counseling, especially cognitive-behavioral therapy (CBT). Medicines 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.
Early treatment of
panic attacks is very important. It can prevent other problems related to panic
disorder. These problems include depression,
anxiety disorders, and
substance abuse.
Frequently Asked Questions
Learning about panic attacks and panic disorder: | |
Being diagnosed: | |
Getting treatment: | |
Ongoing concerns: | |
Cause
The exact cause of
panic disorder isn't clear. Some people are more sensitive to anxiety and panic than others. This may be from your family history or past experiences. You may have seen your parents or other family members experience anxiety. Or you may have experienced traumatic events in your past.
You may be very sensitive to how your body reacts to anxiety-causing experiences. You may mistake your body's reaction as harmful and begin to fear your body's reaction. This is called a cycle of panic. The same experiences that cause you panic may not cause panic in others.
You can have a
panic attack without having panic disorder. Panic
attacks may be triggered by:
- Drinking large amounts of alcohol or abruptly
stopping the use of alcohol.
- Drinking large amounts of caffeine.
- Chain-smoking. It greatly increases the amount of nicotine in
the blood.
- Taking certain medicines (such as those
used to treat asthma and heart conditions) or abruptly stopping certain
medicines (such as those used to treat anxiety or sleep
problems).
- Misusing drugs.
- Having high levels of
stress for a long time.
- Having recently had a baby.
- Having recently
had surgery or been under
general anesthesia.
Panic attacks also can be caused by or linked with
other medical conditions, including:
Symptoms
The main symptom of a
panic attack is an overwhelming feeling of fear or
anxiety. This feeling occurs along with physical reactions.
An attack starts suddenly and usually
lasts from 5 to 20 minutes. But it may last even longer, up to a few hours. You
feel most anxious about 10 minutes into the attack.
It is possible to have one
panic attack after another in waves for an extended period of time. This can
seem like one continuous attack. But if you have continuous symptoms that don't go away within an hour, you probably aren't having a panic attack. You
should seek medical care right away.
Symptoms of a panic attack may
include:
- Rapid breathing (hyperventilation), shortness of breath, or a feeling
of choking or being smothered.
- A pounding or racing heart or an irregular
heartbeat.
- Chest pain.
- Shaking, trembling, or feeling lightheaded or dizzy.
- Sweating, chills, or hot flashes.
- Nausea or an upset stomach.
- Numbness or tingling.
- Fear that you are going to die, lose control, or "go
crazy."
- Feelings of being detached from yourself or from
reality.
The symptoms of a panic
attack can be similar to those of a heart attack. Many people seek emergency
medical treatment for a panic attack for this reason. If you have chest pain
and other
symptoms of a heart attack, get medical
treatment right away. For more information, see the topic
Chest Problems.
Agoraphobia
Panic attacks may begin
without a trigger. Or they can be linked to certain situations, such as being in
large crowds of people in restaurants or stadiums. Sometimes just knowing that you'll be in a certain situation can cause severe anxiety.
People
who have panic attacks often learn to avoid situations that they fear
will trigger a panic attack or situations where they will not be able to escape
easily if a panic attack occurs. If this pattern of avoidance and anxiety is severe,
it can become
agoraphobia, an intense and irrational fear of being in public places.
Isolating yourself and avoiding social situations can interfere with your
ability to work. It can also harm your relationships, especially with your family members and
close friends.
Symptoms in children
Panic attacks aren't common
in children or younger teens. But children who have panic disorder or panic
attacks often have other symptoms in addition to those listed above.
- They may
be overly afraid of common objects such as bugs.
- They may worry too much about
monsters or about going to bed alone.
- They may refuse to go to school or
become unusually upset when they are separated from a parent.
What Happens
A first panic attack often starts without warning during an
ordinary activity such as shopping or walking down the street.
- You may become
confused and think you are "going crazy." You may feel like something terrible 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
such as shortness of breath, a pounding heart, or chest pain. It is common to think that you are
having a heart attack and to seek treatment in a hospital emergency
room.
The intensity of
these symptoms usually peaks within 10 minutes.
For many people, the first panic attack may occur a stressful time. It may happen during a life-threatening illness or accident, the
loss of a relationship, or separation from family. A woman may have her first panic
attack after she gives birth.
It is also possible for a
first panic attack to be caused by a drug reaction or a reaction to
nicotine or caffeine. But after the situation that caused the first panic
attack is resolved, attacks may continue.
Panic disorder
Common traits in panic
disorder include:
- Feeling exhausted from lack
of sleep.
- Using drugs or alcohol (to numb your fears or give you a
false sense of courage to face feared situations).
- Having
depression.
- Having irrational fears (phobias).
