Overview

What is a panic attack?

Some of us may have used this word casually at some point in our lives: when you thought you missed a deadline for a project, when you run into an alarming presence of a snake on a trail, and more. However, an actual panic attack is much more of a frightening experience than one could imagine. A panic attack is an intense moment of overwhelming fear and anxiety when there’s no apparent danger present. Initially, the attacks can come suddenly and unexpectedly, without a trigger.

Panic attack and panic disorder: Are they the same thing?

A person can experience a few panic attacks in a lifetime during a period of stressful events and should eventually go away. A panic attack is a single event. However, if it persists for a long time with a high recurrence rate, it could be panic disorder. DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5) now categorizes panic disorder as either expected or unexpected. An expected panic attack is when a stressor or a cue triggered an episode. An unexpected panic attack is when there’s no stressor present and is usually sudden.

Is panic attack preventable?

No, there are no sure ways to prevent a panic attack from happening. While that sounds discouraging, one promising fact is that there are ways to help with the symptoms if an attack occurs. For example, the most common ways used to treat a panic attack are medication and therapy. While the medicine aims to reduce the intensity of the symptoms, therapy provides a deeper understanding of panic attacks and personalized ways to cope with them.

Panic attack vs. anxiety attack. What’s the difference?

Many people use these terms interchangeably, but they are two different things. Notice the following in mind when distinguishing the difference between the two:

An anxiety attack involves a perception of a situation that seems stressful or threatening. A panic attack, on the contrary, does not necessarily involve a stressor (in the case of an unexpected panic attack).
Symptoms of an anxiety attack can be present throughout the day, with the level varying from mild to severe. However, they are not as disruptive as the symptoms of panic attacks. For example, a person could feel anxious about a major presentation happening later in the day and still carry out a given task until then. However, suppose the person has a panic attack during the presentation. In that case, they will not successfully execute the task because the physical symptoms are too severe and intense.
DSM-5 does not include the term “anxiety attack.” On the other hand, the term “panic attack” is included in the book.

Causes

What are the causes of panic attacks?

It’s not known exactly what can cause panic attacks. It is most likely due to a combination of different elements contributing to the start of panic attacks. Some of the parts are:

Genetics – the chances of you having panic attacks increases if you have someone in the family who has had the experience of panic attacks or has been diagnosed with panic disorder.
Stressful Event – it is normal for people to go through stressful circumstances throughout their lifetime. However, some may be more stressful than others. For example, a death of a loved one, going through a divorce, a high-level stress job. could trigger an episode of a panic attack.
Disposition – in other words, a person’s temperament: the inherent qualities of a person. For example, a death of a loved one, going through a divorce, or a high-level stress job could trigger an episode of a panic attack.

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Symptoms

What are the symptoms of panic attacks?

Not everyone will have the same experience, so it varies. Here are some common ones:
Tightening of the chest
A sudden increase in heart rate
Sweating
Chest pain
Abdominal cramping/pain
Feeling tingly and numb
Nausea
Shaking/trembling
Extreme worry about when it will happen again next
Avoiding the places where you had previously experienced an attack

Diagnosis

Panic attack diagnosis criteria?

If you have experienced a sudden, unexpected, overwhelming fear with or without apparent cause (expected and unexpected panic attack, respectively) and have felt the physical manifestations (increased heartbeat, sweating, shaking), it could have been a panic attack. According to DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5), one must have had four or more of the following symptoms:

Pounding heart
Sweating
Shaking
Shortness of breath
Chills
Tightening of the chest
Chest pain
Fear of dying
Fear of losing control
Nausea

How to diagnose an individual with a panic attack/panic disorder?

Since there is some overlap between panic attack/panic disorder, anxiety disorder, and other conditions (e.g., heart issues), a certified healthcare professional must determine a proper diagnosis. To do so, they may perform one of the following:
A physical exam
Blood tests
self-assessment/questionnaire

Treatment

What treatment options are available for panic attacks?

The two most common ones used for the treatment of panic attacks are medications and therapy. Specialty Clinic of Austin offers both.

What kind of medications are used to treat panic attacks?

