Panic attack

The experience: A woman, age 65, is driving over a bridge when she's gripped with fear. Her heart beats hard and fast; her chest aches; beads of sweat form on her skin. She feels as though she's about to suffocate and is certain she's going to die. She screams, and the friend sitting next to her in the car grabs the steering wheel. The passenger manages to pull the car over safely. The attack passes after about 10 minutes, but it was so frightening that the woman calls her doctor. After performing a physical exam and finding her otherwise healthy, the doctor tells her that she most likely had a panic attack and recommends a psychiatric consultation.

Symptoms: The primary symptom is a feeling of sudden, extreme apprehension, fear, or terror, often associated with feelings that a catastrophe is imminent. Physical symptoms may include shortness of breath, palpitations, chest pain, sweating, a sensation of smothering, and fear of going crazy or losing control. The symptoms are often so severe that people mistakenly believe they are having a heart attack; a 2003 study found that 22% of people who go to the emergency room with chest pain are experiencing panic attacks and have no cardiovascular problems.

During panic attacks, individuals may feel so dissociated from the world, and even from themselves, that they may think they're losing their minds. But panic attacks, in and of themselves, are not a sign of psychosis — once the panic attack passes, the person no longer feels "crazy" or out of control.

A panic attack usually lasts 5–30 minutes, but it can continue for as long as several hours. Although panic attacks typically occur during the day, they can also rouse someone from deep sleep. Because they cause symptoms throughout the body, panic attacks can be mistaken for neurological, gastrointestinal, cardiac, or pulmonary illnesses.

A panic attack can be an isolated event, or attacks may occur repeatedly. Repeated panic attacks are often triggered by a particular situation. Some people develop anticipatory anxiety when they are in situations that have induced panic attacks before, such as driving or riding over a bridge, shopping in a crowded store, or waiting in line. The common denominator for such panic-inducing situations is that they make the individual feel as though he or she is in danger and unable to escape. A panic attack can also be a symptom of another anxiety disorder, such as panic disorder, specific phobia, post-traumatic stress disorder, or generalized anxiety disorder. In these cases, however, a panic attack is one of many symptoms.

Not everyone who has panic attacks has, or will go on to develop, panic disorder (below). A doctor will diagnose panic disorder only if you have repeated, unexpected panic attacks, and if these attacks cause persistent worry about having further attacks or significant changes in behavior.

Cause: The underlying biological cause of panic attacks is not known. However, researchers theorize that it involves abnormalities in the areas of the brain responsible for interpreting potential threats, such as the amygdala, locus ceruleus, and hippocampus. Imbalances of the neurotransmitters norepinephrine and serotonin may also play a role.

Prevalence: Up to 10% of otherwise healthy people experience at least one isolated panic attack each year.

Who's at risk: People with a current or past anxiety or mood disorder are at greater risk for panic attacks. Use of stimulant medications, such as methylphenidate (Ritalin), can also promote panic attacks, as may caffeine and cocaine.

Effective treatments: For a single attack, the best treatment is cognitive behavioral therapy with benzodiazepines, used as needed to help prevent "anticipatory anxiety" (see "Panic disorder") and if an attack occurs.