Panic Attacks

Panic Attacks: Overview

Alternative Names: Anxiety Attacks

Panic disorder is a fairly common condition in which a person has uncomfortable episodes of fear or anxiety that occur suddenly and often without warning.  The attacks – called panic attacks – can last from minutes to hours.  They may occur occasionally or quite frequently and the cause or 'trigger' of these attacks may not be obvious right away.  There is a familial tendency, with the age of onset before 25 years old.  It occurs more often in women than men (2:1) and approximately 3-5% of the population is affected.  Panic disorder can occur in children, but is often not recognized.

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What happens during a panic attack?
The physiologic factors involved stem around arousal of the autonomic nervous system in the manner of a 'fight or flight' response to fearful inner impulses and emotions.  This stress response results in the characteristic body sensations often seen in a person in a panic attack.[1]

Causes and Development; Contributing Risk Factors

Panic is not necessarily brought on by a recognizable circumstance, and it may remain a mystery to the person involved.  These attacks come 'out of the blue'.  At other times, excessive stress or other negative life conditions can trigger an attack.

What can contribute to Panic Attacks?

  • Estrogens Low. There have been research studies in the past that showed association of panic attacks with decreased levels of estrogen in women.  In one article [Journal of Reproductive Medicine, 41(9): pp.633-9 1996], the authors concluded that womens' brains have been shown to be an estrogen target organ.  It is proposed that whenever brain estrogen levels fall below the minimum brain estrogen requirement, for whatever reason and at whatever age, brain center dysfunction may ensue and may cause symptoms of anxiety.
  • Thyroiditis. Occasionally an under-active thyroid condition called Hashimoto's autoimmune thyroiditis, known as HAIT or, simply, thyroiditis has been associated with a range of anxiety symptoms including panic attack.
  • High Sugar Diet. Eating a lot of foods high in refined sugar increases blood lactate levels and may induce panic in susceptible persons.
  • Smoking. A history of smoking may play a small role in the onset of panic disorder in women, but not men.  In comparing 217 patients with panic disorder to 217 age-matched controls, it was found that female patients with panic disorder had a significantly higher smoking prevalence at the onset of their illness than did control subjects 10 years previously (54% versus 35%).  Current smoking prevalence was also higher in those patients with panic attack versus controls (40% versus 25%).  Male smoking rates did not differ between the groups and caffeine intake did not appear to explain these findings.

Signs and Symptoms

Panic attacks are often associated with physical symptoms such as shaking, a feeling your heart is pounding or racing, sweating, chest pain, shortness of breath, a feeling of choking, nausea, cramping, diarrhea, dizziness, an out-of-body sensation (a feeling of being apart from oneself), tingling in the hands, chills or hot flashes, and headache.  A person may also have an extreme fear of losing control, going crazy or dying during a panic attack.  It is very rare for a person to have all of these symptoms at once, although the presence of at least 4 symptoms strongly suggests the diagnosis of panic disorder.

Once panic starts, stresses that normally would have been small and manageable become overwhelming.  A palpable, screaming fear rises inside and for no apparent reason; sufferers feel they are being choked by a panic that races the heart and paralyzes.  Not surprisingly, they begin to fear the attacks themselves.  This can lead to agoraphobia.  Agoraphobia occurs when a person finds it difficult to leave home or another safe area because of the fear of having a panic attack in public or of not having an easy way to escape if the symptoms start.

Many of the symptoms that occur during a panic attack are the same as the symptoms of diseases of the heart, lung, intestine or nervous system.  The similarities of panic disorder to other diseases may add to the person's fear and anxiety during and after a panic attack.

Treatment and Prevention

Nowadays, panic attacks and agoraphobia can be treated successfully in the majority of cases.  In fact, it is estimated that the appropriate therapy from a knowledgeable therapist helps close to 90% of panic attack sufferers.

Should I seek treatment if I'm having panic attacks?
Because of embarrassment or the fear of taking medicine, many people who have panic attacks don't seek medical care.  If you have panic attacks, it is very important to seek medical care and discuss your problem with your doctor.  After you have been evaluated thoroughly, your doctor will be able to tell you if the panic attacks are related to panic disorder or are caused by another problem.

