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Anxiety & Panic Attack Facts

Medically reviewed on Jun 25, 2017 by L. Anderson, PharmD

What is an Anxiety Attack?

Quite often, the term “anxiety attack” and “panic attack” are used interchangeably, but they are not the same condition. Anxiety, or generalized anxiety disorder (GAD) is a chronic, ongoing condition with excessive worry over normal life events, whether minor or major. These feelings are usually out of proportion to the trouble that you may encounter in your everyday life.

Roughly 3% to 8% of people in the U.S. suffer from GAD. When someone says they are having an “anxiety attack”, they are probably suffering from some extreme level of short-lived anxiety, not a true panic attack.

Occasional anxiety is a normal part of life. However, wIth generalized anxiety disorder, these feelings come on gradually and are present each day, not in one individual “attack.” GAD is usually present for months, or even years. You might worry excessively to the point that it interferes with your daily life. Anxiety symptoms may also be triggered by a life crisis or a period of stress, such as loss of employment or a death in the family. Generalized anxiety disorder can also be accompanied by depression and substance abuse disorders.

How Does it Feel to Have Anxiety?

Chronic anxiety is different from a panic attack, but shares many of the same symptoms. Like panic attack symptoms, ongoing anxiety can be very troubling and interfere with your work, sleep, family life, and social functioning.

What is anxiety like? The symptoms of anxiety can include:

  • Frequent, ongoing and excessive feelings of worry, nervousness or anxiousness
  • A rapid heart rate
  • Rapid breathing
  • Excessive perspiration and sweating
  • Trembling, quivering
  • Fatigue
  • Trouble concentrating
  • Headaches, stomach upset
  • Avoidance of circumstances that might trigger severe anxiety

Can anxiety cause muscle tension? Yes, many people who have chronic anxiety feel tense and have muscle aches, too.

What Are the Types of Anxiety?

The five main types of anxiety disorders include:

What Causes Anxiety or Panic Attacks?

The exact causes of most anxiety disorders are not fully known. Researchers believe there are miscommunications between neurotransmitters and receptors in the brain that can worsen anxiety disorders. Anxiety disorders may also be caused by:

  • Traumatic life experiences
  • Difficult relationships
  • Your environment
  • Family history
  • Genetics

What Are Panic Attacks?

What does it feel like to have a panic attack? Panic attacks can occur for no known reason and without warning. In a panic attack, you might feel terrified, anxious, and worried. You might feel like you are doing to die, or that you need to escape. Your heart might start racing; some people mistake a panic attack for having a heart attack. A panic attack starts suddenly and may last for a few minutes or rarely up to an hour. After your panic attack is over, you may become pre-occupied about when the next one might occur.

What is a panic attack like? The reaction is often referred to as the “fight-or-flight” response. Doctors typically look for at least four of these signs of panic attack to make a diagnosis:

  • Rapid heart rate
  • Rapid breathing
  • Shortness of breath
  • A feeling of choking
  • Chest pain or pressure
  • Lightheadedness or dizziness
  • Feeling shaky, trembling, numb or tingling
  • Nausea
  • Excessive sweating
  • Sudden flushing or chills
  • Upset stomach or diarrhea
  • Feeling of doom
  • Fear of dying, feeling a need to escape
  • An intense worry about when the next panic attack will occur

If 3 or less of these symptoms are experienced during a panic attack, it would be termed a limited symptom panic attack.

Types of Panic Attacks

  • Expected (Cued) Panic Attacks: A cued panic attack occurs suddenly due to a known trigger; for example, fear of heights, flying, or public speaking. Expected panic attacks are most often linked with social anxiety disorder, phobias, and agoraphobia. These are not diagnosed as Panic Disorder.
  • Unexpected (Uncued) Panic Attacks: These occur due to an unknown trigger, and when the person has the panic attack they do not make any association with what may have caused it. Unexpected and multiple panic attacks are required to definitively diagnose a panic disorder.

What is Panic Disorder?

