panic attack
noun
a sudden overwhelming feeling of acute and disabling anxiety.
Symptoms
A panic attack is the abrupt onset of intense fear or discomfort that reaches a peak within minutes and includes at least four of the following symptoms:
- Palpitations, pounding heart, or accelerated heart rate
- Sweating
- Trembling or shaking
- Sensations of shortness of breath or smothering
- Feelings of choking
- Chest pain or discomfort
- Nausea or abdominal distress
- Feeling dizzy, unsteady, light-headed, or faint
- Chills or heat sensations
- Paresthesia (numbness or tingling sensations)
- Derealization (feelings of unreality) or depersonalization (being detached from oneself)
- Fear of losing control or “going crazy”
- Fear of dying
Causes
- Long-term, predisposing causes – The onset of panic disorder usually occurs in early adulthood, although it may appear at any age. It occurs more frequently in women and often in people with above average intelligence. Various twin studies where one identical twin has an anxiety disorder have reported a 31–88% incidence of the other twin also having an anxiety disorder diagnosis. Environmental factors such as an overcautious view of the world expressed by parents and cumulative stress over time have been found to be correlated with panic attacks
- Biological causes – obsessive compulsive disorder, Postural Orthostatic Tachycardia Syndrome, post traumatic stress disorder, hypoglycemia, hyperthyroidism, Wilson's disease, mitral valve prolapse, pheochromocytoma, and inner ear disturbances (labyrinthitis). Dysregulation of the norepinephrine system in the locus ceruleus, an area of the brain stem, has been linked to panic attacks
- Phobias – People will often experience panic attacks as a direct result of exposure to a phobic object or situation.
- Short-term triggering causes – Significant personal loss, including an emotional attachment to a romantic partner, life transitions, significant life change.
- Maintaining causes – Avoidance of panic-provoking situations or environments, anxious/negative self-talk ("what-if" thinking), mistaken beliefs ("these symptoms are harmful and/or dangerous"), withheld feelings.
- Hyperventilation syndrome – Breathing from the chest may cause overbreathing, exhaling excessive carbon dioxide in relation to the amount of oxygen in one's bloodstream. Hyperventilation syndrome can cause respiratory alkalosis and hypocapnia. This syndrome often involves prominent mouth breathing as well. This causes a cluster of symptoms, including rapid heart beat, dizziness, and lightheadedness, which can trigger panic attacks.
- Situationally bound panic attacks – Associating certain situations with panic attacks, due to experiencing one in that particular situation, can create a cognitive or behavioral predisposition to having panic attacks in certain situations (situationally bound panic attacks).
- Chronic and/or serious illness – Cardiac conditions that can cause sudden death – such as long QT syndrome, catecholaminergic polymorphic ventricular tachycardia (CPVT) or Wolff-Parkinson-White syndrome – can also result in panic attacks. This is particularly difficult to manage, since the anxiety relates to events that may occur, such as cardiac arrest, or, if an implantable cardioverter-defibrillator is in situ, the possibility of having a shock delivered; it can be difficult for someone with a cardiac condition to distinguish between symptoms of cardiac dysfunction and anxiety. In CPVT, anxiety itself can and does trigger arrythmia. Current management of panic attacks secondary to cardiac conditions appears to rely heavily on benzodiazepines and selective serotonin reuptake inhibitors. However, people in this group often experience multiple and unavoidable hospitalisations, because in people with these types of diagnoses, without an electrocardiogram it can be difficult to differentiate between symptoms of a panic attack versus cardiac symptoms.
- Discontinuation or marked reduction in the dose of a substance such as a drug (drug withdrawal), for example an antidepressant (antidepressant discontinuation syndrome), can cause a panic attack.
Treatment
Medication is useful for alleviating the symptoms of generalized anxiety disorder and is often prescribed in conjunction with other therapies. Some types of anxiety drugs can be habit-forming and are usually prescribed on a short-term or as-needed basis.
Different anxiety disorders have different medication regimens. Some are preventive and some are designed to cure the problem.
Antidepressants, particularly the selective serotonin reuptake inhibitors (SSRIs), are widely used to treat and prevent a variety of anxiety disorders. Examples of SSRIs that are commonly used to treat chronic anxiety include Prozac, Zoloft, Celexa, Paxil, and Lexapro. The antidepressants Effexor and Cymbalta, which act on the brain chemicals serotonin and norephinephrine, and some of the tricyclic antidepressants, like Tofranil, may also help. Finally, antihistamines (such as hydroxyzine) and beta-blockers (such as propranolol) can help mild cases of anxiety as well as performance anxiety, a type of social anxiety disorder. These medicines need to be taken daily whether you have anxiety on that particular day or not, as prescribed by your health care provider.
If you have acute anxiety (panic attack), you will likely need to take an anti-anxiety medicine as well. The most prominent of anti-anxiety drugs for the purpose of immediate relief are those known as benzodiazepines; among them are Ativan, Valium, Librium, Xanax, and Klonopin. They have drawbacks: Benzodiazepines sometimes cause drowsiness, irritability, dizziness, memory and attention problems, and physical dependence. Nonetheless, in recent decades they have largely replaced barbiturates because they tend to be safer if taken in large doses.
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