Pensive woman feeling worried
Mental Health Wellness

Panic attacks: a guide to symptoms and solutions

I first learned about panic attacks in school. 

When people had them, their hearts raced, and they feared they might be having a heart attack. 

They would tremble and sweat. A lot of times, they felt like they were suffocating. 

They had a sense of impending doom and often believed they were going to die.   

That's what it said in our textbook, anyway. But privately, I had my doubts. 

I wondered if people were just letting their emotions get out of hand. 

Or allowing themselves to have a meltdown as a way of getting attention or eliciting sympathy.    

That changed in 2017 when I had a panic attack myself. 

Eric Burk
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Key Points:  

  • The author's perception of panic attacks shifted after a personal experience in 2017, highlighting their intensity and unpredictability.  
  • A detailed description of panic attack symptoms, discussion of treatment options 
  • Practical advice on handling panic attacks at the moment and distinguishing them from heart attacks for timely medical attention. 

I'd just climbed into bed at the end of a normal day. 

I was tired, and it felt good to be off my feet. 

I wasn't worrying about anything. 

I rolled over on my right side to go to sleep like I always did. 

But I had an uncomfortable feeling, like I was holding my breath and wasn't getting enough air. 

My reaction was to take deep breaths; surely that would make the feeling go away. But it didn't. 

I sat up in bed and took the deepest breaths I could, but the feeling of suffocation only got worse.   

It's funny how quickly you panic when you feel like you can't breathe. 

Twenty years earlier, I'd been scuba diving with my wife and son at a depth of around 120 feet. Everything was going fine until we decided to surface. My wife couldn't inflate her BC -- a backpack that controls buoyancy -- and tried to swim to the surface with 20 pounds of lead strapped to her waist. 

She was a water polo player who could swim better than anyone I knew, but I could see she was struggling. I tried to help her release her weights but couldn't figure out how. Then, my son overinflated his BC and began ascending too quickly. If we did that, nitrogen bubbles could form in our bloodstream, leading to a potentially fatal condition called the bends. 

I grabbed his leg and tried to slow his ascent. Using scuba gear at 120 feet is like breathing through a straw, so I quickly became exhausted. My wife was exhausted, too. We both felt like we were suffocating. How did we react? We clawed our way to the surface, disregarding everything we'd learned in training. 

We hadn't been down long enough to suffer from decompression sickness, but we both came close to drowning that day.     

Now I'm sitting on the edge of my bed, having exactly the same feeling, except this time, there's no surface to swim to. 

I must have a pulmonary embolism, I thought. That was the only explanation. My heart started to race. I felt dizzy. I told my wife to take me to an ER. It was only four blocks away, but the drive seemed to take forever. I put my head between my legs to keep from passing out. I almost fell trying to walk from the car to the admitting window. 

 

As I lay on the bed in the ER, I apologized to my wife for all the projects I hadn't finished. I gave her messages to pass along to friends and loved ones. I was sure we were saying our last goodbyes. But I could see the pulse oximeter was reading 100, meaning I was getting all the oxygen I needed. There was nothing abnormal about my EKG. Blood tests revealed no sign of a heart attack. 

The doctor tiptoed carefully around the term "panic attack," but by the time he discharged me, I already knew that's what I'd had.  

What is a panic attack?  

A panic attack is a sudden surge of intense fear and discomfort that seems to come out of nowhere. 

Symptoms are at their worst within three to five minutes and usually begin to subside within twenty. 

They typically include a pounding or accelerated heart rate, palpitations, sweating and shaking, feelings of suffocation or choking, dizziness or light-headedness, nausea, fear of losing control, and fear of dying.  

Because they can occur suddenly and without warning, people who've had one panic attack often become preoccupied with the fear of having another. They may drastically alter their daily routines as a result, avoiding situations where they feel an attack is more likely. 

This is known as panic disorder, when the fear of having an attack becomes as big a problem as the attacks themselves. In some cases, people with panic disorder may be afraid to leave their homes, a condition called agoraphobia.  

What causes them?  

Most researchers agree that the amygdala is involved – the part of our brain that processes fear and other emotions. Neurotransmitters, specifically serotonin, cortisol, and gamma-aminobutyric acid, known as GABA, are also believed to play a role. 

This belief is supported by the fact that antidepressant medications (which affect serotonin) and benzodiazepines (which work on GABA) often help reduce symptoms. Research suggests the feeling of suffocation so many people experience may be due to a deficiency in naturally produced opioids known as endorphins. 

Genetics play a role, too, as attacks tend to run in families. People's immediate surroundings are also a factor. 

Other theories attribute panic attacks to thoughts people have, proposing that misinterpretation of internal physical sensations sets up a vicious loop in which fear increases the intensity of the sensation until a full-blown panic attack develops.   

The main thing to remember is that while there are dozens of competing theories, they all agree on one thing: panic attacks themselves are harmless.  

What can be done about them?  

Fortunately, it isn't necessary to understand the precise cause of panic attacks to manage them effectively.    

As noted earlier, antidepressant medications can lessen the frequency and severity of attacks. Healthcare providers may prescribe selective serotonin reuptake inhibitors (SSRIs) such as Paxil or Prozac or selective serotonin-norepinephrine reuptake inhibitors (SNRIs) such as Effexor and Cymbalta.  

