Related topics: •  Agoraphobia •  Anxiety

Many people experience a sudden terror-filled reaction to everyday situations, like taking a crowded bus or walking along a busy street. Their hearts may start racing, for example, or they may feel an overwhelming need to escape from danger. This response, known as a panic attack, happens when your body acts as if you're in a life-threatening situation by turning on your fight-or-flight stress response, even though you're not actually under threat. The constant fear of having a panic attack may develop into panic disorder, a type of anxiety disorder.

About one in three people has a panic attack over the course of a year, and three to six million Americans will suffer from full-blown panic disorder at some time in their lives. You're likeliest to develop the condition between the ages of 18 and 24, but it can arise at any age. Twice as many women as men are affected by panic disorder, and people with asthma are also at higher risk of getting the disorder.

Panic attacks can happen anyplace and anytime, even while you're sleeping. The American Psychiatric Association says that they generally involve at least four of these symptoms:

•Palpitations, a pounding heart, or an accelerated heart rate

•Sweating

•Trembling or shaking

•Shortness of breath

•A choking sensation

•Chest pain or discomfort

•Nausea or stomach cramps

•A feeling of being dizzy, unsteady, lightheaded, or faint

•Derealization (a feeling of unreality) or depersonalization (a feeling of being detached from oneself)

•Fear of losing control or going crazy

•Fear of dying

•Numbness or a tingling sensation

•Chills or hot flashes

It's also common to feel that you're having a heart attack, going insane, or even dying during one of these attacks. Some people have a sense of great danger or feel an urge to escape.

The symptoms of a panic attack can last anywhere from several seconds to about ten minutes; usually they'll have faded away after an hour or so. If you have panic attacks that persist over a month, experts say, there's a good chance you've got panic disorder.

Researchers aren't sure, although heredity, brain chemistry, and the way you handle stressful situations all appear to play a role. Some researchers suspect that an imbalance in the autonomic nervous system -- the part of the brain that automatically takes care of "housekeeping" chores such as the regulation of your heart rate and body temperature -- may be to blame. They point out that key parts of this system, including the hippocampus and the locus coeruleus, seem to go into overdrive during panic attacks. It isn't clear, though, whether this overactivity causes panic symptoms or shows up as a result of them.

Other researchers think the culprit is probably an oversensitive amygdala, the part of the brain that controls the way you learn to respond unconsciously to signals from the outside world. Some sort of biochemical malfunction may also play a role. People with panic disorder, scientists say, may have trouble processing signals from two brain chemicals -- serotonin, a neurotransmitter that promotes a feeling of calm and well-being, and GABA, a neurotransmitter that turns off active nerve cells. When your brain can't receive these chemical signals, the theory goes, even a low level of anxiety can escalate into a panic attack.

Therapy, drugs, or a combination of both can help 70 to 90 percent of all people with panic disorder. Drugs, especially a class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs), are often the treatment of choice because they can usually bring symptoms under control in three to six weeks, aren't addictive, and don't affect mental alertness or memory. They're not a cure, however; the symptoms usually return if you stop taking them. Your doctor might also suggest that you try an antianxiety drug such as Xanax or Ativan, especially if you have severe panic disorder or need immediate relief (such drugs, called benzodiazepines, act within hours instead of weeks). Keep in mind, though, that these highly addictive drugs can cause severe withdrawal symptoms, may make some people aggressive, and can interfere with therapy.

In the long run, many experts say you're better off with a combination of drugs and cognitive-behavioral therapy, which teaches you how to identify and control the thought patterns that can trigger panic attacks and how to use relaxation techniques in alleviating symptoms. Once you've learned to handle stressful situations effectively, it's often possible to go off drugs altogether.

For the best results, try to avoid other triggers as well. Some stimulants, including caffeine, theobromine (which is found in tea and many asthma medications), amphetamines, and ephedra (a Chinese herb also known as ma huang) are known to stimulate the release of extra noradrenaline, a relative of adrenaline, that can produce panic symptoms. Sleep deprivation may make panic disorder worse, so try to get a full night's rest.

Yes. About 75 percent of people don't receive the treatment they need, but it's important to get the condition under control. That's because it often leads to other problems, particularly phobias (or fears) focused on the situations that trigger panic attacks, like crowding (the fear of crowds is called agoraphobia ). Experts predict that about half of all people with panic disorder will also suffer from clinical depression sometime during their lives, and up to a third will have problems with alcohol and drugs. People with panic disorder also appear to be at higher risk of suicide and irritable bowel syndrome.

Try to find a doctor who has a lot of experience treating panic disorder. Unfortunately, panic disorder isn't always diagnosed quickly because some symptoms of a panic attack can look and sound like a heart attack, asthma, or digestive disorder. In fact, a study in Texas found that 42 percent of people with panic attacks had to visit more than one doctor before they got the treatment they needed. To find someone who specializes in treating anxiety and panic disorders, try the directory at Anxiety Disorders Association of America. Some professionals on this list are psychiatrists, others are psychologists or counselors who can refer you to a local doctor.

References

First published March 3, 1999
Last updated January 28, 2008
Copyright © 1999 Consumer Health Interactive

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