All About Panic Attacks

Panic attacks are characterized by intense fear that doesn't seem to have a clear origin, and they can involve symptoms such as tingling or trembling.

Written and verified by la psicóloga Paula Villasante.

Last update: 16 December, 2022

Panic attacks are a type of exaggerated response to fear. In particular, these are sudden episodes of fear that trigger considerable physical reactions when there doesn’t seem to be a danger or cause.

These episodes can be diurnal or nocturnal, but they involve intense discomfort and fear in the absence of danger, which can be accompanied by neurovegetative discharges, physical and cognitive symptoms, a sensation of imminent death, and an urgent need to escape.

Although they’re not life-threatening, panic attacks can be scary and significantly affect a person’s quality of life. However, there are treatments that currently have proven to be effective in alleviating their symptoms.

Symptoms of panic attacks

Panic attacks generally tend to start suddenly, without warning. They can happen at any time, such as while a person’s driving in their car, sleeping, at the mall, or even in the middle of a meeting.

These attacks can occur frequently or be occasional. In addition, they have many variations. However, the symptoms usually reach their maximum intensity in a few minutes. Those who suffer from them may feel fatigued and exhausted after the symptoms of the attack.

Therefore, the most common symptoms and signs that characterize panic attacks are the following:

• Increased heart rate
• Palpitations
• Dizziness, lightheadedness, or even fainting
• A feeling of imminent danger and/or death
• Headaches or chest pain
• A need to go to the bathroom
• A feeling of unreality or detachment

Why do panic attacks appear?

The cause of panic attacks, as well as panic disorder itself, is unknown.

At first, panic attacks usually appear abruptly. However, over time, they’re triggered only under certain circumstances. At the same time, the flight or fight response to danger plays a key role in the appearance of these attacks.

An example would be the following: If a bear chased you, the body would react instinctively. Therefore, both the heart rate and the respiratory rate would increase as the body prepares for a deadly situation.

Risk factors

Although their real causes are unknown, there are certain predisposing factors to panic attacks, which are the following:

• Having a family history of this condition
• Being more sensitive to stress

Possible complications of panic attacks

If left untreated, panic attacks can disrupt many areas of a person’s life. The fear of having a new attack can even lead to living in a constant state of fear. This, of course, can ruin the quality of life of those who suffer from them.

In summary, panic attacks can lead to complications such as:

• Financial problems
• Alcohol or other substance abuse
• Avoidance of social situations
• Risk of suicide or suicidal thoughts

Types of panic attacks depending on the context

Panic attacks can happen at different times. Therefore, in order to carry out a proper diagnosis, it’s important to take into account the context in which they occur.

Depending on the relationship between the onset of the attack and its triggers, panic attacks can be classified into the following types:

• Unexpected: Their beginning doesn’t occur as the result of a specific situational trigger.
• Predisposed by the situation: When they’re more frequent in certain situations, but aren’t associated with them.
• Determined by the situation: When they occur during exposure to or anticipation of a triggering stimulus.

Panic disorder: Diagnosis

In order to diagnose panic disorder, recurrent and unexpected attacks must be present, and at least one of these attacks must have been related to any of the following symptoms:

• A significant change in behavior
• Concern about the implications of the attack or its consequences
• Persistent restlessness about the possibility of having an attack

Furthermore, there can’t be agoraphobia associated with the attacks, and they can’t be due to the direct effects of a substance or a general medical condition.

The difference between agoraphobia and panic disorder

Agoraphobia is defined as pathological fear, characterized by its disproportion, involuntariness, and irrationality.

This fear usually appears in a set of different situations in which the person feels helpless in the face of the possibility of having a panic attack or any of its symptoms (such as diarrhea or dizziness, for example).

On the other hand, the main characteristic of panic disorder is the presence of unexpected, spontaneous, and recurrent attacks, without an external factor or a feared object that triggers them.

Treatment

In the event that panic attacks become recurrent, the first thing you should do is to talk to your doctor. Your procedure will begin with a physical exam and background questions.

The goal of the doctor in this first step is to make sure that the symptoms aren’t being caused by an organic problem. Later, they may refer you to a mental health specialist, such as a psychiatrist or psychologist.

Treatment for panic attacks is aimed at reducing the number of events, as well as alleviating your symptoms. Usually, this consists of psychotherapy, medication, or a combination of both. In any case, the ideal treatment for each person will depend on their specific case.

Psychotherapy

When it comes to psychotherapy, cognitive behavioral therapy (CBT) has proven useful as a first-line treatment for panic disorder. This type of therapy is often helpful for panic attacks in the sense that it allows you to learn new ways of thinking, behaving, and reacting to the feelings that come with an attack.

Through the application of psychotherapy, the attacks can begin to disappear once the patient learns to react differently to the physical feelings of anxiety and fear that occur during panic attacks.

Drugs

Doctors may also prescribe medications that can help treat panic attacks. For example, they may prescribe the following:

1. Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) and norepinephrine (SNRIs).
2. Beta-blockers.
3. Benzodiazepines.

1. Antidepressants

Both SSRIs and SNRIs are used to treat depression, but they’re also helpful for symptoms of panic attacks. They can take several weeks to start working and can cause side effects, such as headaches, trouble sleeping, or nausea.

These effects are generally not serious for most people, especially if the dose starts out low and increases gradually over time. In any case, it’s important to consult with your doctor about any side effects that you notice.

Also, some tricyclic antidepressants such as imipramine or clomipramine may help. Others that can be used to treat panic attacks include pregabalin (if anxiety symptoms are severe) and clonazepam.

Antidepressants can take 2 to 4 weeks to start working, and up to 8 weeks to work fully.

2. Beta-blockers

These can help control some physical symptoms of panic attacks, such as an increased heart rate. Although doctors don’t usually prescribe this type of medicine for panic disorder, it can be helpful in certain situations that precede it.

3. Benzodiazepines

This group is characterized by its anxiolytic activity. They’re usually effective in quickly reducing panic attack symptoms but can cause tolerance and dependence if used continuously. Therefore, the doctor will only prescribe them for short periods of time if they deem it necessary.

Panic attacks are complex, but they can be treated

Due to the significant limitations that this condition can produce when it comes to a person’s quality of life, it’s important to go to a professional as soon as possible. This must be a specialist in psychology or psychiatry, so treatment could include the use of psychotropic drugs.