When panic attacks occur frequently, the person is said to have a panic disorder, and this is one of many different types of anxiety disorders. Roughly 6 million Americans have panic disorder in any given year, and women experience panic disorder twice as often as men. Up to one-third of people may experience a panic attack in their lifetime, but only 10% of these go on to develop full panic disorder.

Can You Die from Having a Panic Attack?

Panic attacks lead to irrational fear and are very uncomfortable but are not dangerous or life-threatening. However, some people report they are afraid they are dying during a panic attack. Many people feel like they are having symptoms of a heart attack when they experience a panic attack, but upon medical review, no physical signs of a heart attack have occurred. Panic attacks are usually short-lived, peaking in about 10 minutes, but can be recurrent. Panic attacks can be lessened in intensity and frequency with adequate medical treatment involving talk therapy and medications.

Are Agoraphobia and Panic Attacks Related?

People who experience panic attacks may anticipate future attacks and avoid places or situations where the attack may re-occur; this is known as agoraphobia with panic disorder. With agoraphobia, you have fear towards certain places and often avoid situations that might cause you to panic and make you feel trapped, helpless or embarrassed. A person who experiences panic disorder with agoraphobia may avoid normal routines like going to school or work, going to the grocery store, or driving. Panic attacks can occur with no relation to agoraphobia, too; only about one-third of patients with panic disorder also have agoraphobia.

What Are the Possible Causes of a Panic Attack?

A panic attack occurs when there's no obvious danger present. Panic attacks may start in response to a certain fear or situation without warning, and ongoing panic attacks may be brought on by these similar situations.

Like anxiety, the exact causes of panic attacks are not known, but may be due to:

  • Family history or genetics
  • A life-changing event or major stress
  • Being more sensitive to stress or negative emotions
  • Biological changes in the brain

Are Panic Disorders Genetic or Inherited?

If anxiety or panic runs in a family, it can be genetically inherited. It is thought chronic anxiety begins in the brain where cells have difficulty communicating and processing fears. Medications used for anxiety and panic attacks are similar. Drugs that work in the brain, such as antidepressants and benzodiazepines, have been shown in clinical trials to help with both chronic anxiety and panic disorder.

What is the Difference Between Anxiety Attacks and Panic Attacks?

The main difference between anxiety and panic attacks is that anxiety is a chronic, ongoing and excessive level of worry, but a panic attack occurs abruptly, for no apparent reason, and usually lasts for minutes up to rarely one hour. An “anxiety attack” may occur with extreme anxiety to a known rational fear, such as losing your child in the department store. However, once the child is found, the fear disappears.

Another important difference is that panic is regarded as a danger occurring at the moment, while chronic anxiety and worry tend to occur about events in the future. Although the definition of panic attack and anxiety are different, treatments for these disorders often come from similar drug classes.

Here are a few examples of anxiety or panic attacks:

Normal Anxiety

  • Feeling extremely anxious because the hospital called to say they need to redo a medical test.
  • Feeling scared to drive on the highway at night during an ice storm.
  • Nervously awaiting your job application decisions.

Panic Disorder

  • Sitting in a movie theater and suddenly, without warning, feeling panicked like you needed to escape or you would die or lose your mind.
  • A short episode of extreme fear, difficulty breathing, and a pounding chest for no apparent reason.
  • Avoiding a particular place where you previously had a panic attack due to fear that it would occur again, even though the location is normally a safe place to be.

How To Stop a Panic Attack

So the question remains, how to treat panic disorder? Ongoing or recurrent extreme anxiety or panic attacks should be treated as soon as possible by a medical professional. For panic attacks, it’s important that you are treated quickly and that you do not start avoiding what triggered the attack. People who do not get treatment may start avoiding the trigger and stay at home instead, which can negatively impact their work and social life.

How do you control an anxiety disorder like a panic attack? A panic attack is best treated with a combination of medications (like certain antidepressants or short-term use of benzodiazepines) and psychotherapy or talk therapy with a specialist either alone or in a group setting. It may take a few weeks for therapy to reach it’s maximum effect, so it’s important to continue with treatment and not give up.

How Can I Sleep With an Anxiety Disorder Like a Panic Attack?

