What are panic attacks? A detailed breakdown of the condition.

What is a panic attack?

Panic attack is a brief episode of intense anxiety accompanied by physical sensations of fear, such as palpitations, shortness of breath, or dizziness. These attacks often occur unexpectedly and are not associated with a specific external threat. An attack may occur in isolation in a particular situation, regularly develop independently of other psychiatric disorders, or accompany the course of other neurotic conditions.

What kind of disease is this?

Panic attacks are among the types of widespread mental disorders that up to 20% people experience at least once in their lives.

It is noteworthy that this phenomenon is more common among residents of large cities, and women are three times more prone to it than men. In case of regular manifestation of these attacks, panic disorder is diagnosed, noted in 3% of the population.

Previously, this pathology was considered as a vegetovascular, neurocirculatory dystonia or cardioneurosis, and its treatment was performed by therapists and cardiologists. However, nowadays panic attacks are included in the category of stress-related disordersand require therapy provided by psychotherapists and psychiatrists.

Signs of a panic attack

The first signals of a panic attack may resemble a heart attack, with palpitations, heart palpitations or even cardiac arrest. At the time of the attack, there is difficulty breathing, a feeling of shortness of breath, numbness or tingling in the body, a lump in the throat, hot and cold flashes, shivering, and an intense sense of dread. The duration of an attack usually ranges from 5 to 20 minutes. The frequency of these attacks is individualized: some have them once every few months or years, while others have them several times a day. The high frequency of attacks emphasizes the importance of timely medical attention.

Special attention should be paid to possible undertones: panic attacks can be signs of serious diseases, such as thyroid abnormalities, adrenal tumors and other disorders of the endocrine, nervous and cardiovascular systems.

It is important to remember that the first step after a panic attack attack is to see a doctor. Underestimating and ignoring symptoms can have serious consequences. Panic attacks treatableIn my practice, I use simple and effective methods to reduce their intensity and, in the long term, to get rid of them completely. The optimal result is achieved with a comprehensive approach, the main work is psychotherapyI only use medication in very rare cases, if the disease is already long-lasting.

In the psychotherapeutic process I actively use cognitive behavioral therapy techniquesaimed at correcting the thinking and behaviors that cause panic attacks.

I try not to use powerful psychotropic drugs such as antidepressants, anti-anxiety drugs, tranquilizers, and drugs with anticonvulsant effect in my practice, as they give short-term effect, have many side effects and can cause dependence (addiction), as a result of which their effectiveness drops and we have to switch to more "strong" drugs.

Types of panic attacks

I conventionally categorize panic attacks into the following types, although there is no universally accepted classification of this disorder:

Attributed panic attacks:

These attacks occur in a particular situation or context, such as riding on a bus or being in a crowded place. These attacks may be tied to specific circumstances or situations.

Spontaneous or unplanned panic attacks:

These panic attacks occur without warning or an obvious trigger. Neither situational nor environmental factors are associated with the onset of such an attack. A prime example is panic attacks during sleep. Spontaneous attacks are characterized by the absence of overt external stimuli and can be particularly difficult to predict.

Anticipatory or situational panic attacks:

These attacks occur in response to actual or anticipated exposure to certain situations. These situations become triggers for the onset of a panic attack. For example, a person with claustrophobia may expect to experience a panic attack in confined spaces, while a person with aerophobia may expect to experience an attack when an airplane begins to take off.

Conditioned situational panic attacks:

This type of attack is caused by a chemical or biological trigger of the nervous system. Examples include panic attacks after drinking alcohol, smoking, or taking drugs. These attacks can also be caused by hormonal changes (quite common in my practice), such as during pregnancy or after childbirth.

Although this classification is tentative, it helps to understand the variety of panic attack manifestations and their possible triggers.

Panic attack symptoms

Panic attack itself is not a disease, but a syndrome, a complex of symptoms that can accompany the course of other disorders or develop independently.

