Recently one of my patients described a frightening experience. She was driving over a bridge when she suddenly felt afraid. Her heart beat hard and fast, her chest ached, and she began to sweat profusely. She felt as though she was about to suffocate. It was all she could do to keep driving long enough to cross the bridge, when she finally could pull off the road, into the breakdown lane. It took another 10 minutes before she regained her composure.
What happened? My patient probably had a panic attack.
The primary symptom of a panic attack is a feeling of sudden, extreme apprehension, fear, or terror, often associated with feelings that a catastrophe is imminent. Physical symptoms may include shortness of breath, palpitations, chest pain, sweating, a sensation of smothering, and fear of losing control. The symptoms are often so severe that people mistakenly believe they are having a heart attack. One study found that 22% of people who go to the emergency room with chest pain have no cardiovascular problems, but instead are experiencing panic attacks.
A panic attack usually lasts from 5 to 30 minutes, but it can continue for as long as several hours. Although panic attacks typically occur during the day, they can also rouse someone from deep sleep. Because they cause symptoms throughout the body, panic attacks can be mistaken for neurological, gastrointestinal, cardiac, or pulmonary illnesses.
A panic attack can be an isolated event, or attacks may occur repeatedly. Repeated panic attacks are often triggered by a particular situation. Some people develop anticipatory anxiety when they are in situations that have induced panic attacks before, such as driving or riding over a bridge, shopping in a crowded store, or waiting in line. The common denominator for such panic-inducing situations is that they make the individual feel as though he or she is in danger and unable to escape. A panic attack can also be a symptom of another anxiety disorder, such as panic disorder, specific phobia, post-traumatic stress disorder, or generalized anxiety disorder. In these cases, however, a panic attack is one of many symptoms.
Not everyone who has panic attacks has, or will go on to develop, panic disorder—a related but separate condition A doctor will diagnose panic disorder only if you have repeated, unexpected panic attacks, and if these attacks cause persistent worry about having further attacks or significant changes in behavior.
The underlying biological cause of panic attacks is not known. However, researchers theorize that it involves abnormalities in the areas of the brain responsible for interpreting potential threats, such as the amygdala and hippocampus. Imbalances of the neurotransmitters norepinephrine and serotonin may also play a role.
People with a current or past anxiety or mood disorder are at greater risk for panic attacks than other people. Use of stimulant medications, such as methylphenidate (Ritalin), can also promote panic attacks. Even caffeine can trigger a panic attack in someone who is susceptible to them.
The best treatment following an initial panic attack is cognitive behavioral therapy (CBT), to address the underlying anxiety. If this doesn't work, your doctor may recommend a benzodiazepine such as lorazepam (Ativan) or alprazolam (Xanax) in addition to CBT.
Most people who experience one or two isolated panic attacks are able to use the combination of CBT and medication to prevent such attacks in the future.
Have you ever experienced a panic attack? What circumstances triggered it? Were you able to prevent further attacks? What worked for you?
Anxiety and Phobias
Anxiety disorders—which include panic attacks, post-traumatic stress disorder, obsessive-compulsive disorder, and phobias—are among the most common mental illnesses, affecting about 23 million American adults. Thankfully, never before have there been so many therapies to help control anxiety. Coping With Anxiety and Phobias is a special report from Harvard Medical School that provides up-to-date information on these treatments, as well as information on the many types of anxiety disorders, their symptoms, causes, and getting a proper diagnosis.
Are you Living With Anxiety? Connect with others with similar health concerns and issues. Click here to join the group.
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Comments: 29
I have found that hypnotherapy C.D. helps a great deal. I would love to see what others have to say about this.
Tonight, in fact, my daughter experienced a mild panic attack. She said, "I feel so stupid, it's not like there's something wrong with me." I offered her sympathy and the suggestion to run up and down the stairs a few times. As usual, she didn't take my suggestion. What sort of encouragement would be helpful for me, as an observer, to make to her, a target for these attacks?
I love to see more written about this. What about a Live Chat?? I feel a tremendous wish to help her. She's still a teen.
Whatever works! You are fortuante not to have panic disorder, in which the attackes come more frequently and severely. There is no doubt that exercises, both cognitive and physical, can help with the symptoms you describe.
