What causes a panic attack

EVERY so often you may be pressured, stressed or anxious about an event, a near deadline or something you deem important, and you have a panic attack.

According to Dr Roger Roberts, psychiatrist, a panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, during which patients may experience one or more of the following symptoms:

1. Palpitations, pounding heart or fast heart rate

2. Sweating

3. Trembling or shaking

4. Sensations of shortness of breath or smothering

5. Feelings of choking

6. Chest pain or discomfort

7. Nausea or abdominal distress

8. Feeling dizzy, unsteady, light-headed or faint

9. Chills or hot flashes

10. Paraesthesia — numbness or tingling sensation

11. Derealisation — feelings of unreality or depersonalisation — being detached from oneself

12. Fear of losing control or “going crazy”

13. Fear of dying.

Dr Roberts explained that due to symptoms such as fear of ‘going crazy’, dying or having a heart attack, panic attacks are usually very frightening but are physically harmless.

“During the episode of a panic attack, the person may have the urge to flee or escape from where they are. Panic attacks are common symptoms of anxiety disorders,” the psychiatrist said.

But where the panic attacks are recurrent, Dr Roberts explained that the individual might have a panic disorder.

“A panic disorder is characterised by the spontaneous and unexpected occurrence of panic attacks. An important cause of panic attacks for persons who have had previous panic attacks is fear of the panic attacks. These attacks may occur several times per day or week to a few times per year. There is an inherited component to panic disorder and it tends to occur between the ages of 18 and 45,” Dr Roberts said.

He added that women are two to three times more likely to be affected by panic disorders than men.

But the panic attack may also be triggered by an underlying condition or occurrence in the patient’s life.

“There are many triggers for panic attacks; common ones include injury, for example from motor vehicle accidents, diagnosis of a serious medical illness, death of a loved one, or termination of an intimate relationship, interpersonal conflicts and substances both illicit and prescribed such as cocaine, cannabis, caffeine and decongestants,” Dr Roberts said.

Dr Roberts, however, warned against self-diagnosis and encouraged individuals to see a doctor if they suspect they are having a panic attack.

“It is important that panic attacks be diagnosed by a medical professional. In a country like ours, where people tend to display poor health-seeking behaviours coupled with financial difficulties, some people may not seek medical attention for panic attacks primarily because the symptoms are usually short-lived — lasting for minutes, rarely longer than one hour — so symptoms may resolve before they reach a health facility. People may think it is pointless to pay to see a doctor or to wait to see a doctor when they are not having a problem at that time,” he said.

But Dr Roberts explained that panic attacks may mimic serious conditions like cardiovascular diseases, asthma attacks, pulmonary embolism (blood clot in the lungs), thyroid problems, low blood sugar and seizures.

“When people present to the doctor with symptoms of a panic attack, the doctor usually takes a detailed history and performs physical and mental status examinations. An ECG is frequently requested, but the doctor may order other investigations including blood tests, drug screen, urine test and a brain scan if the doctor thinks that the symptoms may be due to a medical condition. Following evaluation, the doctor can diagnose a panic attack and also reassure the person that he or she does not have a medical condition,” the psychiatrist said.

He added that the doctor might be able to diagnose a specific mental illness causing the panic attacks, for example panic disorder, phobias, post-traumatic stress disorder and obsessive-compulsive disorder.

“Approximately half of the people with recurrent panic attacks also have depression, which may be diagnosed for the first time when they seek medical attention for symptoms of a panic attack,” Dr Roberts said.

However, if not treated, Dr Roberts said a panic attack can lead to significant impairment in the person’s function affecting important areas such as school, work and social life. He said treatment might include cognitive behavioural therapy (CBT).

“In CBT, the therapist, usually a psychiatrist or psychologist, treats panic attacks by helping the person to change their negative or irrational thoughts associated with attacks as well as help them to learn to relax. Most persons, especially during the initial stage of treatment, may benefit from a combination of medications, anxiolytic medications, and CBT. Medications may be useful as part of the treatment for co-occurring depression,” Dr Roberts said.

He added that in some individuals, the panic attacks might be brought about by known stimuli, for example, a specific object or place.

“Those individuals can prevent a panic attack by avoiding the known stimuli. However, avoidance of known stimuli is not recommended if the avoidance interferes with the person’s normal function. Individuals whose panic attack may be brought about by or worsened by the use of substances, for example, alcohol, caffeine and illicit drugs, should derive benefit from discontinuation of the substance,” Dr Roberts said.