Medications and psychotherapy are often used to treat anxiety disorders, and sleep should improve in a few weeks after treatment starts. However, your doctor may prescribe a benzodiazepine such as lorazepam (brand name: Ativan) or clonazepam (brand name: Klonopin) for short-term use to help lower anxiety and aid with sleep until the maintenance medicine, such as an antidepressant takes full effect, sometimes up to 4 weeks.

How Long Do the Symptoms of a Panic Attack Last?

A panic attack typically lasts for short periods of time, usually peaking in about 10 minutes, but may rarely last up to an hour. Panic attacks can occur several times daily, or people may go weeks or months between panic attacks. In contrast, generalized anxiety disorder results in excessive worry over everyday situations and occurs over many months, or even years. General anxiety is not as abrupt and does not occur without warning like a panic attack, although anxiety can be severe.

Can Panic Attacks Happen at Random?

Yes, panic attacks can occur for no known reason and without warning, although patients may anticipate having a future panic which can worsen their condition. An anxiety or panic attack can start suddenly and may only last for a few minutes or may last up to an hour. Panic attacks can recur and you should seek treatment from a healthcare provider for ongoing panic attacks to determine if you need treatment and talk therapy.

Are Panic Attacks a Sign of Depression?

No, a panic attack is classified as an anxiety disorder. Major depressive disorder (MDD) is a different mental health condition; however, patients can have both depression and panic disorder at the same time. Similar medications are often used to treat both conditions.

Panic disorder is often accompanied by other medical disorders including:

  • Other anxiety disorders
  • Depression
  • Irritable bowel syndrome or other gastrointestinal issues
  • Asthma
  • Drug abuse and alcoholism

Can Too Much Caffeine Cause a Panic Attack?

Caffeine may aggravate panic attacks and make them worse. It is advised that people with a history of panic attacks avoid or limit:

  • Caffeine and other stimulants
  • Alcohol
  • Illicit drug use

If you take prescription medications, have your doctor or pharmacist review your medicines to be sure you are not taking any medications that may also worsen your panic attacks.

Treatment Options For a Panic Attack

Treatment of panic attacks or severe anxiety may involve specific medications that act in the brain to reset neurotransmitters that are theorized to be involved with fear. Short-term use of medications that provide a sedative (sleep-inducing) or calming effect may also be prescribed. Your doctor may also decide to prescribe other medications “off-label”, meaning they are not specifically FDA-approved for panic attacks, but have been used successfully in clinical treatment.

Learn More: Medication for Panic Attacks

What is the best medicine for panic attacks? Several classes of medication have been shown effective for the treatment of panic disorder symptoms. Medications can:

  • Reduce the attack frequency
  • Lessen the anticipation of an impending attack
  • Help to prevent avoidance of places or situations that might trigger an attack

Selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants, monoamine oxidase inhibitors, and benzodiazepines have all been shown to have a positive effect, but some are not well tolerated from a side effect standpoint. Therapy may continue for a year or more after symptom control, but relapse rates can be high upon drug discontinuation.

SSRI Antidepressants

SSRI (selective serotonin reuptake inhibitor) antidepressants are often recommended as the first-line choice of medicines to treat panic attacks due to safety and a tolerable effect profile profile. SSRI antidepressants have been used effectively for panic attacks. The average time for effect onset can range from 2 to 4 weeks, but full clinical effect can extend to 12 weeks in some patients. Start with low doses at the beginning of therapy to avoid the stimulating effect and anxiety that some of these medications can produce.

Selection of treatment in patients should be guided by tolerance to side effects, previous treatment history, dosing frequency, and cost concerns. SSRIs approved by the FDA for panic disorder treatment include fluoxetine (Prozac), paroxetine (Paxil, Pexeva) and sertraline (Zoloft). Medications that have shown a positive effect in clinical trials for panic attack compared to placebo include:

Generic Name Brand Name(s)
Citalopram Celexa
Escitalopram Lexapro
Fluoxetine Prozac
Fluvoxamine Luvox, Luvox CR
Paroxetine Paxil, Paxil CR, Pexeva
Sertraline Zoloft

Common side effects with SSRIs may include:

  • Headache
  • Dizziness
  • Irritability
  • Stomach upset (nausea or diarrhea)
  • Insomnia
  • Fatigue
  • Dry mouth
  • Sexual dysfunction
  • Withdrawal syndrome with rapid discontinuation
  • Increased suicide risk

Paroxetine (Paxil) has a higher risk of withdrawal symptoms than fluoxetine due to a shorter half-life, but fluoxetine may be more stimulating.