There are several kinds of medications used to treat symptoms of panic attacks. They are:

- Selective serotonin reuptake inhibitors (SSRIs) – typically used as antidepressants, are a set of drugs that can help with panic attacks, anxiety disorder, depression, and more. Serotonin, a type of neurotransmitter (a chemical messenger in the brain), plays a major role in stabilizing mood and happiness. The SSRIs work by increasing the duration of serotonin acting on the postsynaptic neuron, thereby preventing the reabsorption of serotonin by the presynaptic neuron (hence the name ‘serotonin reuptake inhibitor’). As a result, more serotonin neurotransmitters can stabilize mood and help with the symptoms of panic attacks, such as anxiety.
  Specialty Clinic of Austin has several SSRIs to offer to anyone with panic attacks/panic disorder. They include, but are not limited to:

- - Fluoxetine (Prozac)
  - Paroxetine (Paxil)
  - Sertraline (Zoloft)

- Serotonin and norepinephrine reuptake inhibitors (SNRIs) – functioning similar to the SSRIs, SNRIs are another set of antidepressants that can help with panic attacks. Specialty Clinic of Austin can offer these as well, with the most common one being venlafaxine (Effexor).
- Benzodiazepines – benzodiazepines are a class of depressants that act as sedatives. As the name implies, these medications have a calming effect on brain activity by stimulating neurons to release GABA (a type of inhibitory neurotransmitter in the brain). It can then aid in reducing the symptoms of anxiety and panic disorder. The most commonly used benzodiazepines for panic attacks are:
  - Alprazolam (Xanax)
  - Clonazepam (Klonopin)

The three types of drugs listed above are FDA-approved and produce effective results in patients with panic attacks. However, some may work better than others for some people. Talk with your healthcare professional to see which type is best suited for you.

How does therapy help with panic attacks?

While the medications help with the physical aspects of panic attacks, therapy helps with a more holistic approach to how to deal with panic attacks. One of the most common types of therapy, called Cognitive Behavioral Therapy (CBT), aims to change the cognitive and behavioral aspects of specific problems an individual faces at the time.

What can I expect from CBT?

The approach may include, but are not limited to:

Teaching the patient personalized coping strategies
Learning to face the fear instead of avoiding it
Coming up with problem-solving skills to deal with the problems

It is essential that the patient is active in the process and is willing to put in the effort to follow through with the treatment plan. Other than medications and therapy, a patient may also see improvements via joining a support group, modifying to a healthier lifestyle (getting enough sleep, exercise), and seeking ways to manage stress daily (yoga, breathing technique.).

Sources:

American Psychological Association. (2017, July). What Is Cognitive Behavioral Therapy? APA. https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral
Ankrom, S. (2020a, July 7). DSM-5 Criteria for Diagnosing Panic Disorder. Verywell Mind. https://www.verywellmind.com/diagnosing-panic-disorder-2583930
Ankrom, S. (2020b, November 17). What Is the Difference Between Panic and Anxiety Attacks? Verywell Mind. https://www.verywellmind.com/anxiety-attacks-versus-panic-attacks-2584396
NHS website. (2021, March 2). Overview – Selective serotonin reuptake inhibitors (SSRIs). Nhs.Uk. https://www.nhs.uk/mental-health/talking-therapies-medicine-treatments/medicines-and-psychiatry/ssri-antidepressants/overview/
Panic attacks and panic disorder – Diagnosis and treatment – Mayo Clinic. (2018, May 4). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/panic-attacks/diagnosis-treatment/drc-20376027
Vandergriendt, C. (2019, September 30). What’s the Difference Between a Panic Attack and an Anxiety Attack? Healthline. https://www.healthline.com/health/panic-attack-vs-anxiety-attack

Information

Medically reviewed by:

Charles Sweet, MD, MPH

Dr. Sweet is a native Texan and attended The University of Texas at Austin for undergraduate studies. He earned his Doctor of Medicine and Master of Public Health degrees at the University of Illinois and then did residency training at the prestigious Johns Hopkins Hospital, Dr. Sweet came back to Austin, TX for specialized training in Child and Adolescent Psychiatry and has been in practice since 2009.

Dr. Sweet believes strongly in working with, and training Physician Assistants to treat the behavioral health needs of adults, children and adolescents.

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