12 October, 2017

Symptoms of panic attacks and what to do

A panic attack is a sudden onset of intense anxiety or terror without any obvious threat. It is a misfiring of the so called “fight flight or freeze” adrenaline reaction.

Dr Michael McDonough, Consultant Psychiatrist and head of our Anxiety Disorders Service spoke about panic attacks on RTÉ Radio 1's John Murray Show

Dr Michael McDonough, Consultant Psychiatrist and head of our Anxiety Disorders Service spoke about panic attacks on RTÉ Radio 1's John Murray Show

RTE Radio 1's John Murray Show - Panic attacks

Typical symptoms of panic attacks

Panic attacks can include usually four or more of the following:

  • Pounding heart
  • Sweating
  • Shaking
  • Shortness of breath which can include:
    • Feeling of choking
    • Chest pain
    • Nausea/ tummy cramps
    • Feeling dizzy or unsteady
  • An out of body or unreal feeling
  • Shivers or hot flushes
  • Pins and needles

Panics can be full blown or milder “near” panics and they usually build to a crescendo in 10 minutes. Often the person understandably makes a catastrophic interpretation of what’s happening

  • “I feel dizzy - I will faint” 
  • “I feel like I’m not really here - I’m going mad” 
  • “I can’t breathe properly - I’m going to suffocate”

Panics burn out after several minutes, but lingering effects may last hours. 

What is panic disorder?

Panic Disorder may be diagnosed when there are recurrent panics that disrupt a person’s life. Once someone has one they understandably fear another will happen which can often generate new episodes. 

What might a panic attack feel like?

An example of a typical agoraphobic panic:

Get on train – wary of getting trapped, stuck – start to feel tense, sweaty – try to calm self-down – stand near exit – hold onto something to steady self – reinforces the idea that something bad is on the way – train stops between stations – I am trapped – try to catch breath – rapid breathing – makes dizzy – fear of fainting – feel unreal –  intense terror – fear I am dying – leave at next station

Do panic attack symptoms vary?

The physical symptoms tend to be much the same, but the focus of fear tends to vary for different people. Some fear collapsing, others a heart attack or others a feeling of losing control

Trigger situations that provoke the panics can vary also

  • fear of being far from home - agoraphobia
  • night time panics
  • confined spaces
  • worry induced panic
  • or panic triggered by trauma memories 

How do you know it is a panic attack and does not have a physical cause?

By looking at the symptoms and the fact that the main sensation is fear.

A few medical problems can mimic panic, but the signs are usually fairly obvious of the medical problem. 

Common examples are: 

  • Overactive thyroid or adrenal gland
  • Certain kinds of seizures
  • Heart palpitations
  • Lung problems like asthma

Most people suspect a medical cause with their first panic and go to A/E or to their GP

Some are misdiagnosed has having a medical or heart problem though there is more awareness of panic now than there used to be.

Can panic attacks be a symptom of another mental health problem?

Yes, very much. Less than half have isolated so called panic disorder.
Panics often accompany depression and if mood and energy is low this should be considered as a possible underlying cause. When we are down we tend to be more anxious and more vulnerable to panic feelings
50% develop agoraphobia – a fear of being away from safety usually home 

Panic may also be a sign of another anxiety disorder such as  

  • social anxiety
  • obsessive-compulsive disorder
  • a phobia or even 
  • post-traumatic stress disorder

In one third of people, the panic is mixed with alcohol or drug misuse

How common are panic attacks?

Panic attacks are very common, 7-9% of the population suffer from them and twice this amount if milder panics are included. 

Who is more likely to suffer from panic attacks?  

  • Panic attacks are more common in women with a ratio of 3:2. 
  • Most panic problems start late teens early 20s, but they can occur at any age. 
  • Often associated with stressful events, life upheavals or traumas either past or present such as: 
    • Loss of employment or being widowed or separated 
    • Early life adversity or abuse. 

What is the best way to deal with a panic attack?

Breathing and relaxation training is no longer considered the best approach. They tend to subtly maintain the idea that panic is dangerous or life threatening. 

We now recommend for typical panic:

To “go with it”. This is similar to the meditational idea of “detached acceptance”. Test out whether the panic will really harm you by riding it out. Stay in the situation if you can until panic subsides. Learn that although very unpleasant panic isn’t dangerous and won’t cause lasting harm

However, each person is different. If panic is linked with another problem, like past trauma or abandonment feelings or depression then it may not be best to tough it out. A more compassionate therapeutic approach may be needed initially. This highlights the importance of a careful assessment

When do you need to start looking for expert help?

If panics are causing significant disruption to your life they should be addressed early, the earlier the better.
A brief focused therapy using Cognitive Behaviour Therapy aims to break the maintenance cycle and is very effective for typical panic. It usually takes 4 to 10 sessions
But as mentioned earlier, it is important to note that panic can indicate a more complex underlying problem, so a careful mental health assessment is needed to start with.

Where can I get a mental health assessment?

Expert assessments can be done by mental health teams or CBT therapists and can be set up through GPs.
Increasing numbers of GPs have good expertise in anxiety but not all GPs are familiar with the latest developments in this area so it’s helpful to do your own research on what proven therapies are available.

What types of treatments are available?

Sometimes serotonin boosting antidepressants are used especially if depression is present but good psychotherapy is the preferred treatment for most. Valium like sedatives are best avoided.
Some individuals require longer term therapies to address underlying problems with confidence, relationships or past traumas.
This long term therapy tends to be taken on by therapists with a different training to the standard CBT therapy mentioned before
It is important to note also that some people have addictions to alcohol or sedative drugs and panics are a symptom of drug or alcohol withdrawal. These individuals obviously need their addiction addressed first.