What causes panic attacks? 7 possible conditions
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Panic attacks are intense and frightening episodes in which a person may perceive a threat, even though no actual threat exists. Severe panic attacks can cause a person to believe they are experiencing a heart attack. Untreated panic attacks can lead a person to avoid others or avoid going outdoors for fear of experiencing another panic attack.
A panic attack is the chief symptom for people suffering from a panic disorder.
The exact cause of a panic attack is often unknown. A variety of factors can influence the likelihood a person will be prone to panic attacks. These include having a family history of panic attacks and experiencing a significant amount of stress.
People with a family history of panic attacks are at increased risk for having panic attacks.
Additional risk factors for panic attacks include:
- a history of childhood abuse
- experiencing a traumatic event, such as a serious car accident
- undergoing a major life change, such as having a baby
- losing a loved one
- working or living in a high-stress situation
Panic attacks can occur suddenly and without warning. Symptoms may come on gradually then peak at about ten minutes. Panic attacks trigger the sympathetic nervous system, leading to the “fight or flight” response that people have when faced with danger.
Panic attack symptoms are similar to reactions a person has when perceiving danger. Symptoms include:
- chest pain
- difficulty swallowing
- feeling that death is imminent
- feeling faint
- hot flashes
- rapid heartbeat
- shortness of breath
- stomach pain
- tingling or numbness
Patients may be overcome with the fear that a panic attack will reoccur. A person may feel unsafe for fear of having another panic attack.
Panic attack symptoms can be similar to symptoms of serious health condition, such as a heart attack. Patients should seek medical attention after a panic attack to rule out an emergency health condition.
To diagnose a panic attack, a doctor will conduct a physical exam by evaluating symptoms.
To rule out a heart attack, a doctor will likely use an electrocardiogram (EKG) to measure the electric function of the heart. A doctor may also recommend blood tests to check thyroid hormones. A thyroid hormone imbalance can affect the body’s ability to regulate heart rhythms.
Having a single panic attack does not mean that a person has panic disorder. Criteria for diagnosing a panic disorder include:
- frequent, unexpected panic attacks
- a change of lifestyle or behavior due to an ongoing fear of a panic attack
- a panic attack that is unrelated to another condition, such as substance abuse, social phobia, depression, or obsessive-compulsive disorder
Panic attacks can worsen if a patient does not seek treatment.
Doctors often treat panic disorders with a combination of medication and psychotherapy. Some patients may experience one panic attack and never experience another, so they may not need treatment. Patients with recurring panic attacks may need treatment.
- Benzodiazepines: These medications include alprazolam (Niravam, Xanax), clonazepam (Klonopin), and lorazepam (Ativan). They depress the central nervous system and have a mild sedative effect. These medications can be habit-forming.
- Beta Blockers: These medications include carvedilol, propranolol, and timolol. They may reduce the symptoms associated with a panic attack, including sweating, dizziness, and a pounding heartbeat. These medications are not as commonly prescribed as others to reduce panic attacks.
- Selective Serotonin Reuptake Inhibitors (SSRIs): These medications include fluoxetine (Prozac), paroxetine (Paxil and Pexeva), and sertraline (Zoloft). SSRIs are usually the first-line treatment for panic attacks because they have lesser side effects than other medications. However, side effects can include difficulty sleeping, nausea, and headache.
- Selective and Norepinephrine Reuptake Inhibitors (SNRIs): Venlafaxine hydrochloride (Effexor XR) is an FDA-approved SNRI that treats panic disorder.
A psychotherapy approach known as cognitive behavioral therapy can help to reduce panic attacks. Therapy aims to address a patient’s thinking, behavior, and reactions associated with a panic attack to reduce fears and anxieties. Psychotherapy may aim to help a patient “re-train” his or her brain to differentiate between real and perceived threats.
Therapy can help patients overcome fears related to experiencing a panic attack. When symptoms start to improve, patients can often discontinue therapy.
Taking steps to reduce stress and improve health can reduce the incidence of panic attacks. For example, getting plenty of sleep and staying physically active can lower stress levels. Alcohol, caffeine, and illegal drugs can trigger a panic attack and are best avoided.
Stress management techniques such as deep breathing or progressive muscle relaxation can reduce panic attack triggers. Also, attending a support group can help patients identify positive coping mechanisms for reducing fear and anxiety.
Patients with chronic panic attacks are at increased risk to develop what the American Psychiatric Association calls a “Triple A” threat. This threat includes:
- Anticipatory anxiety: This is triggered by simply thinking about a future possible panic attack and may cause a person to be reclusive.
- Avoidance: A panic attack sufferer may start to avoid going to public places for fear that he or she will experience a panic attack.
- Agoraphobia: Avoidance can lead to agoraphobia, or the intense fear of being in public places. A person may become fearful of leaving home.
Seeking treatment for panic attacks can help a patient experience a life free from fear and anxiety. By addressing underlying conditions and stress that can lead to a panic attack, patients can likely find relief.
Most panic attacks that people have are unpredictable, and preventing them is difficult. However, patients can take steps to enhance their overall well-being. This will reduce the likelihood they will have a panic attack. Seeking a physician’s care and following treatment recommendations can help a patient prevent a panic attack.
Taking steps to minimize stress can also help a patient prevent panic attacks. This includes engaging in regular physical activity and getting enough rest on a regular basis.
- Answers to your questions about panic disorder. (2013). American Psychological Association. Retrieved September 21, 2013, from
- Panic attacks and panic disorder. (2012, May 31). Mayo Clinic. Retrieved from September 21, 2013, from http://www.mayoclinic.com/health/panic-attacks/DS00338/METHOD=print
- Panic disorder and agoraphobia. (n.d.). Anxiety and Depression Association of America. Retrieved September 21, 2013, from http://www.adaa.org/understanding-anxiety/panic-disorder-agoraphobia/symptoms
- Panic disorder. (2012). American Psychiatric Association. Retrieved September 21, 2013, from
- What is panic disorder? (n.d.). National Institute of Mental Health. Retrieved September 21, 2013, from http://www.nimh.nih.gov/health/topics/panic-disorder/index.shtml
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