SNRI Antidepressants

Venlafaxine ER (Effexor ER), a serotonin-norepinephrine reuptake inhibitor (SNRI) has been shown in clinical trials to be effective for treatment of panic disorder and is FDA-approved for this use. SNRIs, like SSRIs, are considered a first-line choice of treatment for panic disorder. Use of the immediate-release venlafaxine for panic disorder is not recommended as it is associated with more side effects than the extended-release product.

Generic Name Brand Name(s)
Venlafaxine extended release (ER) Effexor ER
Duloxetine Cymbalta

Common side effects with SNRIs may include:

  • Nausea
  • Headache
  • Dry mouth
  • Stomach pain
  • Constipation
  • Loss of appetite, weight loss
  • Excessive sweating
  • Fatigue
  • Sexual dysfunction
  • Withdrawal syndrome with rapid discontinuation
  • Increased suicide risk

When stopping SSRI or SNRI treatment for panic disorder, a slow taper over several months is generally recommended to avoid withdrawal symptoms.

Tricyclic Antidepressants (TCAs)

In general, the class of tricyclic antidepressants has been shown effective for panic disorder; however, many patients may not be able to tolerate the side effects of this class. Imipramine and clomipramine have been shown to be more effective than placebo in lowering attack frequency. As with the SSRIs and SNRIs, treatment effect may not be seen until after 4 weeks, and may need to extend until 12 weeks of therapy. The elderly may not tolerate this class of medication for panic attack treatment due to anticholinergic effects.

Generic Name Brand Name(s)
Clomipramine Anafranil
Imipramine Tofranil
Desipramine Norpramin
Nortriptyline Pamelor, Aventyl

Common side effects with TCAs may include:

  • Anticholinergic effects like dry mouth, blurred vision, and constipation
  • Excessive sweating
  • Difficulty sleeping
  • Fainting or dizziness upon standing
  • Fatigue and weakness
  • Weight gain
  • Sexual dysfunction
  • Cardiac problems or high blood pressure

Benzodiazepines

Benzodiazepines, a common class of anti-anxiety medications, have been shown in clinical trials to be effective for panic disorders. These drugs are central nervous system depressants and can cause extreme drowsiness.

When possible, this class of drug should be used only in the short-term and with extreme caution because they can cause sedation, judgment problems, memory impairment, and addiction. Discontinuation of this class should be slowly tapered, over several weeks or even months, to avoid withdrawal symptoms.

Benzodiazepines may have a place at the outset of therapy in patients with severe symptoms while antidepressants or other longer-term agents take effect. They can also be combined with SSRIs or SNRIs for breakthrough symptoms. Avoid use in patients with a history of substance abuse, including alcohol, due to addiction potential. Although all agents in this class are effective for panic disorder, only alprazolam and clonazepam are FDA-approved for panic disorder.

Examples of benzodiazepines used in the treatment of panic disorder include:

Generic Name Brand Name(s)
Alprazolam Xanax, Xanax XR, Niravam
Clonazepam Klonopin
Diazepam Valium
Lorazepam Ativan
Oxazepam Brand discontinued

Common side effects with benzodiazepines may include:

  • Addiction, dependence
  • Anxiety
  • Drowsiness, somnolence, fatigue
  • Memory impairment
  • Withdrawal symptoms (anxiety, rebound insomnia, tremor, seizures)

Monoamine oxidase inhibitors (MAOIs)

Certain monoamine oxidase inhibitors (MAOIs) have been shown to be more effective than placebo for treatment of panic disorder; however, they are not specifically FDA approved for this use. Due to dietary restrictions, side effects such as hypertensive crisis, and drug interactions, MAOIs are rarely used to treat panic disorder. MAOIs should not be used with serotonin-modulating antidepressants due to the risk for serotonin syndrome.

