Diseases & Conditions

Panic attacks

Panic attacksCausesDiagnosisMedicationsRisk FactorsSymptomsTreatment


A sudden onset of apprehension or intense fear lasting for a brief duration is known as a panic attack. The first panic attack can be a scary experience with a lot of people thinking that they are having a nervous breakdown or heart attack.

Causes of panic attacks

  • Heredity
  • Biological causes of panic disorder - Obsessive compulsive disorder, hypoglycemia, post traumatic stress disorder, hyperthyroidism, Wilson’s disease, mitral valve prolapse, pheochromocytoma, labyrinthitis and vitamin B deficiency.
  • Phobias
  • Short-term triggers of panic disorder- Emotional attachment, personal loss, significant changes in life
  • Maintaining causes
  • Un-assertive communication
  • Medications
  • Alcohol, drug or medication withdrawal
  • Hyperventilation syndrome
  • Pharmacological triggers
  • Illnesses

Psychological considerations of panic attacks

Even though the victim of a panic attack may think that his/her body is dying, it is in reality trying to protect itself. A sudden sense of fear releases adrenalin that prepares the body for intense physical activity. This causes an increase in the heart rate, rapid breathing and sweating. Because no physical activity actually happens, the carbon dioxide levels reduce resulting in dizziness, burning, lightheadedness and numbness. When adrenaline is released, the blood flowing to the head decreases and this can also cause dizziness.

Diagnosis of panic attacks

Panic attacks may at first seem similar to a lot of harmful and fatal conditions. A physical examination and study of the patient’s history can determine whether other conditions are causing the symptoms similar to that of panic attacks. Details such as medications, stress, and excessive caffeine intake by the patient will have to be considered. Vital organs will have to be checked and if required ECGs, EEGs and X-Rays will have to be done. Other neurological conditions like seizures should also be ruled out before treatment can start.

Medication of panic attacks

Medication for panic disorders commence only after the patient has been evaluated by a mental health expert for other mental disorders. Effective medications for panic attacks are:

  • SSRIs (Selective serotonin reuptake inhibitors)
    • Sertraline(Zoloft)
    • Fluoxetine (Prozac)
    • Paroxetine (Paxil)
    • Citalopram (Celexa)
    • Escitalopram (Lexapro)
    • Fluvoxamine (Luvox)
  • SSNRIs (Selective serotonin and norepinephrine reuptake inhibitors)
    • Duloxetine(Cymbalta)
    • Venlafaxine (Effexor)
  • Medication from benzodiazepine family
  • Propanol (Beta blockers)
  • Tricyclic antidepressants

Risks involved of panic attacks

Panic attacks can be treated with very specific drugs and if left untreated for long can create unnecessary and avoidable complications. Development of phobias especially agoraphobia which is the fear of leaving the house, depression, school or work problems, wanting to suicide, other mental disturbances and substance abuse are common. They are also at a higher risk of developing heart related problems.

Symptoms of panic attacks

The following is the diagnostic criteria (DSM IV) for panic attacks. Abrupt development of any 4 (or more) of the symptoms which reach a peak in 10 minutes indicate the possibility of panic attacks.

  • Intense panic
  • Palpitations
  • Sweating
  • Trembling/ shaking
  • Muscle tension
  • Blurry vision
  • Breathlessness
  • Choking sensation
  • Chest pain
  • Nausea
  • Feeling dizzy, faint, lightheaded or unsteady
  • Derealization
  • Fear of going insane
  • Fear of dying
  • Paresthesias
  • Chills / hot flashes
  • Knees feel weak
  • Confusion
  • Tunnel vision
  • Blank mind
  • Feel that time is going very slow
  • Wanting to escape
  • Insides feel warm
  • Head pressure

Treatment for panic attacks

Behavior therapy, psychological therapies and medication have been found effective in treating panic attacks.

Psychotherapy- A combination of behavioral and cognitive therapy that emphasizes on helping the patient to understand panic disorders have been found most appropriate and useful.

Paper bag breathing- Breathing into a paper bag can help to balance the oxygen and carbon dioxide levels in the blood. This is however dangerous if hyperventilation is because of lack of oxygen rather than carbon dioxide.