This condition, while not physically threatening and non-life-threatening is always difficult for the patient. The debut of manifestations is usually observed at the age of 20-30 years. Panic attacks can occur suddenly after psychoemotional stress or against a background of seemingly complete well-being.

The duration of a typical panic attack averages 15-30 minutes, although in rare cases it can last up to an hour.

The symptoms of panic attacks in men and women are similar, and the main ones include:

1. Anxious and irrational thinking: The patient may experience anxiety and unreasonable worries that may be difficult to explain.
2. A strong sense of fear, a premonition of danger: An intense sense of fear, despite the absence of a specific threat, often accompanies a panic attack.
3. Fear of losing your mind, control, or death: The patient may experience fear of losing their mind, loss of control, or even fear of death.
4. Dizziness, pre-syncope or fainting: Feelings of unsteadiness, dizziness, or even loss of consciousness may occur during an attack.
5. Tingling and chills, especially in the arms and hands: Bodily symptoms include a tingling sensation, frozen feeling, or even shivering, especially in the arm area.
6. Shivering or shaking: Shaking or trembling of the limbs can be one manifestation of a panic attack.
7. Shortness of breath or tightness in the throat: Feeling shortness of breath or tightness in the throat may be part of the physical response to the attack.
8. Chills: A feeling of cold or even chills may accompany the attack.
9. Sweating: There may be increased sweating during a panic attack.
10. Tides: Sudden hot or cold flushes may be part of the symptomatology.
11. Heart palpitations: Increased heart rate may occur during an attack.
12. A feeling of tightness in the chest: A feeling of pressure or tightness in the chest area can be a physical manifestation of a panic attack.
13. Difficulty breathing, including shortness of breath: Difficulty breathing and a feeling of shortness of breath may occur during an attack.
14. Nausea or upset stomach: Feeling nauseous or even physically upset stomach can be part of a stress response.
15. Abdominal spasms: Pain or cramping in the abdominal area may be an associated phenomenon.
16. Dry mouth: The sensation of dry mouth can occur as a result of physiological changes in the body.
17. A feeling of unreality and detachment from the world around me: The patient may experience unreality of the world around them or feel disconnected from reality.

Causes of panic attacks

To date, the exact causes of panic attacks have not been fully elucidated.

However, there is a suggestion that there is a genetic predisposition that can lead to overactivity of certain parts of the brain (usually closely related to the production of stress hormones). This overactivity can cause excessive reactions to minimal external stimuli (stress), which are perceived by the human brain as a danger.

Increased likelihood of panic attacks may be associated with acute and chronic psycho-emotional stress, internal conflicts, negative attitudes, and frequent exposure to life-threatening situations. The patient's harmful habits may also have an impact. Some somatic diseases, such as thyroid, cardiovascular, and respiratory diseases, may also increase the likelihood of developing panic attacks.

Self-diagnosis of a panic attack

To identify a panic attack, you should pay attention to the following signs, including:

• Inability to focus.
• Inability to relax.
• The constant expectation of danger.
• Distractedness.
• A constant state of irritability.
• A sense of tension.

These symptoms may accompany you during the attack and may continue after the attack is over, affecting your overall emotional state and daily life.

How not to confuse panic attacks with other illnesses

We call panic attacks a condition that was previously defined as an attack of vegetovascular or neurocirculatory dystonia. Unfortunately, some "old school" doctors still follow outdated methods, such as recommending MRI scans of the cervical spine, studying blood flow in the brain, and using collar massages, courses of vascular medications and nootropics to treat panic disorder. It is important to realize that these treatments are ineffective, appearing to be just a waste of money, and have no effect on overall health. Only a psychotherapist can help you overcome panic attacks effectively and on a long-term basis.

How do you differentiate between a panic attack and a stroke?