You might want to have your daughter look at a book such as The Anxiety and Phobia Workbook or 10 Simple Solutions to Panic: How to Overcome Panic Attacks, Calm
Physical Symptoms, & Reclaim Your Life. These self-help approaches can be enormously useful.
Even though they have moved and settled in a state away (a mile from my family), and my dad is doing well with treatment, she continues to have these attacks and fret about what is "wrong" with her. She gets angry with me when I suggest she should investigate the panic attack prognosis and then has her friends and other family members agreeing that I'm wrong and a "bad daughter" for suggesting this. I'm basically ready to give up. Suggestions?
There is an evil in my head that I can't get rid of, inside are my private battles with hell,in this body without a soul,Shared by only a few of my comrades in arms with a thousand yard stare in their eyes.It all started in a room filled with people who were united in their deep concern for the welfare of returning veterans. Many people spoke. Veterans spoke. Stories were told. Hearts were poured out.
But suddenly, amidst all this good will, a rift spread across the room. A difference of opinion emerged. How to best serve a returning veteran? It was not so easy a question as we might have guessed.
The cause of the rift?
Peace!Imagine that. Peace!, as the catalyst of confrontation. But it was,A crowd of very decent, well-meaning people sat in the middle and said, We want to care for our veterans. We also want to talk about peace.Battle lines were hastily drawn. On one side, were people affiliated with the Department of Veterans Affairs. On the other side, the veterans.
Oh no, the VA men said. You cannot speak of peace. If you ever want to build rapport with veterans, you cannot utter a word about peace! They went on to explain that veterans view peace-activists as the enemy. If they so much as hear that word—peace!—they will turn tail and run the other way. And you'll have lost them forever. These are views of VA armchair warriors. These were the VA experts. They knew everything about the veterans. They carried that weight with them or so they thought. Then the veterans in the room responded. They said, Um ! Yes but…we're not all opposed to talking about peace. In fact, given our troubles with war, we rather enjoy the discussion.Now there is truth, of course, in the suggestion that many veterans do feel a certain hostility from the peace movement—even those veterans who have been disquieted by their own experiences in war. But my feeling, as an Iraq War veteran, is that they tend to be threatened mostly by the rhetoric that is leveled directly against the actions they took in war. Veterans are not inherently opposed to peaceful days, and most, I think would be perfectly receptive to a discussion of diplomacy vs. Military action in future situations.
And so the debate went back and forth, the moral divide opened, and the well-meaning people in the middle began to slip down into it. They looked to the left at the few passionate veterans in the room, and then they looked to the right at the men from the VA who said they'd worked with and heard the stories from thousands of veterans. Trust us,they said. We know what we're talking about.Almost like they cough think for us.
You could see the struggle ensue before your eyes. You could feel it. In the end, the well-meaning people in the middle grabbed hold of a rope called neutrality.
And there they hung, murmuring, We do not want to upset our veterans, so we will not talk about peace or anything else of importance. We will not talk about politics,or about stopping the war in Iraq,or preventing a war in Iran,or about depleted uranium,or about the 120 War Vets Commit Suicide Each Week,no lets keep it simple lets talk about nothing.The cause for war had won!
I was disturbed by what I'd heard those VA men didn't say.That veterans have no legal right to specific types of medical care. The information is coming from documents related to a civil lawsuit filed by veterans of the Iraq and Afghanistan war who claim the government is illegally denying mental health treatment to some troops.Army officials in upstate New York instructed representatives from the Department of Veterans Affairs not to help disabled soldiers at Fort Drum Army base with their military disability paperwork last year.
But I was not entirely surprised. One man was a psychiatrist. He explained the psychological dimensions of PTSD. Another was a chaplain. He explained the spiritual dimensions of PTSD. But by virtue of their jobs and the hands that fed them, they could not delve too deeply into the moral questions of policy.
This is where I became most incensed.
