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attack is a sudden, intense fear or
anxiety that may make you short of breath or dizzy or
make your heart pound. You may feel out of control. Some people believe that they
are having a heart attack or are about to die. An attack usually lasts from 5
to 20 minutes. But it may last even longer, up to a few hours. You have the most
anxiety about 10 minutes after the attack starts. 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.
More women than men get panic attacks.
Experts aren't sure what causes panic attacks and panic disorder. But the
body has a natural response when you are stressed or in danger. It speeds up
your heart, makes you breathe faster, and gives you a burst of energy. This is
fight-or-flight response. It gets you ready to either
cope with or run away from danger. A panic attack occurs when this response
happens when there is no danger.
Panic attacks and panic disorder
may be caused by an imbalance of brain chemicals or a family history of panic
disorder. They sometimes happen with no clear cause.
attacks may also be brought on by:
You have a higher chance of getting panic disorder if you
have a parent with
Symptoms of a panic attack
Symptoms of panic disorder may include:
Some people have a fear of being in crowds, standing in
line, or going into shopping malls. They are afraid of having another panic
attack or of not being able to escape. This problem is called
agoraphobia. It can be so bad for some people that
they never leave their homes.
People who have panic
disorder often have depression at the same time.
Your doctor will ask about your past health and do a physical exam. The
exam may include listening to your heart, checking your blood pressure, and
ordering blood tests to look for other causes of your problem.
Treatment for panic attacks
and panic disorder includes
counseling, especially cognitive-behavioral therapy (CBT). Medicines 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.
Early treatment of
panic attacks is very important. It can prevent other problems related to panic
disorder. These problems include depression,
anxiety disorders, and
Learning about panic attacks and panic disorder:
Health Tools help you make wise health decisions or take action to improve your health.
The exact cause of
panic disorder isn't clear. It is thought that it may be caused by an imbalance of chemicals in the brain (neurotransmitters). It also
may be passed down through families (genetic).
You can have a
panic attack without having panic disorder. Panic
attacks may be triggered by:
Panic attacks also can be caused by or linked with
other medical conditions, including:
The main symptom of a
panic attack is an overwhelming feeling of fear or
anxiety. This feeling occurs along with physical reactions.
An attack starts suddenly and usually
lasts from 5 to 20 minutes. But it may last even longer, up to a few hours. You
feel most anxious about 10 minutes into the attack.
It is possible to have one
panic attack after another in waves for an extended period of time. This can
seem like one continuous attack. But if you have continuous symptoms that don't go away within an hour, you probably aren't having a panic attack. You
should seek medical care right away.
Symptoms of a panic attack may
The symptoms of a panic
attack can be similar to those of a heart attack. Many people seek emergency
medical treatment for a panic attack for this reason. If you have chest pain
symptoms of a heart attack, get medical
treatment right away. For more information, see the topic
Panic attacks may begin
without a trigger. Or they can be linked to certain situations, such as being in
large crowds of people in restaurants or stadiums. Sometimes just knowing that you'll be in a certain situation can cause severe anxiety.
who have panic attacks often learn to avoid situations that they fear
will trigger a panic attack or situations where they will not be able to escape
easily if a panic attack occurs. If this pattern of avoidance and anxiety is severe,
it can become
agoraphobia, an intense and irrational fear of being in public places.
Isolating yourself and avoiding social situations can interfere with your
ability to work. It can also harm your relationships, especially with your family members and
Panic attacks aren't common
in children or younger teens. But children who have panic disorder or panic
attacks often have other symptoms in addition to those listed above.
A first panic attack often starts without warning during an
ordinary activity such as shopping or walking down the street.
The intensity of
these symptoms usually peaks within 10 minutes.
For many people, the first panic attack may occur a stressful time. It may happen during a life-threatening illness or accident, the
loss of a relationship, or separation from family. A woman may have her first panic
attack after she gives birth.
It is also possible for a
first panic attack to be caused by a drug reaction or a reaction to
nicotine or caffeine. But after the situation that caused the first panic
attack is resolved, attacks may continue.
