What is a panic attack?
A panic attack is an intense attack of fear and anxiety that begins suddenly in the absence of real danger and reaches its peak within a few minutes. The attack is accompanied by strong physical symptoms and often lasts 5–20 minutes.
During a panic attack, sensations such as a pounding heart, sweating, chest pain and tightness, trembling, nausea and dizziness are felt many times more strongly than normal. They are joined by a fear of losing control, going mad or dying. Having one or two panic attacks in a lifetime is relatively common. If attacks keep recurring and the person starts living in fear of the next one, the condition is called panic disorder.
What are the causes and risk factors of panic attacks?
Several factors play a role together in the development of panic disorder.
- Biological factors — changes in the regulation of the substances that transmit signals between nerve cells in the brain, and an inherited predisposition.
- Psychological factors — wrongly interpreting ordinary bodily sensations such as palpitations or breathlessness as signs of dangerous illnesses like a “heart attack, stroke or asthma”. This fear intensifies the symptoms and a vicious circle develops.
- Life events — severe stress, bereavement, trauma in childhood.
- Taking or stopping caffeine, alcohol and certain substances can trigger attacks.
What are the symptoms of a panic attack?
During a panic attack, several of the following symptoms are usually present at the same time (the diagnosis is made only by a doctor, after ruling out other causes).
- Racing heart
- Sweating, chills or hot flushes
- Trembling
- A choking sensation or feeling short of breath
- Chest pain or tightness
- Nausea or abdominal discomfort
- Dizziness, blacking out, fear of fainting
- Numbness or tingling
- Feeling that your surroundings or yourself are unreal
- Fear of losing control or going mad
- Fear of dying
There is also a form of panic disorder combined with agoraphobia: fearing that “it will suddenly happen again and I won’t be able to get help”, the person avoids crowded places, public transport and being far from home, and chooses “safe” places for themselves.
When is emergency help needed?
You should know that a panic attack itself is not life-threatening and does not cause madness. However, if symptoms such as chest pain, breathlessness or loss of consciousness occur for the first time or differ from your usual attacks, heart problems and other serious causes must be ruled out before they are considered a panic attack — in that case call 103 immediately or go to an emergency department. Also seek urgent help if you have thoughts of harming yourself.
How is a panic attack diagnosed?
The diagnosis is based on detailed questioning about the symptoms. Similar symptoms can also be caused by heart rhythm disorders, an overactive thyroid gland, low blood sugar, asthma, the effects of certain medicines and substances, and rarely epileptic seizures. That is why, when necessary, the doctor orders an ECG, blood tests, a neurological examination and an EEG. Panic disorder often occurs together with depression, so assessing mood is also important — on this: Could it be depression?
How is a panic attack treated?
The aims of treatment are to reduce panic attacks and eliminate them as completely as possible, to change the patient’s attitude towards panic attacks, to resolve accompanying psychological problems and to give full information about the condition.
- Psychotherapy — cognitive behavioural therapy in particular is the main method with proven effectiveness in panic disorder.
- Medication — where needed, the doctor chooses a suitable medicine for long-term use.
The best results are often achieved by using both together. The doctor decides individually which approach to choose. Taking sedatives on your own and for a long time is unacceptable because of the risk of dependence.
What helps during an attack and in everyday life?
- During an attack, breathe slowly and deeply: breathe in through your nose and slowly out through your mouth.
- Remind yourself that this feeling will pass and is not dangerous.
- Focus your attention on specific objects and sounds around you.
- Take regular physical activity and keep a regular sleep pattern.
- Cut down on caffeine and alcohol.
- Completely avoiding the places you fear strengthens the fear — work on this together with a therapist.
Frequently asked questions
Can you die from a panic attack?
No, a panic attack itself is not fatal. However, chest pain and breathlessness occurring for the first time require heart causes to be ruled out.
Do panic attacks go away completely?
With treatment, attacks decrease considerably or disappear completely in most people. The earlier you seek help, the better.
Which doctor should I see?
The first appointment may be with a neurologist, a general physician or a psychiatrist; once physical causes have been ruled out, a psychotherapist or psychiatrist joins the treatment.
Can a panic attack happen during sleep?
Yes, some people have night-time panic attacks: they wake suddenly with intense fear, palpitations and breathlessness. Because similar night-time episodes can also be caused by sleep apnoea, heart rhythm disorders or nocturnal seizures, a medical assessment is needed.
Do caffeine and energy drinks affect panic attacks?
Caffeine can intensify palpitations and anxiety, and in some people it triggers attacks. People with panic attacks are usually advised to cut down on caffeine.