Generic Name Brand Name(s)
phenelzine Nardil
tranylcypromine Parnate

Common side effects with MAOIs may include:

  • Anxiety, restlessness
  • Chills
  • Dizziness, orthostatic hypotension
  • Confusion
  • Rash
  • Constipation
  • Diarrhea
  • Dry mouth
  • Drowsiness
  • Erectile dysfunction, anorgasmia
  • Headache
  • Loss of appetite
  • Insomnia
  • Swelling

Other Treatments

Mirtazapine: (Remeron, Remeron SolTab )

  • Mirtazapine, a tetracyclic antidepressant, has been shown in some open-label clinical trials to be effective for panic disorder. This is a sedating antidepressant and may be better tolerated by patients who have worsening anxiety or stimulation due to SSRI treatment.

Beta Blockers:

  • Beta-blockers can help control some of the physical symptoms of panic disorder, such as rapid heart rate, but they are not frequently prescribed. Although beta blockers like propranolol have been used to treat symptoms of panic disorder, placebo-controlled studies have not demonstrated effectiveness.

Psychotherapy or Talk Therapy

Psychotherapy is a well-established and effective treatment often used for panic disorders. A goal of treatment in panic disorder is to learn to manage it successfully, yet realize all anxiety may not be completely eliminated.

  • Cognitive behavioral therapy (CBT) -- helps patients identify and change thoughts or behaviors that contribute to anxiety or panic. Therapy can lessen the panic sensations and help patients to overcome fear that may lead them to avoiding places or situations. CBT teaches you different ways of thinking and reacting to the feelings that come on with a panic attack. Attacks can begin to disappear once you learn to react differently to the physical sensations of anxiety and fear that occur during panic attacks. Sessions are usually attended once weekly for 3 to 4 months.

Patient support groups for anxiety may be helpful for some patients. Patients have the opportunity to learn that they are not unique in experiencing excessive worry, anxiety, or panic attacks. Support groups are not a substitute for effective treatment, but they can be a helpful addition to it.

Learn More: Join the Drugs.com Panic Disorder Support Group

Are Herbal Supplements Used for Anxiety or Panic Attacks?

Although several herbal treatments have been looked at for treatment of anxiety disorders, more research is required. Herbal and dietary supplements are not reviewed by the FDA for effectiveness, and they can also lead to serious side effects or drug interactions. Always check with your doctor or pharmacist before using any natural remedies for panic attacks or anxiety.

Preventing Panic Attacks

Panic attacks may occur without warning and there's no guaranteed way to prevent a first panic attack.

If you’ve had a panic attack, it’s important to get medical advice as soon as possible. Early treatment will help to prevent worsening of the disorder and future panic attacks. In addition the following lifestyle changes may help to decrease a recurrence of panic attacks:

  • Take your medications as directed, avoiding caffeine, and other stimulants.
  • Avoid alcohol, illicit drugs, and smoking, which can trigger or worsen panic attacks.
  • Maintain a regular exercise program to lessen stress and anxiety.
  • Eat a healthy diet and don’t skip meals.
  • Attend talk therapy (psychotherapy) if prescribed by your healthcare provider or join a medically recommended support group.
  • Consider yoga, meditation, or relaxation exercises to help with stress.
  • Learn breathing exercises to help lower stress.
  • Keep a daily log of triggers that worsen your anxiety, and try to manage these triggers.

How to Get Help With Panic Attacks

Anxiety and Depression Association of America
8730 Georgia Avenue, Suite 412
Silver Spring , MD 20910
Phone: (240) 485-1001
On the web: https://www.adaa.org/

National Institute of Mental Health
6001 Executive Boulevard, Room 8184, MSC 9663
Bethesda , MD 20892-9663
Phone: 866-615-6464
On the web: https://www.nimh.nih.gov/

See Also:

Recommended for you

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