Understanding panic attacks: Symptoms and treatment

What are panic attacks?

Panic attacks are unmistakable. You're involved in some ordinary aspect of life when suddenly your heart begins to pound and you hyperventilate, sweat, and tremble. You fear you are having a heart attack, or even dying. Then, 10 minutes or so later, it's gone. What just happened?

Unfortunately, there is no clear answer. You may have had a panic attack.  Panic attacks are fairly common, usually beginning between ages 15 and 25. If you have recurrent panic attacks - and for some sufferers, they recur again and again - and if a persistent fear of subsequent attacks occurs or if you change your behaviour significantly because of such attacks, you have panic disorder. Between attacks, sufferers live in dread of the next one.

Many people with panic disorder relate an attack to what they were doing when it occurred. They may assume that the restaurant, lift, or classroom caused the attack, and decide to avoid that situation. In these cases, panic disorder may lead to agoraphobia -- the fear of leaving home or being in public places -- though the relationship between the two conditions is unclear.

What causes panic attacks?

The underlying cause of panic attacks and panic disorder is not clear. There is evidence of both a genetic and a biochemical basis. There is also an association with phobias, such as school phobia or agoraphobia, as well as with depression, alcohol or cigarette abuse, suicide risk, and seasonal affective disorder - a type of depression that occurs during winter months.  

The sudden feeling of terror or doom often brings on hyperventilation - uncontrollable, rapid, shallow breathing. This in itself can cause many of the other physical symptoms by upsetting the balance of oxygen and carbon dioxide in the bloodstream.  

Panic disorder may begin after a serious illness or accident, the death of a close friend, separation from the family, or the birth of a baby. Attacks may also accompany the use of mind-altering drugs. Most often, however, a panic attack comes "out of the blue". It may even begin during sleep.  

Some medical problems and medications can cause panic attacks, including some antidepressants at high dosage. Panic disorder that begins after age 40 suggests depression or another underlying medical health disorder.

What are the symptoms of a panic attack?

If you have four or more of the following symptoms, you may be having a panic attack:

• Sudden high level of anxiety - with or without a cause
• Heart palpitations
• Sweating
• Shaking
• A ‘smothering’ sensation
• A feeling of choking
• Chest pain or discomfort
• Nausea
• Dizziness or faintness
• A sense of unreality
• A fear of dying
• Numbness or tingling
• Chills or hot flushes

An isolated panic attack, while extremely unpleasant, is not uncommon or life-threatening. Panic disorder and panic attacks are not the same thing. All panic disorders have panic attacks as a symptom but having a panic attack does not mean you have panic disorders. Panic attacks can be a symptom of other anxiety disorders as well.

You may think you're having a heart attack -- and it's true that the symptoms can be similar. However, most people having a panic attack have had one before, triggered by a similar event or situation.  

The chest pain of a panic attack usually stays in the mid-chest area (the pain of a heart attack commonly moves toward the left arm). It is often accompanied by rapid breathing, rapid heartbeat, and fear. A panic attack usually lasts only a few minutes, comes suddenly and leaves suddenly, but leaves one exhausted.