What is panic attacks?

During a panic attack, you may have a feeling of intense fear or terror, trouble breathing, chest pain or tightness, heartbeat changes, dizziness, sweating, and shaking. A panic attack starts suddenly and usually lasts from 5 to 20 minutes but may last even longer. An attack can begin with a stressful event. Or it can happen without a cause.

Although panic attacks can cause scary symptoms, you can learn to manage them with self-care, counseling, and medicine.

A first panic attack often starts without warning during an everyday activity such as shopping or walking down the street. When it happens, you may feel short of breath or feel your heart pounding. You may think you're "going crazy." Or you may feel like something bad is going to happen.

A panic attack may cause a feeling of intense fear, terror, or anxiety. Other symptoms include trouble breathing, chest pain or tightness, and a fast or irregular heartbeat.

Treatment for panic attacks and panic disorder includes counseling, such as cognitive-behavioral therapy (CBT). Medicines, such as antidepressants, may also help. Treatment can help most people control or even stop attacks. But symptoms can come back, especially if you stop treatment too soon.

Your doctor will ask about your health and symptoms and do a physical exam. You may get blood tests to rule out other causes of your symptoms. You may have panic disorder if you have at least two unexpected panic attacks, worry about having another attack, and avoid situations that may trigger it.

Medicines for panic disorder are used to:

• Control the symptoms of panic attacks.
• Reduce how many attacks you have and how bad they are.
• Reduce the anxiety and fear linked with having another attack.

Your symptoms should start to improve within a few weeks after you start to take medicines. If they don't improve within 6 to 8 weeks, you may need a higher dose. Or you may need another medicine.

Medicines used most often to treat panic attacks and panic disorder include:

• Antidepressants (SSRIs). Examples are citalopram, escitalopram, and sertraline.
• Antidepressants with mixed neurotransmitter effects (SSNRIs). An example is venlafaxine.
• Other types of antidepressants and benzodiazepines.

• Take your medicine exactly as directed. Call your doctor if you think you are having a problem with your medicine.
• Go to your counseling sessions and follow-up appointments.
• Recognize and accept your anxiety. Then, when you are in a situation that makes you anxious, say to yourself, "This is not an emergency. I feel uncomfortable, but I am not in danger. I can keep going even if I feel anxious."
• Be kind to your body:
  • Relieve tension with exercise or a massage.
  • Get enough rest.
  • Avoid alcohol, caffeine, nicotine, and illegal drugs. They can increase your anxiety level, cause sleep problems, or trigger a panic attack.
  • Learn and do relaxation techniques. See below for more about these techniques.
• Engage your mind. Get out and do something you enjoy. Go to a funny movie, or take a walk or hike. Plan your day. Having too much or too little to do can make you anxious.
• Keep a record of your symptoms. Discuss your fears with a good friend or family member, or join a support group for people with similar problems. Talking to others sometimes relieves stress.
• Get involved in social groups, or volunteer to help others. Being alone sometimes makes things seem worse than they are.
• Get at least 30 minutes of exercise on most days of the week to relieve stress. Walking is a good choice. You also may want to do other activities, such as running, swimming, cycling, or playing tennis or team sports.

Relaxation techniques

Do relaxation exercises for 10 to 20 minutes a day. You can play soothing, relaxing music while you do them, if you wish.

• Tell others in your house that you are going to do your relaxation exercises. Ask them not to disturb you.
• Find a comfortable place, away from all distractions and noise.
• Lie down on your back, or sit with your back straight.
• Focus on your breathing. Make it slow and steady.
• Breathe in through your nose. Breathe out through either your nose or mouth.
• Breathe deeply, filling up the area between your navel and your rib cage. Breathe so that your belly goes up and down.
• Do not hold your breath.
• Breathe like this for 5 to 10 minutes. Notice the feeling of calmness throughout your whole body.

As you continue to breathe slowly and deeply, relax by doing the following for another 5 to 10 minutes:

• Tighten and relax each muscle group in your body. You can begin at your toes and work your way up to your head.
• Imagine your muscle groups relaxing and becoming heavy.
• Empty your mind of all thoughts.
• Let yourself relax more and more deeply.
• Become aware of the state of calmness that surrounds you.
• When your relaxation time is over, you can bring yourself back to alertness by moving your fingers and toes and then your hands and feet and then stretching and moving your entire body. Sometimes people fall asleep during relaxation, but they usually wake up shortly afterward.
• Always give yourself time to return to full alertness before you drive a car or do anything that might cause an accident if you are not fully alert. Never play a relaxation tape while driving a car.

Experts aren't sure what causes panic attacks and panic disorder. Attacks occur when you feel stressed or sense danger even though there is none. They may be more likely if you have a family history of panic disorder. They may be triggered by things such as depression, high stress levels, and heavy alcohol use.

A panic attack is a sudden, intense fear or anxiety. It may make you short of breath or dizzy or make your heart pound. You may feel out of control. Some people believe that they're having a heart attack or are about to die. An attack usually lasts from 5 to 20 minutes. But it may last longer, up to a few hours. If these attacks happen often, they are called a panic disorder.

Panic attacks can be scary and so bad that they get in the way of your daily activities. Treatment can help most people have fewer symptoms or even stop the attacks.