Anti-anxiety medications such as Xanax and Ativan can reduce symptoms, too. However, they can be highly addictive, so providers usually try antidepressants first.   

Psychotherapy is also helpful. Cognitive behavioral therapy, for example, teaches people to identify distorted thoughts that contribute to their panic attacks. Once these thoughts are identified, therapy challenges and replaces them with more accurate and less distressing thoughts. Through the process of cognitive restructuring, people learn to think in more balanced and less catastrophic ways, which can reduce the severity of their attacks.    

Two other techniques I use in therapy are systematic desensitization, where clients are gradually exposed to their triggers in a safe and controlled environment, and interoceptive exposure, which involves inducing some of the physical sensations associated with panic attacks in a controlled setting. Both these techniques help clients overcome their fear of panic attacks.   

6 ways to combat a panic attack in the moment   

  1. If you're in a safe place, stay where you are. Moving around or leaving the situation can increase feelings of panic. 
  2. Don't try to fight it. Struggling not to have a panic attack will only add to your anxiety. Just accept that the attack is happening and let it pass.  
  3. Remind yourself that what you're having is a panic attack. As unpleasant as they are, they aren't life-threatening. You just need to ride it out. It will soon be over, and you'll be fine. If you've had panic attacks before, tell yourself, "I know what to do. I've handled these in the past. I'm always okay when they're over, and this time will be no different."   
  4. If you feel like you're suffocating, resist the urge to gasp for air like I did. Instead, focus on controlling your breathing. Take slow, deep breaths. Inhale for a count of four, hold for a count of four, and exhale for a count of four. This is called box breathing. It will prevent hyperventilation and help calm your body. 
  5. Focus on your surroundings and try to identify the following: 
  • 5 things you can see  
  • 4 things you can touch  
  • 3 things you can hear  
  • 2 things you can smell   
  • 1 thing you can taste  

This is known as grounding. It shifts your focus away from anxious thoughts and feelings and helps you stay connected to the present moment.   

  1. When the attack has passed, try to stay where you are for a while. This helps you recognize that the area itself is harmless and that you can be okay in it (for example, a crowded waiting room). Running away from areas as soon as an attack is over can reinforce unwarranted fear of those places.  

How do I know I'm not having a REAL heart attack?  

Because their symptoms are similar, distinguishing between a panic attack and a heart attack can be difficult in the heat of the moment. 

If you have a history of heart disease or risk factors such as diabetes or high blood pressure, it's always best to err on the side of caution and seek medical treatment.   

However, there are significant differences between the two types of attacks that are worth noting. 

Although heart attacks can occur suddenly, they generally begin with mild pain or discomfort that gradually gets worse over the course of several minutes. 

There's often a squeezing or crushing sensation – as if an elephant is standing on your chest – with pain radiating to the arm, jaw, neck, shoulders, and back; even the stomach, like heartburn. 

These episodes may come and go several times before an actual heart attack occurs and are frequently preceded by several days or weeks of abnormal fatigue.  

The pain associated with panic attacks, on the other hand, is rarely described as crushing; when pain occurs, it's usually sharp and stabbing. It always remains in the chest and goes away as soon as the panic attack is over. 

The pain of a heart attack may rise and fall, but it doesn't go away.  

Heart attacks usually occur after people have engaged in strenuous physical activity, especially if they aren't accustomed to it. 

Panic attacks aren't related to physical exertion and can occur at any time.  

Finally, the classic symptom of a panic attack – a racing heartbeat – isn't a specific sign or symptom of a heart attack. A person's heart may beat faster when they have a heart attack, and a rapid or erratic heartbeat can be a sign of a potentially serious medical condition known as AFib (atrial fibrillation). Still, a racing heartbeat isn't a typical symptom of heart attacks. More often, heart attacks are experienced as chest pain or discomfort, pain in the jaw, neck, or back, pain or discomfort in both arms or shoulders, feeling weak or light-headed, and feeling short of breath.  

Again, if you've never experienced any of these symptoms before or have doubts about what is happening to you, it's best to play it safe and get emergency treatment as soon as possible. 

Call 911 instead of having someone drive you to the hospital like I did. That way, if you're really having a heart attack, treatment can begin as soon as emergency responders arrive at your home.  

What I learned from having a panic attack  

Having a panic attack taught me things I could never have learned in a classroom. It allowed me to appreciate how terrifying panic attacks are and how they can happen to anyone. 

I'm so calm in everyday life that I assumed I was immune to them, but I experienced every symptom of panic I'd ever read about in a span of about 5 minutes. 

The panic attack I had in 2017 was much scarier than the experience of actually nearly drowning in 1997. 

That's how bad they can be. 

But I've also learned they're totally harmless and can be effectively treated, and I haven't had another one since then.    

More about the author

Eric brings over 30 years of mental health experience, serving individuals, couples, and families. As the Clinical Director of an intensive outpatient program, he specialized in mental health and substance abuse treatment. Eric’s background includes mentoring therapists and providing direct client care. He’s a licensed psychotherapist with expertise in a wide range of conditions, employing diverse therapeutic approaches with an emphasis on empathetic listening and unconditional positive regard. Eric and his wife Lynn, also a licensed therapist, enjoy family travel adventures and have explored destinations worldwide.

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