Panic attacks

What is a panic attack?

A panic attack is a severe attack of חרדה or fear which occurs suddenly, often without warning, and reaches a peak within 10 minutes. In addition to the anxiety, various other symptoms may also occur during a panic attack, such as racing heart, chest pain, sweating, shaking, dizziness, flushing, churning stomach, faintness and breathlessness.

• A 'thumping heart' or rapid heart rate (דפיקות לב).

• Sweating and trembling.

• יובש בפה.

• Hot flushes or chills.

• Feeling short of breath, sometimes with choking sensations.

• Chest pains.

• תחושת בחילה (nauseated), סחרחורת, or faint.

• Fear of dying or going crazy.

• Numbness or pins and needles.

• Feelings of unreality, or being detached from yourself.

The physical symptoms that occur with panic attacks do not mean there is a physical problem with the heart, chest, etc. The symptoms 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 (epinephrine). 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.

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 when 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.

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 recurrent and unexpected. If you have panic disorder, you also have ongoing worry about having further attacks and/or worry about the symptoms that you have during attacks.

For example, you may worry that the 'thumping heart' (palpitations) or chest pains that you have with panic attacks are due to a serious heart problem like a heart attack. Some people worry that they may die during a panic attack. In panic disorder, you may also change your behaviour as a result of the panic attacks, in a way that affects you negatively (for example, only leaving the house if you have someone with you.)

Panic attacks without panic disorder can occur for no apparent reason or be triggered by particular events or situations that are stressful. Slight abnormalities in the balance of some brain chemicals (neurotransmitters) may play a role. This is probably why medicines used for treatments for panic disorder work well. Anyone can have a panic attack.

To ease a panic attack, or to prevent one from becoming worse, relaxation techniques and breathing exercises may help. Many people find that deep-breathing exercises are useful. This means taking a long, slow breath in through the nose, and very slowly breathing out through the mouth. 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.

Taking regular exercise and meals, and avoiding caffeine and alcohol, can also help manage your stress levels and improve your mood and general well-being.

No treatment is needed if you just have an occasional panic attack. It may help if you understand what panic attacks are and why/how they happen. 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.

Self-help for panic disorder

Self-help, like books based on CBT principles (see below) or support groups, and the measures described above to help panic attacks, have been shown to be effective in treating panic disorder.

Cognitive behavioural therapy (CBT) for panic disorder

CBT is a type of specialist talking treatment. Studies show that it works well for over half of people with panic disorder (and for those with agoraphobia) and is recommended for people with moderate to severe panic disorder.

Medicines for panic disorder

Antidepressants work well to prevent panic attacks in more than half of cases, even if you are not depressed. Symptoms of panic are thought to be associated with the production of brain chemicals (neurotransmitters) such as serotonin, and antidepressants are believed to interfere with the way these chemicals work. The group of antidepressants known as selective serotonin reuptake inhibitors (SSRIs) are a first-line choice. If SSRIs do not work, other types of antidepressants such as imipramine או קלומיפרמין are sometimes used.

A combination of CBT and antidepressants may work better than either treatment alone.