Distinguishing a panic attack from a stroke can be very difficult because they share some common symptoms. Here are a few key differences:

1. Origin of symptoms:
   • Panic attack: Occurs as a response to stress and can often occur at rest. The body's "hit or run" response to stress hormones can cause rapid heart rate, chest pain and shortness of breath.
   • Stroke: Stroke symptoms are caused by a disruption of blood flow in the brain and can occur suddenly.
2. Physical Activity:
   • Panic attack: Can occur at any time, including at rest (sleep).
   • Stroke: Often develops during physical activity.
3. Speed of development:
   • Panic attack: Usually peaks in about 10 minutes and slowly fades away.
   • Stroke: It's almost always instantaneous.

It should be noted that it is important to seek medical attention immediately if serious illnesses, including stroke, are suspected.

How to distinguish hypertension from panic attacks?

Distinguishing between a hypertensive crisis and a panic attack can also be difficult, as both conditions can be accompanied by an increase in blood pressure. Here are a few key differences:

1. Origin of symptoms:
   • Hypertensive crisis: Caused by high blood pressure and is usually associated with hypertension (persistently high blood pressure).
   • Panic attack: Caused by stress or anxiety, and while it can temporarily raise blood pressure, the increase is usually short-lived.
2. Duration of elevated blood pressure:
   • Hypertensive crisis: Characterized by a prolonged and sustained increase in blood pressure.
   • Panic attack: A temporary increase in blood pressure that returns to normal after the attack is over.
3. Symptoms:
   • Hypertensive crisis: May be accompanied by headache, dizziness, nausea, visual disturbances and other symptoms characteristic of high blood pressure.
   • Panic attack: Includes palpitations, shallow breathing, tremors, and dizziness, but usually without the symptoms characteristic of hypertension.

It is important to emphasize that if you suspect a hypertensive crisis or panic attack, especially if you have a cardiac problem, it is important to seek medical attention immediately.

How do you differentiate between a panic attack and anxiety?

Anxiety and panic attack are two different conditions, although they may share some commonalities. Here's how you can tell them apart:

1. Nature of manifestation:
   • Anxiety: Usually associated with a sense of impending danger or anxiety. A person may gradually feel anxious in response to certain events or circumstances.
   • Panic attack: Occurs suddenly and is often not associated with a specific perceived threat. It manifests as a sudden and intense attack of fear with physical symptoms.
2. Duration and intensity:
   • Anxiety: May be prolonged and gradually increasing in intensity. The intensity may vary depending on the situation.
   • Panic attack: Usually short-term, with high intensity over a relatively short period of time.
3. Physical Symptoms:
   • Anxiety: May be accompanied by various physical manifestations such as tension, anxiety, increased heart rate, but these are usually less severe than in a panic attack.
   • Panic attack: Often accompanied by more intense physical manifestations such as palpitations, sweating, shivering, and feeling short of breath.
4. Situational Connections:
   • Anxiety: May be related to certain situations or events that cause anxiety.
   • Panic attack: Often occurs unexpectedly and may not have a specific link to external factors.

It is important to note that anxiety disorders and panic attacks can exist independently of each other or combined as part of an overall mental health condition.

What to do in a panic attack?

A panic attack can be a frightening and unpleasant experience, but there are several strategies that can help manage it. Here are a few recommendations:

1. Deep breathing: practicing deep breathing can help reduce physical tension and anxiety levels. Try inhaling slowly through your nose, holding your breath for a few seconds, and then exhaling slowly through your mouth.
2. Focusing on the world around you: Try to focus your attention on specific objects around you. Identify what is in your field of vision and describe the details to yourself. This can help distract you from the symptoms of a panic attack.
3. Positive statements: repeat positive phrases or statements to yourself in your mind. For example, you might tell yourself that this is a temporary condition, that you are safe, and that the attack will soon pass.
4. Application of relaxation techniques: Use relaxation techniques such as progressive muscle relaxation or meditation. These techniques can help relieve physical and emotional tension.
5. Changing Mindsets: try to change your thoughts to a more positive view of the situation. Think of it as just a panic attack and not a real threat to your life.
6. Reach out for support: If you are not alone, ask for support from someone close to you. Simply talking to another person or just knowing that someone is there for you can provide significant relief.
7. Professional help: If panic attacks become regular or severely interfere with your daily life, seek help from a psychotherapist or psychiatrist. Professionals can help you develop effective strategies to manage stress and anxiety.

