A panic attack is a sudden episode of intense, overwhelming anxiety that produces severe physical symptoms.

Panic attacks occur frequently and unexpectedly and are often not related to any external threat. A panic attack (also called an anxiety attack) can last from a few minutes to half an hour. But the physical and emotional effects of the attack may last for a few hours.

The episode triggers a number of panic attack symptoms, including heart palpitations, dizziness, nausea, tingling, breathlessness and chest pains that occur repeatedly and unexpectedly.

These attacks occur when the brain’s normal mechanism for reacting to a threat (the so-called “fight or flight” response) becomes inappropriately aroused.

A person who experiences recurring panic attacks is said to have panic disorder, which is a type of anxiety disorder. They generally have recurring and unexpected panic attacks and persistent fears of repeated attacks.

Between two and four percent of the population will suffer from panic disorder at some point in their lives, according to the South African Depression & Anxiety Group (SADAG).

Panic is twice as common in women as it is in men. For women, the average age of onset is during their early 20s, while for men it is in their 40s.

It's not known what causes panic attacks or panic disorder, but these factors may play a role:

  • Genetics
  • Acute stress (for example, caused by a chronic illness or relationship problems)
  • Tendency to be acutely sensitive to stress or prone to negative emotions
  • Changes in the way parts of your brain function
  • Use or withdrawal from addictive substances like drugs, alcohol and caffeine

What are its symptoms?

Panic attacks may start off by coming on suddenly and without warning, but over time, they're usually triggered by certain situations.

There are psychological and physical panic attack symptoms. The South African Depression &, Anxiety Group lists the following among the most common panic attack symptoms:

  • Feeling of being overwhelmed by fright and terror, with accompanying physical distress lasting for four to six minutes
  • Racing/pounding heart
  • Chest pains
  • Dizziness, lightheadedness, nausea
  • Difficulty breathing
  • Tingling or numbness in the hands
  • Flushes or chills
  • Sense of unreality
  • Fear of losing control or doing something embarrassing
  • Fear of going crazy
  • Fear of death.

An attack can make you feel like you’re about to die but it's usually harmless once the symptoms pass.

See your doctor if:

  • Your panic attack continues for longer than 20 minutes.
  • You still feel unwell after your breathing returns to normal.
  • You still have a rapid or irregular heartbeat or chest pains after your panic attack.
  • You regularly have panic attacks.

How is it diagnosed?

Diagnosis of panic disorder can be difficult. Several other physical and mental disorders are related to panic attacks. Depression, generalised anxiety disorder, social phobia, substance abuse, and personality disorders often occur with panic disorder. You may be evaluated for these and other disorders.

Consult your doctor who will give you a thorough physical and mental evaluation and ask you about your symptoms. This is based on the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-V). In the DSM-V, panic disorder is defined as repeating, unexpected panic attacks. It is followed by at least one month of concern about having a panic attack, worry about the consequences of panic attacks, and a change in behaviour as a result of the attacks.

Your doctor will also look for and rule out medical disorders that could cause your symptoms including:

  • Hyperthyroidism
  • Cardiac arrhythmias
  • Parkinson’s disease treated with levodopa
  • Heart attack
  • Pulmonary embolism
  • Episodic hypoglycaemia.

Your doctor should also ask about your intake of medication, food, herbs and supplements.

Use or withdrawal from addictive substances can cause symptoms of panic. Substances that can cause symptoms of panic include stimulants, such as cocaine and caffeine. Your doctor may also ask about your use of alcohol, nicotine, addictive medications (particularly sedatives), illegal drugs and other substances.

What are your treatment options?

The main aim in treating panic disorder is to reduce the number of panic attacks and ease the severity of symptoms.

Treatment usually includes a combination of medication, psychotherapy (usually cognitive behavioural therapy or CBT), and self-help. This includes reading literature on the topic, support groups, or relaxation techniques.

Antidepressant medications and tranquilisers are usually used to treat panic, as they “repair” the underlying chemical imbalance.

Selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants are two types of antidepressants that are often recommended for treating panic disorder.

Before starting any form of treatment, your GP will discuss all of the options with you, outlining the advantages of each type and making you aware of any possible risks or side effects.

No single treatment works for everyone and you may need to try a number of treatments before finding one that works for you.

During an attack, you can create relief by doing the following:

  • Breathe in deeply through your nose
  • Breathe out slowly through your mouth
  • Focus your thinking on the word “calm”
  • Keep calm and concentrate on your breathing. You should start to feel better as the level of carbon dioxide in your blood returns to normal, although you may feel tired afterwards.

Can it be prevented?

While panic disorder cannot be prevented, you may be able to prevent or reduce the number of additional panic attacks with proper treatment, including the following:

  • Get treatment for panic attacks as soon as possible to help stop them from getting worse or becoming more frequent.
  • Stick with your treatment plan to help prevent relapses or worsening of panic attack symptoms.
  • Get regular physical activity, which may play a role in protecting against anxiety.
  • Learn relaxation techniques, such as deep breathing and muscle stretches, to relieve stress.
  • Exercise regularly
  • Eat regular meals to stabilise your blood sugar levels.
  • Avoid caffeine, alcohol and smoking – these can make panic attacks worse.

For more info
South African Depression & Anxiety Group

The accuracy of this information was checked and approved by physician Dr Thomas Blake in June 2015