A panic attack is a sudden surge of intense fear or discomfort that reaches a peak within minutes.
Panic disorder is characterised by recurrent, unexpected panic attacks, usually without a warning or identifiable trigger. It is a common mental health condition, often, beginning in early adulthood, with women being more at risk. If left untreated, it can affect a person’s home, work or school life.
Symptoms
A panic attack cannot be stopped once it starts; symptoms appear suddenly, reach a peak in a few minutes, and may last up to 20 minutes. People with panic disorder experience –
- Sudden and intense feelings of anxiety or terror
- A fear of death or impending doom
- Feelings of helplessness and being out of control, and constant concern about when the next attack will happen
- Depersonalisation – a detachment from themselves, and feelings of unreality
- Fear of places where they have experienced panic attacks in the past
The physical symptoms of a panic attack include–
- Increased heart rate, sweating, and chills
- Trembling, weakness, numbing of hands
- Difficulty in breathing, chest pain, dry mouth
- Stomach pain, and a need to visit the toilet
Severely affected individuals experience such panic attacks several times a week, while others have them once or twice a month.
Causes
Like most other mental health conditions, panic disorder is attributed to a combination of psychological, physical, and environmental factors. They could be because of:
- A chemical imbalance in the brain, involving neurotransmitters like serotonin and cortisol.
- Certain regions in the brain being hyperexcitable in some individuals.
- Adverse childhood conditions, or the trauma associated with losing a loved one.
- Genetics: the risk of a person developing it increases when a close family member has panic disorder.
- Certain people being extremely sensitive to high levels of carbon dioxide, who could experience a panic attack while breathing such air.
- Minor physical symptoms being interpreted as catastrophic events, triggering an exaggerated nervous system response to cause a panic attack.
Diagnosis
It is important to identify and differentiate a panic attack from a panic disorder. Some people experience a panic attack when there is a specific trigger like public speaking, closed spaces, or heights. Such phobias are common, but they cannot be diagnosed as panic disorder.
Only when someone has recurrent and unexpected panic attacks, without a specific reason, and is constantly worried for about a month about the next attack, is it diagnosed as panic disorder. Therefore, a detailed investigation of symptoms is essential for proper diagnosis.
A physical examination is also performed to rule out other medical conditions that can cause similar symptoms.
Treatment
The two objectives while treating panic disorder are to reduce the severity of symptoms, and bring down the number of panic attacks. Most people require psychological therapy in combination with medications. The severity of the condition and the general health of the affected persons determine the final treatment plan.
Psychological treatment
- Cognitive Behavioural Therapy (CBT) is an effective solution for panic disorder. Multiple sessions are usually required, where the therapist asks about the thoughts and reactions that an individual has during a panic attack. The focus of the discussion is to identify negative thoughts and beliefs and replace them with more rational ones. Individuals are also taught how to cope with future attacks, by behaviour modifications like breathing techniques.
- Support groups can also help as they involve meeting with other individuals who are similarly affected.
Self help
In addition to medications, there are certain things that can help to keep the mind and body calm –
- Yoga, breathing exercises, massage, and aromatherapy help to relax the mind.
- Physical activity, cycling, walking, or any moderate activity releases tension.
- Muscle-strengthening exercises for the hips, back, abdomen and shoulders.
- A healthy and balanced diet, avoiding sugary food, alcohol, and smoking.
There are a few techniques that can help affected individuals during a panic attack.
- It is best not to move around during an attack and stop by the side when driving a vehicle.
- Focusing on something routine and non-threatening will help deal with frightening thoughts during an attack.
- Slow and deep breathing will help to ease anxiety and bring about relaxation.
- Positive thoughts and images of peaceful situations can help as a distraction.
- Do not try to resist or fight a panic attack when it happens but wait for it to pass.
Medications
Antidepressants – These medicines become effective after a couple of weeks, so it is important to continue with them even if they do not seem to work. There are two commonly prescribed antidepressants –
- Selective Serotonin Reuptake Inhibitors (SSRIs) are commonly prescribed for panic disorder. They work by raising the level of the chemical serotonin in the brain. Symptoms usually get worse before they get better, and these medicines are started at a low dose and gradually increased. Even while discontinuing them, the dose is gradually tapered. They may cause a few side effects like blurred vision, loss of libido, headaches, sweating and disturbed sleep.
- Tricyclic antidepressants are given if symptoms do not improve after a 12-week course of SSRIs. These medicines also regulate the levels of serotonin, elevate the mood, and create positive feelings. But they have more side effects than SSRIs, at least till the body gets used to the medicine.
Antiepileptic drugs are used to treat epilepsy (fits) but are also given to treat anxiety and panic disorder. They have their own side effects that require regular monitoring.
Panic disorder can significantly affect the quality of life and often leads to severe depression, with a high risk of alcoholism and substance abuse. Fortunately, in most cases panic disorder is managed quite effectively with treatment. Once the person recognises that the symptoms are not life-threatening, they learn to cope with attacks better.
Sources:
1.https://www.nhs.uk/mental-health/conditions/panic-disorder/
2.https://www.ncbi.nlm.nih.gov/books/NBK430973/
3.https://www.nimh.nih.gov/health/publications/panic-disorder-when-fear-overwhelms