Remember, effective methods can vary from person to person, and it's important to find the ones that work best for you.

How to deal with a panic attack on your own?

It is important to remember that a panic attack is a temporary phenomenon. At the time of the attack, remind yourself that these feelings are passing and will not cause physical harm, despite their frightening intensity. Panic attacks usually peak within 10 minutes and then gradually subside.

• Take deep breaths. Focus on breathing slowly and deeply, paying attention to each breath.
• Find a quiet place. Visual and auditory stimuli can make a panic attack worse. Try to find a calmer place, perhaps leaving a busy environment or moving closer to a wall for support.
• Focus your attention on the object. In a moment of overwhelming anxious thoughts, focusing on a physical object in the environment can help you feel more confident.
• A walk or light physical activity. Walking can take you out of a stressful situation, and rhythmic movement also helps regulate breathing.
• Identify your stimuli (triggers). If you have frequent panic attacks, explore their possible triggers, such as confined spaces or crowds. Managing or avoiding these situations can reduce the frequency and intensity of attacks.
• Use lavender oil. Lavender is a traditional remedy that many people use to relieve stress and achieve relaxation.

Muscle relaxation method

Another sign of panic attacks is muscle tension. The use of muscle relaxation techniques can help to alleviate an attack because, by relaxing the body, the person's brain can muffle and reduce other symptoms, such as rapid breathing and heartbeat.

Progressive muscle relaxation - is a widely used method of alleviating anxiety and panic attacks.

It involves sequentially tensing and then relaxing different muscle groups. Do the following exercises during a panic attack:

1. Take a breath and tense your muscles and hold the tension for 5 seconds.
2. Exhale slowly while relaxing this muscle.
3. Allow the muscle to relax for 10 seconds before moving on to the next muscle group.

How to help a person having a panic attack?

1. Stay calm: Despite your own feelings of anxiety, try to remain calm and reassure the person. Reassure him or her that you will stay by his or her side, remind him or her that the attack is temporary, and reassure him or her that he or she is safe.
2. Ask how you can help: A person facing a panic attack may know what support they need. Ask how you can help, bearing in mind that everyone may have their own ways of dealing with attacks.
3. Study the warning symptoms: If you have the opportunity, learn the signs that indicate the onset of a panic attack. People exhibit different symptoms, and understanding them in advance will help you provide support more quickly and effectively.
4. Make your words more impactful: Use specific requests instead of general phrases like "don't worry". Offer to get out of the room for air, help the person keep breathing normally, or start a light conversation if he or she won't be quiet.

How do you get rid of panic attacks?

There are two main methods for overcoming panic attacks: psychotherapy (without medication), drug therapy, and a combination of the two.

A psychotherapist, depending on the severity of the illness, provides the appropriate type of treatment.

1. Psychotherapy: Psychotherapeutic techniques such as cognitive behavioral therapy (CBT) or psychoanalysis have shown good effectiveness in treating panic attacks. They help a person understand and change their thoughts, feelings, and behaviors related to the attacks.
2. Drug therapy: Medications such as anxiolytics or antidepressants are used to alleviate the symptoms of panic attacks. Usually, these medications are prescribed by a psychiatrist.
3. A combined approach: In some cases it is necessary to combine psychotherapy and medication as a means of relieving the acute phase of the disease.

What kind of doctor treats panic attacks? 

Psychotherapist: A psychotherapy specialist who is experienced in treating psychological and emotional illnesses, including panic attacks. He first carries out a full diagnosis, which is required to include a hormone test and other necessary tests. After the diagnosis is made, an individual program of treatment and psychological support is developed for the patient.

It's important to break down your symptoms with your doctor so he or she can determine the best treatment method for your situation.

How do you treat panic attacks?

Panic Attack Treatment: Cognitive Behavioral Therapy

I use cognitive behavioral therapy (CBT), a method that is the foundation of psychotherapy, to treat panic attacks.