Common traits in panic
panic attacks can be mild to severe. They may continue for
years, especially if you also have
agoraphobia (avoiding places where you fear another
attack will occur). You may have long periods of time
without panic attacks. And you may have other periods of time when attacks occur
You may need longer or different treatment if you have
both panic disorder and agoraphobia. You may also have
other conditions linked with panic disorder and panic attacks, such as drug
or alcohol problems, depression, or other mental health disorders. You will
need treatment for these conditions.
Panic disorder may last a
lifetime, but its symptoms can be controlled with treatment. Most people who have
panic disorder get better with treatment. They are able to get back to a normal
lifestyle. But relapse can occur, especially if treatment is stopped
Your risk for
panic attacks and panic disorder may be higher if you:
Call your doctor if you
It can be hard to tell the difference
between the symptoms of a panic attack (such as shortness of breath and chest
pain) and the
symptoms of a heart attack or another serious medical
problem. If you have symptoms of a panic attack, be sure to get medical care right away so that other medical conditions can be ruled out.
The following health professionals can diagnose
panic attacks. They may work together with other health
professionals to treat panic attacks and
Treatment for panic attacks and panic disorder may also
be provided by a:
Many community mental health centers, hospital outpatient
clinics, and family service agencies have treatment programs for people with
To prepare for your appointment, see the topic Making the Most of Your Appointment.
You may be diagnosed with panic
disorder if you have at least two unexpected panic
attacks along with fear or worry about having another panic attack and avoiding
situations that may trigger it.
will ask you questions about your symptoms. He or she will listen to your heart and check
your blood pressure. You may get blood tests. The doctor may need to rule out
other physical conditions that have symptoms similar to panic disorder, such as
mitral valve prolapse, or
reduces how many panic attacks you have and how often you have them. It lowers the anxiety you feel because of
the fear of future attacks. And it improves the quality of your life. Treatment may include:
Unfortunately, many people don't
seek treatment for anxiety disorders. You may not seek treatment because you
think the symptoms aren't bad enough. Or maybe you think that you can work things out on your
own. But getting treatment is important.
If you need help
deciding whether to see your doctor, see
some reasons why people don't get help and how to overcome them.
If your panic attacks were caused by a specific trigger, such as a
medicine reaction, you may not need treatment after the trigger has been
removed. In this case, that would mean stopping the medicine with the help of
But sometimes panic attacks caused by outside factors can continue
after the trigger has been removed. They may turn into panic disorder.
Panic attacks may also start suddenly without a known trigger.
You may have mild to severe panic attacks off and on for years, especially if you also
agoraphobia (avoiding places where you fear another
attack will occur).
Even after treatment is
stopped because the attacks appear to be under control, attacks can suddenly
return. Learn your early warning signs and triggers so you can seek
panic attacks get too severe or happen too often, you
may need to be hospitalized until they are under control. You also may need a
brief hospital stay if you have panic attacks along with another health
condition, such as
depression. Panic attacks combined with these conditions can be
harder to treat.
An important part of ongoing treatment is making sure
that you are taking your medicine as prescribed. Often people who feel better after
using medicine for a period of time may believe they are "cured" and no longer
need treatment. But when medicine is stopped, symptoms usually return. So it's
important to continue the treatment plan.
will be continually checked to see if you have other conditions linked with panic disorder, such as depression or
problems with drugs or alcohol. These conditions will also need
Panic disorder cannot be prevented.
But you may be able to
prevent or reduce the number of panic attacks with home treatment. For example, you can try relaxation exercises or limiting alcohol and caffeine.
Here are steps you can take to decrease the number
panic attacks you have. These steps can also reduce the severity of your
symptoms when an attack does occur:
When a person has panic attacks, his or her entire family is affected.
If someone in your family has panic attacks, you may feel frustrated,
overworked (because you have to take over his or her responsibilities), or
socially isolated because the person restricts family activities. These
feelings are common.
Family therapy, a type of counseling that involves the
entire family, may help.
