How to Manage Your Panic Attacks

Find out what causes panic attacks and how panic attacks can be treated before they take over your life.

Panic attacks are truly frightening events. Your heart races, you can't catch your breath. You feel dizzy, your stomach hurts, your mouth is dry. You feel like you're going to die or go crazy.

What Causes A Panic Attack?

The attacks come on quite quickly and peak within just a few minutes, often disappearing as suddenly as they appeared. Sometimes panic attacks are provoked by events going on around you, but sometimes they "come out of the blue" and arise for no reason at all. They may even wake you up out of your sleep.

The belief is that these panic attacks are caused by, or result from, the "misfiring" of the parts of the brain designed to alert us to things around us that might harm us (the "fight or flight" reaction that most of us have heard about). The misfiring refers to the fact that although the panic attack symptoms appear, there is no apparent danger facing us.

In addition to the attacks themselves, people suffering from panic disorder often have other symptoms including "anticipatory anxiety"- that is worry about the occurrence of the next attack. Since these attacks generally occur "somewhere," often the person suffering panic attacks may begin to avoid those areas where the attacks have previously appeared (agoraphobia). This may involve avoiding people, places, and things that have been known to be associated with panic attacks, and this results in a change in daily activities as a result of the attacks.

Panic Attack or Medical Problem

The tragedy is that many suffering from panic attacks often misinterpret the panic attack symptoms as being the result of some medical problem—such as heart attack, stomach, neurologic or other type medical problem. Often the patient ends up in the emergency room as a result of their panic attacks. During the time it takes to do the "workup" in the ER, the symptoms often resolve, and so when the doctor reports, "We can't find any medical cause for your symptoms and I think you're having a panic attack," the sufferer no longer is concerned, accepts the results and leaves. The problem is that, at the time of the next attack, the sufferer is in "the same boat" with regard to uncertainty about the cause of their symptoms. Often it is years before the correct diagnosis is made and accepted by the patient.

Medication and Therapy for Treatment of Panic Attacks

In general, the most effective treatment of panic attacks involves:

• education about panic disorder
• therapy aimed at controlling the response to the panic attacks
• medication to control and prevent recurrent panic attacks
• other types of treatment

The most important part of panic attack treatment involves understanding what the attacks are, that the symptoms really represent "a panic attack." It often takes years of suffering from the attacks before the patient gets to this point. Educational information about panic attacks can be found on the HealthyPlace website. Psychotherapy treatment for panic attacks and panic disorder generally involves:

• behavioral therapy aimed at learning to relax and control the symptoms of the panic attack
• cognitive behavioral approaches aimed at lessening the impact of the attack ("What's the worst thing that will happen?")
• relaxation exercises

The medication treatment for panic attacks involves two different approaches:

1. tranquilizers aimed at reducing the symptoms of the attack when they appear; and
2. other medications to reduce or prevent the recurrence of the panic attacks.

The first panic attack treatment involves the use of tranquilizers (usually "benzodiazepines"such as Xanax, Ativan, or Klonopin). This is, however, at best a "short-term approach." The longer-term, and more appropriate preventative approach, generally involves the use of serotonin-increasing "antidepressants" (such as the SSRIs (Prozac, , Paxil, Celexa, Lexapro-- or SNRIs such as Effexor or Cymbalta). Other medications may prove effective as well. To find a list of all anxiety medications approved and useful for panic attacks, please see other areas of this website.

There are nutritional approaches that have been suggested for panic attacks, but none of these have proven to be effective for most sufferers of the attacks.

This Tuesday, April 14, on HealthyPlace TV, we'll be going into more detail on the symptoms and treatments for this interesting and potentially disabling disorder. We hope you'll join us for the live show. If not, click the "on-demand" button on the player to watch the replay.

Dr. Harry Croft is a Board-Certified Psychiatrist and Medical Director of HealthyPlace.com. Dr. Croft is also the co-host of the HealthyPlace TV Show.

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