- Having other
anxiety disorders, such as
post-traumatic stress disorder.
- Having
trouble relating to other people in social settings because of intense feelings
of anxiety.
Recurrent
panic attacks can be mild to severe. They may continue for
years, especially if you also have
agoraphobia (avoiding places where you fear another
attack will occur). You may have long periods of time
without panic attacks. And you may have other periods of time when attacks occur
often.
You may need longer or different treatment if you have
both panic disorder and agoraphobia. You may also have
other conditions linked with panic disorder and panic attacks, such as drug
or alcohol problems, depression, or other mental health disorders. You will
need treatment for these conditions.
Panic disorder may last a
lifetime, but its symptoms can be controlled with treatment. Most people who have
panic disorder get better with treatment. They are able to get back to a normal
lifestyle. But relapse can occur, especially if treatment is stopped
too soon.
What Increases Your Risk
Your risk for
panic attacks and panic disorder may be higher if you:
- Have a family history of panic disorder. You are also at increased risk if
you have a parent with either
depression or
bipolar disorder.
- Have
other conditions associated with panic disorder or panic attacks, such as
depression.
- Drink alcohol, use illegal drugs, chain-smoke
cigarettes, or drink large amounts of coffee or other caffeinated
beverages.
- Take medicines known to trigger panic attacks, such as
those used to treat asthma or heart problems.
- Have had
previous, unexpected panic attacks.
When To Call a Doctor
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 interferes with your ability to do your daily
activities.
- Occasional physical symptoms (such as shortness of
breath and chest pain), and you are not 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 the
symptoms of a heart attack or 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.
Who to see
The following health professionals can diagnose
panic attacks. They may work together with other health
professionals to treat panic attacks and
panic disorder:
Treatment for panic attacks and panic disorder may also
be provided by a:
Many community mental health centers, hospital outpatient
clinics, and family service agencies have treatment programs for people with
panic disorder.
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Exams and Tests
You may be diagnosed with panic
disorder if you have at least two unexpected panic
attacks along with fear or worry about having another panic attack and avoiding
situations that may trigger it.
The doctor
will ask you questions about your symptoms. He or she will listen to your heart and check
your blood pressure. You may get blood tests. The doctor may need to rule out
other physical conditions that have symptoms similar to panic disorder, such as
a
heart attack or
hyperthyroidism.
Treatment Overview
Successful treatment
reduces how many panic attacks you have and how often you have them. It lowers the anxiety you feel because of
the fear of future attacks. And it improves the quality of your life. Treatment may include:
Unfortunately, many people don't
seek treatment for anxiety disorders. 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.
If you need help
deciding whether to see your doctor, see
some reasons why people don't get help and how to overcome them.
Triggers
If your panic attacks were caused by a specific trigger, such as a
medicine reaction, you may not need treatment after the trigger has been
removed. In this case, that would mean stopping the medicine with the help of
your doctor.
But sometimes panic attacks caused by outside factors can continue
after the trigger has been removed. They may turn into panic disorder.
Panic attacks may also start suddenly without a known trigger.
Recurring panic attacks
You may have mild to severe panic attacks off and on for years, especially if you also
have
agoraphobia (avoiding places where you fear another
attack will occur).
Even after treatment is
stopped because the attacks appear to be under control, attacks can suddenly
return. Learn your early warning signs and triggers so you can seek
treatment early.
If your
panic attacks get too severe or happen too often, you
may need to be hospitalized until they are under control. You also may need a
brief hospital stay if you have panic attacks along with another health
condition, such as
agoraphobia or
depression. Panic attacks combined with these conditions can be
harder to treat.
Ongoing treatment
An important part of ongoing treatment is making sure
that you are taking your medicine as prescribed. Often people who feel better after
using medicine for a period of time may believe they are "cured" and no longer
need treatment. But when medicine is stopped, symptoms usually return. So it's
important to continue the treatment plan.
You
will be continually checked to see if you have other conditions linked with panic disorder, such as depression or
problems with drugs or alcohol. These conditions will also need
treatment.
Prevention
Panic disorder cannot be prevented.
But you may be able to
prevent or reduce the number of panic attacks with home treatment. For example, you can try relaxation exercises or limiting alcohol and caffeine.
Home Treatment
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:
Support for the family
When a person has panic attacks, his or her entire family is affected.
If someone in your family has panic attacks, you may feel frustrated,
overworked (because you have to take over his or her responsibilities), or
socially isolated because the person restricts family activities. These
feelings are common.
Family therapy, a type of counseling that involves the
entire family, may help.
For more information,
see:
- Helping Someone During a Panic Attack.
