What are panic attacks and panic disorder?

A panic attack is a sudden, intense fear or anxiety that may make you short of breath or dizzy or make your heart pound. You may feel out of control. Some people believe they are having a heart attack or are about to die. An attack usually lasts from 5 to 20 minutes but may last even longer, up to a few hours. You have the most anxiety about 10 minutes after the attack starts. If these attacks happen often, they are called a panic disorder.

Panic attacks can be scary and so bad that they get in the way of your daily activities. Treatment can help most people have fewer symptoms or even stop the attacks.

More women than men get panic attacks.

What causes panic attacks and panic disorder?

Experts aren't sure what causes panic attacks and panic disorder. But the body has a natural response when you are stressed or in danger. It speeds up your heart, makes you breathe faster, and gives you a burst of energy. This is called the fight-or-flight response. It gets you ready to either cope with or run away from danger. A panic attack occurs when this response happens when there is no danger.

Panic attacks and panic disorder may be caused by an imbalance of brain chemicals or a family history of panic disorder. They sometimes happen with no clear cause.

Panic attacks may also be brought on by:

• A health problem such as an overactive thyroid (hyperthyroidism), or heart or breathing problems.
• Depression or another mood disorder.
• Alcohol abuse.
• Using too much nicotine or too much caffeine.
• Taking certain medicines, such as those used to treat asthma and heart problems.
• Using illegal drugs such as marijuana or cocaine.
• Living with high levels of stress for a long time.

You have a higher chance of getting panic disorder if you have a parent with depression or bipolar disorder.

What are the symptoms?

Symptoms of a panic attack may include:

• A feeling of intense fear, terror, or anxiety.
• Trouble breathing or very fast breathing.
• Chest pain or tightness.
• A heartbeat that races or is not regular.
• Sweating.
• Nausea or an upset stomach.
• Dizziness and shaking.
• Numbness or tingling.

Symptoms of panic disorder may include:

• Repeated panic attacks when there is no reason for the fight-or-flight response.
• Changing your daily activities because you worry that you will have another attack.

Some people have a fear of being in crowds, standing in line, or going into shopping malls. They are afraid of having another panic attack or of not being able to escape. This problem is called agoraphobia and can be so bad for some people that they never leave their homes.

About half of people who have panic disorder also have agoraphobia.¹ People with panic disorder often have depression at the same time.

How are panic attacks and panic disorder diagnosed?

Your doctor will ask about your past health and do a physical exam. The exam may include listening to your heart, checking your blood pressure, and ordering blood tests to look for other causes of your problem. Your doctor may ask you to do some simple things that test your memory and other mental skills.

How are they treated?

Treatments for panic attacks and panic disorder include counseling and medicine. Using both will often work best. Treatment can help most people control or even stop attacks. But symptoms can come back, especially if you stop treatment too soon.^{2, 1}

Early treatment of panic attacks is very important. It can prevent other problems related to panic disorder. These problems include depression, anxiety disorders, and substance abuse.

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