Cognitive Behavioral Therapy (CBT): This method teaches different ways of thinking, behaving, and reacting to feelings that occur during or before panic attacks. The effectiveness of CBT is that by learning to respond differently to the physical sensations of anxiety and fear, a person can make attacks less frequent.

Exposure therapy: This is a common component of cognitive behavioral therapy that focuses on overcoming the fears and beliefs associated with panic disorder. The goal is a step-by-step habituation to activities that the person has been avoiding because of fears. Exposure therapy is sometimes used in combination with relaxation exercises.

Treating panic attacks involves not only therapeutic methods, but also an individualized approach to each patient, taking into account their unique needs and the nature of their illness. In just a few consultations, you will be able to effectively manage your panic attacks and return to your normal lifestyle.

Medications for panic attacks

This section is presented by me as an introductory read, for your general development and understanding of what exists and what is used today in the medication treatment of panic attacks.

Having a lot of positive experience in the treatment of panic attacks, in my practice I have very rarely had to prescribe medication. These were typically patients with a long history of the disease and already actively taking a variety of antidepressants.

Important! The medications used to treat panic attacks can come with an extensive list of side effects. Some of them can be highly addictive or habit-forming, which can reduce their effectiveness and encourage switching to more powerful medications in the long term. In addition, individual intolerance to the drug is possible, which manifests itself in a worsening of well-being after starting to take it.

It is important to consider all of these risks when deciding whether to use medication treatment for panic attacks.

There are a variety of medications that can be offered including:

1. Antidepressants: (Anafranil, Paxil, Cipralex, Zoloft, Lerivon, etc.) Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) may be prescribed to stabilize mood and reduce symptoms.
2. Beta-blockers: These medications can help reduce physical symptoms of anxiety, such as rapid heartbeat and trembling.
3. Anti-anxiety medications: Benzodiazepines can be used to relieve anxiety symptoms in the short term, but their use may be limited due to potential dependence.

In terms of quick panic attack relief, the following medications can be considered:

• Corvalol: Used as a sedative.
• Glycine: Used to relieve stress and tension.
• Bifren: A drug to help with anxiety.
• Quetixol: Used to reduce anxiety.
• Novo-Passit, Persen, Valemedin: Plant medicines that may have a calming effect.

Fast-acting drugs also include drugs from the group of benzodiazepine tranquilizers (used once, they help reduce a panic attack):

• alprazolam (Xanax),
• clonazepam,
• diazepam (Relanium),
• bromodihydrochlorophenylbenzodiazepine (phenazepam).

It is important to note that the choice of medication and its dosage should be determined by a doctor based on the individual characteristics of the patient.

The effects of panic attacks

The effects of panic attacks and panic disorder, if left untreated, can have a significant impact on various areas of your life. The following are potential complications associated with panic attacks:

1. The development of specific phobias: Panic attacks can lead to the formation of phobias, such as a fear of driving or leaving the house.
2. Frequent medical attention: Seeking medical care because of health problems or other illnesses can become routine.
3. Avoidance of social situations: Fear of a repeat attack can lead to avoidance of social events and social interactions.
4. Problems at work or school: Panic attacks can have an impact on performance and success in school or work.
5. Depression: Depressive states, anxiety disorders, and other mental disorders can occur after panic attacks.
6. Increased risk of suicide: There may be an increased risk of suicidal thoughts and actions.
7. Substance Abuse: Some people may resort to drinking alcohol or using other substances in an attempt to cope with symptoms.
8. Financial concerns: The need for medical care and other disorder-related expenses can lead to financial hardship.
9. Agoraphobia: Some people may develop agoraphobia by avoiding places or situations that cause anxiety for fear of not being able to escape or get help in the event of an attack.

Panic attack treatment is an important step to prevent negative consequences and improve quality of life. If you or someone close to you is experiencing these symptoms, you should not delay seeking help. It is important to identify the condition as early as possible to prevent future attacks from recurring.

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