Other treatment considerations.
Several kinds of psychological counseling are very effective for treating panic disorder and are as effective as medicine, but do not work as quickly.  If an underlying contributing condition can not be found, a combination of both psychological counseling and medicine seems to be the best treatment for panic disorder.  Types of behavioral therapy involving counter-conditioning treatment of fear responses have helped to abort panic attacks, but are of little use during the attack.  By
imagining a scene a person is just a little afraid of and then using relaxation techniques and affirmations to overcome the fear, people have been able to progressively face more stressful imagined fearful scenes until they were able to tolerate their worst fears.

One study reported that in 9 of 22 patients with panic disorders, attacks were more frequent in winter.  The authors suggest that, since there was positive benefit from light therapy in a single patient who underwent light treatment, seasonal panic disorder may be a variant of seasonal affective disorder (SAD).  They encouraged the possibility of light therapy in patients with seasonal panic disorder.

Urine samples were taken from 14 untreated panic attack patients and compared to those from 13 age- and sex-matched controls.  It was found that panic attack patients had significantly higher pH (alkaline) levels than controls (7.0 versus 5.5).  It was suggested that panic disorder individuals may have a series of subtle hyperventilating episodes (breathing too rapidly and/or deeply) that may account for this alkalinity.  Urine pH could be a simple way to evaluate respiratory status and subsequently the success of breathing retraining in patients with panic disorder.  Since slowing down the breathing rate or breathing into a paper bag will help restore normal pH, these techniques have helped reduce symptoms in some cases.

Additional support for an overly acidic system, apart from breathing, comes from the fact that in people with chronic anxiety unrelated to life events, an injection of sodium lactate can trigger a panic attack.

How long does treatment last?
How long treatment should continue depends on you.  The complete elimination of panic attacks is a reasonable goal.  Your doctor will design a treatment plan just for you.  A treatment period lasting at least 6 to 9 months is usually recommended.  Some people with panic disorder are able to stop taking medicine after only a short time, and some people need treatments over long periods of time or even for their lifetime.

References and Further Information

[1] Psychiatric specialists from the University of Göttingen in Germany recently reported results from a new study that found levels of the adrenal stress hormone cortisol surging in the beginning phase of a panic attack.  Researchers had twenty-five patients with panic disorder collect multiple saliva samples over a two-hour period while in the grips of a panic attack.  Then the patients collected samples again twenty-four hours later, after the attack had subsided.  Investigators discovered that levels of cortisol were markedly higher, by nearly 40%, during the early stages of the panic attack than they were the next day, when symptoms had abated.

Signs, symptoms & indicators of Panic Attacks:

Symptoms - Metabolic

Conditions that suggest Panic Attacks:

Mental

Symptoms - Mind - Emotional

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Risk factors for Panic Attacks:

Addictions

Cigarette Smoke Damage

Female patients with panic disorder had a significantly higher smoking prevalence at the onset of their illness than did control subjects 10 years previously (54% vs. 35%).  Current smoking prevalence was also higher in those patients with panic attack versus controls (40% vs. 25%).  Male smoking rates did not differ between the groups.  [Psychiatric Research, 1992;43: pp.253-62]

Autoimmune

Chronic Thyroiditis

Hashimoto's autoimmune thyroiditis has been associated with a range of anxiety symptoms including panic attack.

Circulation

Mitral Valve Prolapse

People with mitral valve prolapse (MVP) seem somehow to be 'wired' differently.  Their autonomic response can be much more volatile and unstable so that normal stresses and surprises set off an exaggerated response, flooding their systems with stress hormones called the catecholamines.  In fact, there may not be a specific stressor; people with MVP are intermittently and unpredictably awash in their own catecholamines.  This leaves them alternately innervated and exhausted – "wired but tired" is a common feeling.