For more information,
panic disorder are used to control the symptoms
panic attacks, reduce their number and severity, and
anxiety and fear linked with having another
Your symptoms of
panic disorder should start to improve within a few weeks after you start taking
medicines. If improvement is not seen within 6 to 8 weeks, a higher dose or
another medicine may be needed.
medicines used to treat panic attacks need to be continued for a year or longer
and then may be decreased gradually over several
weeks. If you have panic attacks again while
medicines are being stopped, the medicines may be continued for at least a few
months more. Some people may need to stay on medicines for a long time to keep
symptoms under control.
Taking medicines for panic disorder
during pregnancy may increase the risk of birth defects. If you are pregnant
or thinking of becoming pregnant, talk to your doctor. You may need to keep taking medicines if your panic disorder is severe. Your doctor can help weigh the risks of
treatment against the risk of harm to your pregnancy.
Medicines used most often to treat panic attacks include:
Medicines sometimes used to treat panic disorder include:
Medicines to treat
panic disorder often may prevent another panic attack. But they may not take away
the fear of having another attack. Counseling can help you handle this fear.
The fear of having an attack may actually bring on another attack.
Cognitive-behavioral therapy focuses on changing certain thinking and behavior patterns. It has been proved effective for treating panic disorder. Other types of counseling you might choose to seek
Support groups are
often good places to share information, problem-solving tips, and emotions
related to panic disorder.
Online discussion forums and websites may also offer information and support.
Self-help materials can help you learn to cope with panic
disorder or anxiety. These include instructional
videos, books, and audio materials.
Body-centered relaxation exercises can be useful for
reducing anxiety and treating symptoms of stress. They include:
Mindfulness activities are techniques that help relax the mind. They are often
combined with body-centered relaxation exercises. These techniques include:
This American Academy of Pediatrics website has information for parents about childhood issues, from before the child is born to young adulthood. You'll find information on child growth and development, immunizations, safety, health issues, behavior, and much more.
The Anxiety Disorders Association of America (ADAA)
works to improve the lives of people who have anxiety disorders. Members of the
association are not only people who have or are interested in anxiety disorders
but also health professionals who do research and treat people who have anxiety
Other Works Consulted
American Psychiatric Association (2009). Practice guideline for the treatment of patients with panic disorder. Available online: http://psychiatryonline.org/guidelines.aspx.
Huppert JC, et al. (2009). Anxiety disorders: Cognitive-behavioral therapy. In BJ Sadock et al., eds., Kaplan and Sadock's Comprehensive Textbook of Psychiatry, 9th ed., vol. 1, pp. 1915–1926. Philadelphia: Lippincott Williams and Wilkins.
Iacoviello BM, Mathew SJ (2010). Anxiety disorder. In EG Nabel, ed., ACP Medicine, section 13, chap. 1. Hamilton, ON: BC Decker.
McClure-Tone EB, Pine DS (2009). Clinical features of the anxiety disorders. In BJ Sadock et al., eds., Kaplan and Sadock's Comprehensive Textbook of Psychiatry, 9th ed., vol. 1, pp. 1844–1856. Philadelphia: Lippincott Williams and Wilkins.
Ravindran LN, Stein MB (2009). Anxiety disorders: Somatic treatment. In BJ Sadock et al., eds., Kaplan and Sadock’s Comprehensive Textbook of Psychiatry, 9th ed., vol. 1, pp. 1906–1914. Philadelphia: Lippincott Williams and Wilkins.
U.S. Department of Health and Human Services (2008).
2008 Physical Activity Guidelines for Americans (ODPHP
Publication No. U0036). Washington, DC: U.S. Government Printing Office.
Vannice GK (2012). Medical nutrition therapy for psychiatric conditions. In LK Mahan et al., eds., Krause's Food and the Nutrition Care Process, 13th ed., pp. 956–969. St Louis: Saunders.
May 17, 2013
Anne C. Poinier, MD - Internal Medicine & Lisa S. Weinstock, MD - Psychiatry
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