Because war with Iran is not yet a policy, I said to my friend who was also at the meeting. There are no troops on the ground to support or not to support. There are no units in contact. There is no mission to believe in or to doubt. This is a great burden off our shoulders and clears the table for the possibility of diplomacy. This is the time to talk about it. This is the time to talk about non-violence, before the violence begins, before the troops are sent, and before we have another polarizing war which we cannot speak of critically without offending somebody.
But I was not entirely surprised. One man was a psychiatrist. He explained the psychological dimensions of PTSD. Another was a chaplain. He explained the spiritual dimensions of PTSD. But by virtue of their jobs and the hands that fed them, they could not delve too deeply into the moral questions of policy.
This is where I became most incensed.
Because war with Iran is not yet a policy, I said to my friend who was also at the meeting. There are no troops on the ground to support or not to support. There are no units in contact. There is no mission to believe in or to doubt. This is a great burden off our shoulders and clears the table for the possibility of diplomacy. This is the time to talk about it. This is the time to talk about non-violence, before the violence begins, before the troops are sent, and before we have another polarizing war which we cannot speak of critically without offending somebody.Welcome back to the land of confusion.
What was so extraordinary about this particular episode was that the painstaking neutrality embraced by all these well-meaning people to spare the feelings of the veterans had effectively trumped their own instincts to speak for peace. They were silenced. They silenced themselves, not only about the present war, but about future ones as well.
My friend and I both vets agreed, we'd witnessed a surprising phenomenon. And we realized that the effort to prevent future wars might be effectively impeded through its manipulation.
If, for example, Iran was pressed upon the American people not as a war of its own, but merely as an extension of the same war on terror already taking place in Iraq, then so much the more difficult it would be to oppose for those people desperately wishing to show support for the troops.
It was a noble thing to do, and I'm pleased that it we veterans who have done it. God bless you all
Email comments to doctho@roadrunner.com
Two weeks later, I went for a follow up visit with my psychiatrist and was told that panic attacks were quite common in conjunction with people recovering from major depression, and taking the medication I was on. He gave me exactly seven Xanax, and told me to be careful with them because they were highly addictive. Just knowing that this was something happening in my mind, though, was enough. The panic attacks immediately improved, although I did use the medicine for extreme attacks. Also, knowing that the medicine was there if I couldn't control it was a great relief. I never took the last one.
I stopped taking the anti-depressant soon after I found out it could be related. The attacks continued for several years, but after the first year, they were extremely rare. I don't think the SSRI was completely to blame. In my head, I always thought it had more to do with the depression. I had become used to not caring at all whether I lived or died, but when I started to get healthy, I also had to learn to take care of myself again. Once again afraid of consequences, I think the fear drive got out of control. Anyway, that explanation worked for me.
Sorry, I didn't mean to go headlong into my own little anecdote. The point at the beginning was just to demonstrate how important articles like this are. The most important thing for me in overcoming this disorder was my own mental preparation. I had never heard of them when I was finally diagnosed. I still feel like I might get one when I stress myself too much—it's an ongoing battle, although usually that battle is an easy victory for me now.
I have medication to take if its a severe attack, but I have little need of it now. I just recognize them for what they are and deal with them immediately. I also plan ahead to avoid triggers. I do not shop on days that will find the malls packed. By planning ahead, I can enjoy my trips out.
It is wonderful to see how this type of article can help others.
I would like to know if these paitents are treated with depresents and how safe would it be on a long term basis.
Thanks!
To the people who mentioned exercise it really does help as does finding food triggers & breathing exercises.To get me to exercise my doc did a stress test to convince me my heart was okay.
I found this thread after doing a search on panic and diabetes.After many years of me knowing something was wrong besides panic but nobody buying it. A doctor thought to check my sugar my fasting was border but my glucose tolerance was off the chart and I was Dx with type 2.
I beleive my panic originated with my sugar as I rarley have them now unless I slip in managment of my sugar. I had gotten way better and then really bad again.Looking back everything my doctor had me do for my panic ( diet exercise avoiding trigger foods) is also what I do for my sugar and my trigger foods were things like white pasta & high fructose foods.The panic started again when I lapsed.
I see a lot of studies of panic causing sugar issues but not much info of sugar causing panic and even then its people like me not professionals. Besides the 1 other poster im curious ?does anyone else also have diabetes?