Medications
Medicines for
panic disorder are used to control the symptoms
of
panic attacks, reduce their number and severity, and
reduce the
anxiety and fear linked with having another
attack.
Your symptoms of
panic disorder should start to improve within a few weeks after you start taking
medicines. If improvement is not seen within 6 to 8 weeks, a higher dose or
another medicine may be needed.
Some
medicines used to treat panic attacks need to be continued for a year or longer
and then may be decreased gradually over several
weeks. If you have panic attacks again while
medicines are being stopped, the medicines may be continued for at least a few
months more. Some people may need to stay on medicines for a long time to keep
symptoms under control.
Taking medicines for panic disorder
during pregnancy may increase the risk of birth defects. If you are pregnant
or thinking of becoming pregnant, talk to your doctor. You may need to keep taking medicines if your panic disorder is severe. Your doctor can help weigh the risks of
treatment against the risk of harm to your pregnancy.
Medicine choices
Medicines used most often to treat panic attacks include:
- Antidepressants, such as Paxil, Prozac, or Zoloft.
- Benzodiazepines, such as Ativan, Valium, or Xanax.
Medicines sometimes used to treat panic disorder include:
- Antidepressants, such as Anafranil, Norpramin, and Tofranil.
- Antidepressants with mixed
neurotransmitter effects, such as Effexor.
- Monoamine oxidase inhibitors (MAOIs), such as Marplan, Nardil, or Parnate.
Other Treatment
Counseling
Medicines to treat
panic disorder often may prevent another panic attack. But they may not take away
the fear of having another attack. Counseling can help you handle this fear.
The fear of having an attack may actually bring on another attack.
Cognitive-behavioral therapy focuses on changing certain thinking and behavior patterns. It has been proved effective for treating panic disorder.
Support groups and self-help
Support groups are
often good places to share information, problem-solving tips, and emotions
related to panic disorder.
Online discussion forums and websites may also offer information and support.
Self-help materials can help you learn to cope with panic
disorder or anxiety. These include instructional
videos, books, and audio materials.
Relaxation exercises
Body-centered relaxation exercises can be useful for
reducing anxiety and treating symptoms of stress. They include:
Mindfulness activities
Mindfulness activities are techniques that help relax the mind. They are often
combined with body-centered relaxation exercises. These techniques include:
- Meditation, where you focus your attention on the things that are
happening right now in the present moment. One way to do this is by paying
attention to your breathing.
- Stress Management: Doing Meditation
- Guided imagery (visualization). This is a method of using your
imagination to help you relax and release tension caused by stress. Your body
responds to the images in your mind.
- Stress Management: Doing Guided Imagery to Relax
Other Places To Get Help
Organizations
HealthyChildren.org (U.S.)
www.healthychildren.org
Anxiety and Depression Association of America (ADAA)
www.adaa.org
References
Other Works Consulted
- American Psychiatric Association (2009). Practice guideline for the treatment of patients with panic disorder. Available online: http://psychiatryonline.org/guidelines.aspx.
- Huppert JC, et al. (2009). Anxiety disorders: Cognitive-behavioral therapy. In BJ Sadock et al., eds., Kaplan and Sadock's Comprehensive Textbook of Psychiatry, 9th ed., vol. 1, pp. 1915-1926. Philadelphia: Lippincott Williams and Wilkins.
- McClure-Tone EB, Pine DS (2009). Clinical features of the anxiety disorders. In BJ Sadock et al., eds., Kaplan and Sadock's Comprehensive Textbook of Psychiatry, 9th ed., vol. 1, pp. 1844-1856. Philadelphia: Lippincott Williams and Wilkins.
- Ravindran LN, Stein MB (2009). Anxiety disorders: Somatic treatment. In BJ Sadock et al., eds., Kaplan and Sadock's Comprehensive Textbook of Psychiatry, 9th ed., vol. 1, pp. 1906-1914. Philadelphia: Lippincott Williams and Wilkins.
- U.S. Department of Health and Human Services (2008). 2008 Physical Activity Guidelines for Americans (ODPHP Publication No. U0036). Washington, DC: U.S. Government Printing Office. Available online: http://www.health.gov/paguidelines/guidelines/default.aspx.
- Vannice GK (2012). Medical nutrition therapy for psychiatric conditions. In LK Mahan et al., eds., Krause's Food and the Nutrition Care Process, 13th ed., pp. 956-969. St Louis: Saunders.
Credits
ByHealthwise Staff
Primary Medical ReviewerAnne C. Poinier, MD - Internal Medicine
Adam Husney, MD - Family Medicine
Kathleen Romito, MD - Family Medicine
Specialist Medical ReviewerChristine R. Maldonado, PhD - Behavioral Health