Panic attack and Panic disorder

What is a panic attack?
A panic attack is a severe attack of anxiety and fear which occurs suddenly (out of the blue), without warning, and for no apparent reason. In addition to the anxiety, various other symptoms may also occur during a panic attack.

Symptoms:

A ‘thumping heart’ (palpitations)
Shortness of breath, sometimes with choking sensations
Chest pain or tightening of chest muscles
Sweating and trembling
Dry mouth
Hot flushes
Feeling sick (nauseated), dizzy or fainting
Fear of dying
Numbness or pins and needles
Feelings of unreality, or being detached from yourself

The physical symptoms do not mean there is a physical problem with the heart, chest, etc. These mainly occur because of an overdrive of nervous impulses from the brain to various parts of the body during a panic attack. This overdrive of nervous impulses can lead to the body producing hormones which include adrenaline. This is sometimes referred to as a ‘fight or flight’ response. This kind of reaction is normal in people when they feel they are in danger. During a panic attack the body can react in the same way, though with higher intensity.
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 a ‘thumping heart’, 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. Over-breathing may make you feel very light-headed and even lose consciousness for a brief period; however, losing consciousness whilst over-breathing is very uncommon.
A panic attack usually lasts 5-10 minutes; however, sometimes panic attacks come in waves for up to two hours.
What is panic disorder?
At least 1 in 10 people have occasional panic attacks. If you have panic disorder it means that you have repeated panic attacks. The frequency of attacks can vary. About 1 in 50 people have panic disorder.
In panic disorder, there may be an initial event which causes panic, but then the attacks after that are not always predictable.
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. Stressful life events such as bereavement may sometimes trigger a panic attack.
Agoraphobia and other fears
Some people with panic disorder worry about having a panic attack in a public place where it is difficult to get out of, or where help may not be available, or where it can be embarrassing. This may cause them to develop agoraphobia. About 1 in 3 people with panic disorder also develop agoraphobia.

If you have agoraphobia you have a number of fears of various places and situations. So, for example, you may be afraid to:

Be in an open place.
Enter shops, crowds or public places.
Travel in trains, buses, or planes.
Be on a bridge or in a lift.
Be in a cinema, restaurant, etc., where there is no easy exit.
Be anywhere far from your home – many people with agoraphobia stay inside their home for most or all of the time.

Dealing with a panic attack:
To ease a panic attack, or to prevent one from becoming worse, breathe as slowly and as deeply as you can. Really focus on your breathing. Learning and using relaxation techniques may help. Many people find that deep-breathing exercises are useful. This means taking a long, slow breath in, and very slowly breathing out. If you do this a few times, and concentrate fully on breathing, you may find it quite relaxing.
Some people find that moving from chest breathing to tummy (abdominal) breathing can be helpful. Sitting quietly, try putting one hand on your chest and the other on your tummy. You should aim to breathe quietly by moving your tummy with your chest moving very little. This encourages the lower chest muscle (diaphragm) to work efficiently and may help you avoid over-breathing.
What is the treatment?
No treatment is needed if you just have an occasional panic attack. It may help if you understand about panic attacks. This may reassure you that any physical symptoms you have during a panic attack are not due to a physical disease. It may help to know how to deal with a panic attack. Treatment can help if you have repeated attacks (panic disorder). The main aim of treatment is to reduce the number and severity of panic attacks.
Cognitive behavioural therapy (CBT) :
CBT is a type of specialist talking treatment and is probably the most effective treatment. Studies show that it works well for over half of people with panic disorder (and agoraphobia). It deals with your current thought processes and/or behaviours and aims to change them through creating strategies to deal with negative patterns, which may help you to deal with panic attacks and manage panic disorder more effectively. It does not dwell into your past.
Medications:
Antidepressants work well to prevent panic attacks in more than half of cases, even if you are not depressed. Citalopram and sertraline are commonly used for panic disorder. They belong to the group of antidepressants known as selective serotonin reuptake inhibitors (SSRIs). If SSRIs do not work, other types of antidepressants are sometimes used.

If it works, it is usual to take an antidepressant for at least a year. Do not stop medication without your doctor’s advice. In about half of people who are successfully treated, there is a return of panic attacks when treatment is stopped. An option then is to take an antidepressant long-term.
A combination of CBT and antidepressants works better than either treatment alone.