A panic attack is not dangerous or life-threatening

Everyone has felt panicked at some point. You’ve got a big college exam ahead of you or you have to think fast to avoid a car swerving into your lane. Your heart speeds up, you feel anxious, your muscles tense and you feel keyed up. But these feelings and reactions go away and have a known cause. People who have panic disorders (PDs) don’t experience panic the same way.

Panic disorder is a mental disorder defined as recurring panic attacks or episodes of intense fear along with physical symptoms that strike often and without warning, even during sleep. For most people panic attacks last a few minutes, although in rare instances, they can persist for an hour or more. Usually the attacks don’t have a specific cause and don’t have a warning.

A panic attack is not dangerous or life-threatening. People with the disorder tend to become anxious between episodes, fearing another attack. People might develop phobias about places or situations where they have had panic attacks, such as at a grocery store. As the frequency of the attacks become more intense, the person may avoid places or situations where they fear they might have another attack, even though it might have nothing to do with the episode.

Panic disorder is twice as common in women as in men, affecting nearly 2 percent of adults, or about 2.4 million Americans, every year. The disorder usually begins in young adulthood before age 24.

Prognosis

PD doesn’t have a cure, but it does have treatments to help head off attacks and treat the attacks as they happen. Therapy includes cognitive-behavioral treatments along with medications.

An isolated panic attack is probably nothing to worry about. But recurring episodes can cause considerable disability and should be investigated by a psychiatrist or another physician skilled at identifying and helping people with anxiety disorders. Without treatment, people with panic disorder may develop a fear of supermarkets, public transportation, parties, restaurants or other places or situations in which they have experienced previous panic attacks.

In about one-third of cases, these irrational fears progress to agoraphobia, or the fear of being in a place or situation from which escape might be difficult or embarrassing. Some agoraphobics are afraid to leave home or other familiar surroundings. In many cases, early diagnosis and treatment can alleviate panic symptoms before agoraphobia has a chance to develop.

Treatments

According to research, at least 70 percent of people with panic disorder can be helped by cognitive-behavioral psychotherapy, medications or a combination of both. Among those who respond to treatment, significant improvement is usually seen within six to eight weeks.

Cognitive-behavioral psychotherapy operates under the theory that panic attacks are basically a learned response to something the patient is afraid of. Therapy sessions focus on helping the patient “unlearn” those physical reactions.

The therapist may suggest certain relaxation techniques, such as slow, controlled breathing, to refocus attention when panic begins to rise. The therapist might also offer a reality check by pointing out, for example, that a slightly elevated heart rate cannot cause a heart attack. Aside from the therapeutic exercises, talking things out during therapy sessions can be extremely beneficial to patients as they combat panic disorder.

Like cognitive-behavioral psychotherapy, medications such as benzodiazepines, monoamine oxidase inhibitors, selective serotonin reuptake inhibitors and tricyclic antidepressants have been shown to reduce the frequency and severity of panic attacks.

Children, teens and adults being treated with antidepressants, particularly people being treated for depression, should be watched closely for worsening of depression and for increased suicidal thinking or behavior. Close watching may be especially important early in treatment or when the dose is changed - either increased or decreased. Bring up your concerns immediately with your doctor.

Paxil may increase the risk for birth defects, particularly heart defects, when women take it during the first three months of pregnancy, according to a 2005 advisory from the Food and Drug Administration (FDA). The FDA is waiting for the results of recent studies to better understand the higher risk.

Discuss with your doctor about the health risks of Paxil if you plan to become pregnant or are in the first three months of pregnancy. You may want to consider taking a different antidepressant. Do not stop taking the drug without first talking to your doctor.

Anxiety disorders

You are in the grocery store when suddenly, for no apparent reason, you are gripped by terror. Your heart races, you can’t catch your breath, your muscles tense up, your hands tingle, you break into a sweat and feel faint. The sensations are so unexpected and overpowering that you think you are going to die or lose your mind right there at the checkout counter.

Within a couple of minutes, the episode passes almost as abruptly as it began. Although there are no residual physical effects, you worry about your health. During the next few weeks, your anxiety rises at the mere thought of having another panic attack. Your anxiety grows so intense it begins to disrupt your work and family life. Over the next few months, you begin avoiding social situations, figuring if another panic attack strikes, at least you’ll suffer through it in the privacy of your own home.

If this scenario sounds familiar, you may be among the more than 19 million Americans with one or more anxiety disorders, an umbrella psychiatric diagnosis that includes panic disorder, generalized anxiety disorder, obsessive-compulsive disorder, post-traumatic stress disorder and phobias. As with many other mental illnesses, anxiety disorders are chronic, unremitting and may grow worse unless properly treated. Sufferers may be tormented by episodes of panic, irrational thoughts and fears, compulsive behaviors or rituals, flashbacks, nightmares, or numerous frightening physical symptoms. Other problems such as substance abuse or depression often accompany anxiety disorders. While no cure for anxiety disorders exists, many effective treatments are available to relieve symptoms and greatly improve your quality of life. Unfortunately, a large percentage of sufferers never gets properly diagnosed or treated mainly because of the social stigma attached to anxiety disorders and other mental health problems. What causes anxiety disorders?

No one has pinpointed the precise cause of anxiety disorders, but there are many theories. As with other psychiatric illnesses, anxiety disorders are probably rooted in biology, psychology, social circumstances and environment to varying degrees. Panic disorder, for example, may stem partly from an overproduction of the “fight-or-flight” hormones epinephrine and norepinephrine deep within the brain stem. An imbalance of the brain chemical serotonin, which is believed to play a major role in mood regulation, also may be involved.

Some people inherit a tendency toward an anxiety disorder. A genetic predisposition may be triggered or exacerbated by distorted thinking and learned behaviors. For example, fear of future panic attacks (or even the fear of fear itself) may distort people’s perception of normal physiological fluctuations.

Mentally healthy people think nothing of sweat on a warm day or noticing a subtle change in their heart rate when someone they are attracted to enters the room. But someone with an anxiety disorder may perceive those same physiological changes as harbingers of doom. Researchers also have found that certain environmental stresses, such as the death of a loved one, getting divorced, moving to a different city or starting college, may precipitate or aggravate anxiety disorder symptoms.

Many families have an aunt, cousin or other relative who never shows up at weddings or other large gatherings. This kind of avoidance behavior may have nothing to do with the individual’s like or dislike of family members. It may have everything to do with fear. Social phobia, the overwhelming and disabling fear of disapproval in social settings, is one of a wide variety of known phobias. A phobia is defined as a persistent, irrational fear of a certain object or situation. Phobic people often feel so overwhelmed by their anxiety that they will do almost anything to avoid the object of their fear.