Overview

A panic attack is a sudden episode of intense fear that triggers severe physical reactions when there is no real danger or apparent cause. Panic attacks can be very frightening. When panic attacks occur, you might think you're losing control, having a heart attack or even dying.

Many people have just one or two panic attacks in their lifetimes, and the problem goes away, perhaps when a stressful situation ends. But if you've had recurrent, unexpected panic attacks and spent long periods in constant fear of another attack, you may have a condition called panic disorder.

Although panic attacks themselves aren't life-threatening, they can be frightening and significantly affect your quality of life. But treatment can be very effective.

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Symptoms

Panic attacks typically begin suddenly, without warning. They can strike at any time — when you're driving a car, at the mall, sound asleep or in the middle of a business meeting. You may have occasional panic attacks, or they may occur frequently.

Panic attacks have many variations, but symptoms usually peak within minutes. You may feel fatigued and worn out after a panic attack subsides.

Panic attacks typically include some of these signs or symptoms:

• Sense of impending doom or danger

• Fear of loss of control or death

• Rapid, pounding heart rate

• Sweating

• Trembling or shaking

• Shortness of breath or tightness in your throat

• Chills

• Hot flashes

• Nausea

• Abdominal cramping

• Chest pain

• Headache

• Dizziness, lightheadedness or faintness

• Numbness or tingling sensation

• Feeling of unreality or detachment

One of the worst things about panic attacks is the intense fear that you'll have another one. You may fear having panic attacks so much that you avoid certain situations where they may occur.

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Diagnosis

Your primary care provider will determine if you have panic attacks, panic disorder or another condition, such as heart or thyroid problems, with symptoms that resemble panic attacks.

To help pinpoint a diagnosis, you may have:

• A complete physical exam

• Blood tests to check your thyroid and other possible conditions and tests on your heart, such as an electrocardiogram (ECG or EKG)

• A psychological evaluation to talk about your symptoms, fears or concerns, stressful situations, relationship problems, situations you may be avoiding, and family history

You may fill out a psychological self-assessment or questionnaire. You also may be asked about alcohol or other substance use.

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Criteria for diagnosis of panic disorder

Not everyone who has panic attacks has panic disorder. For a diagnosis of panic disorder, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, lists these points:

• You have frequent, unexpected panic attacks.

• At least one of your attacks has been followed by one month or more of ongoing worry about having another attack; continued fear of the consequences of an attack, such as losing control, having a heart attack or "going crazy"; or significant changes in your behavior, such as avoiding situations that you think may trigger a panic attack.

• Your panic attacks aren't caused by drugs or other substance use, a medical condition, or another mental health condition, such as social phobia or obsessive-compulsive disorder.

If you have panic attacks but not a diagnosed panic disorder, you can still benefit from treatment. If panic attacks aren't treated, they can get worse and develop into panic disorder or phobias.

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Treatment

Treatment can help reduce the intensity and frequency of your panic attacks and improve your function in daily life. The main treatment options are psychotherapy and medications. One or both types of treatment may be recommended, depending on your preference, your history, the severity of your panic disorder and whether you have access to therapists who have special training in treating panic disorders.

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Psychotherapy

Psychotherapy, also called talk therapy, is considered an effective first choice treatment for panic attacks and panic disorder. Psychotherapy can help you understand panic attacks and panic disorder and learn how to cope with them.

A form of psychotherapy called cognitive behavioral therapy can help you learn, through your own experience, that panic symptoms are not dangerous. Your therapist will help you gradually re-create the symptoms of a panic attack in a safe, repetitive manner. Once the physical sensations of panic no longer feel threatening, the attacks begin to resolve. Successful treatment can also help you overcome fears of situations that you've avoided because of panic attacks.

Seeing results from treatment can take time and effort. You may start to see panic attack symptoms reduce within several weeks, and often symptoms decrease significantly or go away within several months. You may schedule occasional maintenance visits to help ensure that your panic attacks remain under control or to treat recurrences.

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Medications

Medications can help reduce symptoms associated with panic attacks as well as depression if that's an issue for you. Several types of medication have been shown to be effective in managing symptoms of panic attacks, including:

• Selective serotonin reuptake inhibitors (SSRIs). Generally safe with a low risk of serious side effects, SSRI antidepressants are typically recommended as the first choice of medications to treat panic attacks. SSRIs approved by the Food and Drug Administration (FDA) for the treatment of panic disorder include fluoxetine (Prozac), paroxetine (Paxil, Pexeva) and sertraline (Zoloft).

• Serotonin and norepinephrine reuptake inhibitors (SNRIs). These medications are another class of antidepressants. The SNRI venlafaxine (Effexor XR) is FDA approved for the treatment of panic disorder.

• Benzodiazepines. These sedatives are central nervous system depressants. Benzodiazepines approved by the FDA for the treatment of panic disorder include alprazolam (Xanax) and clonazepam (Klonopin). Benzodiazepines are generally used only on a short-term basis because they can be habit-forming, causing mental or physical dependence. These medications are not a good choice if you've had problems with alcohol or drug use. They can also interact with other drugs, causing dangerous side effects.