If the sympathetic nervous system of a person with MVP is aroused, they can suddenly feel crushing chest pain, with heartbeat racing and pounding.  They may begin to hyperventilate, feel short of breath, and break out into a cold sweat.  This may occur without warning or immediate threat.  There can be sensations of chest pain, a feeling of doom or detachment, a fear of dying, or a desire to flee.  If they don't know why this is happening, the symptoms themselves are scary, and the fear of the unknown can prompt an even greater release of stress hormones, driving them into the kind of meltdown of the autonomic nervous system called a panic attack.  This is an intense and scary experience, the sensations of which can easily be confused with those of a heart attack.  Once people experience this, they generally have a persistent fear of having another attack, which puts them on a "hair trigger", ready to respond to the slightest symptoms by releasing the very stress hormones that induce the panic attacks, thus escalating a new attack.

Diet

Excess Sugar Consumption

Eating a lot of foods high in refined sugar increases blood lactate levels and may induce panic in susceptible persons.

Environment / Toxicity

Hormones

Progesterone Low or Estrogen Dominance

It has been reported that women with low progesterone levels experience less intense or less frequent panic attacks after progesterone supplementation.  In some cases, sublingual progesterone in olive oil has produced immediate benefit.

Low Adrenal Function / Adrenal Insufficiency

When adrenal function is low, caffeine consumption may contribute to panic attacks.  Caffeine interferes with adenosine, a brain chemical that normally has a calming effect, and raises the level of lactate, a biochemical known to produce panic attacks.

Metabolic

Nutrients

EFA (Essential Fatty Acid) Type 3 Requirement

In one study, 3 out of 4 patients with panic attacks or a history of agoraphobia for 10 or more years improved within 3 months after taking flaxseed oil.

Panic Attacks suggests the following may be present:

Circulation

Mitral Valve Prolapse

People with mitral valve prolapse (MVP) seem somehow to be 'wired' differently.  Their autonomic response can be much more volatile and unstable so that normal stresses and surprises set off an exaggerated response, flooding their systems with stress hormones called the catecholamines.  In fact, there may not be a specific stressor; people with MVP are intermittently and unpredictably awash in their own catecholamines.  This leaves them alternately innervated and exhausted – "wired but tired" is a common feeling.

If the sympathetic nervous system of a person with MVP is aroused, they can suddenly feel crushing chest pain, with heartbeat racing and pounding.  They may begin to hyperventilate, feel short of breath, and break out into a cold sweat.  This may occur without warning or immediate threat.  There can be sensations of chest pain, a feeling of doom or detachment, a fear of dying, or a desire to flee.  If they don't know why this is happening, the symptoms themselves are scary, and the fear of the unknown can prompt an even greater release of stress hormones, driving them into the kind of meltdown of the autonomic nervous system called a panic attack.  This is an intense and scary experience, the sensations of which can easily be confused with those of a heart attack.  Once people experience this, they generally have a persistent fear of having another attack, which puts them on a "hair trigger", ready to respond to the slightest symptoms by releasing the very stress hormones that induce the panic attacks, thus escalating a new attack.

Recommendations for Panic Attacks:

Botanical

Kava

Germany's Commission E, that country's official herb-regulating body, has authorized the use of kava as a medical treatment for "states of nervous anxiety, tension, and agitation."

Diet

Alkalizing Agents/Diet

For people with chronic anxiety unrelated to life events, injection of an acid such as sodium lactate can trigger a panic attack.

Sugar Avoidance / Reduction

Eating a lot of foods high in refined sugar increases blood lactate levels and may induce panic in susceptible individuals.

Caffeine/Coffee Avoidance

Coffee can cause adrenal insufficiency which in turn can lead to panic attacks.

Environmental

Sunlight Exposure

A study found that 9 of 22 patients had panic attacks more frequently in winter.

Habits

Tobacco Avoidance

A history of smoking may play a small role in the onset of panic disorder in women, but not in men.

Lab Tests/Rule-Outs

Test Estrogen Level

There has been research showing an association of panic attacks with decreased levels of estrogen in women.

Test Thyroid Function

Hashimoto's autoimmune thyroiditis has been associated with a range of anxiety symptoms including panic attack.

Nutrient

Inositol

Inositol has been found to be effective in treating panic disorder.  Inositol works by regulating the action of serotonin, a calming neurotransmitter, within the nerve cells.  Its safety has been noted up to 20gm per day.

Psychological

Visualization/Relaxation Techniques

Types of behavioral therapy involving counter-conditioning treatment of fear responses have helped to abort panic attacks.

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