A panic attack is a sudden feeling of extreme anxiety accompanied by significant physical symptoms such as trembling, sweating and shortness of breath. They are usually accompanied by an overwhelming fear of catastrophe ? the person may feel they are dying or suffering a heart attack, or they may fear they are going mad. They can occur in response to specific situations (such as crowded areas) or spontaneously and with no obvious cause. They are usually short-lived (lasting a few minutes) but are so unpleasant that a person may live in fear of it happening again ? in many cases, this will lead to the person avoiding situations that they think will trigger an attack (?avoidance behaviour?).

Panic attacks quite commonly accompany other anxiety conditions such as generalised anxiety and specific phobias (particularly Agoraphobia ? the fear of open spaces). However they can occur outwith these other conditions ? a study in 1994 found that 3 people in every 100 had experienced panic attacks alone.

Panic Disorder is the term used by Psychiatrists for those psychological conditions in which panic attacks predominate.

Psychological Symptoms of Panic Attacks

Intense anxiety
Fear of dying
Fear of losing control or going mad
Depersonalisation (the unpleasant feeling that you are not ?real? or are detached from yourself)
Derealisation (the unpleasant feeling that your environment is ?fake? or you are an ?actor in a play?)

Physical Symptoms of Panic Attacks

Shortness of breath or feeling ?smothered?
Choking
Palpitations (feeling the heart racing or beating irregularly)
Chest pain
Sweating
Dizziness or feeling faint
Nausea or abdominal discomfort
Flushing of the skin or feeling chilled
Trembling or shaking

The feeing of being unable to breath can lead to a compensatory increase in breathing rate (hyperventilation) by the person. This in turn can affect the body adversely, leading to both a worsening of the physical symptoms above and additional symptoms:

Physical Symptoms of Hyperventilation

Tinnitus (ringing in the ears)
Numbness or tingling sensations in the hands, feet and face
Headache
Weakness
Spasms of the hand and foot muscles

In a panic attack, people will usually experience at least 4 of the above symptoms, although most experience many more than this. For a diagnosis of Panic Disorder, the person will experience at least 4 panic attacks in a 4-week period, or experience significant fear of a further attack (and exhibit avoidance behaviour) for 4 weeks following a single episode.

Treatment

If the panic attacks are associated with other conditions such as generalised anxiety, phobia or depression, then the appropriate course of action is to address these underlying issues first ? the panic attacks should subside as these other issues are resolved.

If the panic attacks are the main problem, then (as with most psychological problems) two courses of action are available ? drug treatment and psychological therapies.

The drug treatment of panic attacks limited. Sedative drugs such as the Benzodiazepines (e.g. Diazepam (Valium)) are very effective in the short term, but are highly addictive and can lead to dependence. Further, when these drugs are withdrawn, a resurgence of the panic is likely. Antidepressants, particularly the Selective Serotonin Reuptake Inhibitors (SSRIs) such as Citalopram (Cipramil) and Paroxetine (Seroxat), are licensed for use in panic disorder. They can cause an initial worsening of symptoms when first taken, and can cause other side effects such as gastro-intestinal disturbance and sexual dysfunction. Drug treatments are not as effective as psychological therapies in these conditions.

NICE (National Institute for Clinical Excellence) recommends Cognitive Therapy for the treatment of panic attacks and panic disorder. Their research has shown it to be more effective than any drug treatments. Therapies such as Cognitive Behavioural Therapy (CBT) and Neuro-Linguistic Programming (NLP) involve the patient seeing a therapist on a one-to-one basis for hour-long sessions. The total treatment course is typically between 6 and 12 sessions, with one session a week. The therapies involve an explanation of the psychological and physical symptoms of panic attacks, and may involve the deliberate precipitation of a panic attack during a session. The aim is to reduce the fear associated with the physical symptoms ? this fear is often a cause of the attacks itself and the associated avoidance behaviours. Once the fear of the panic attacks is reduced, the attacks themselves will lessen in frequency and severity and, hopefully, disappear altogether.

Despite the clear recommendations by NICE, the availability of Cognitive Therapy remains limited in the NHS. If your GP or local Mental Health Trust is unable to provide the appropriate treatment for your condition, they may be able to recommend a therapist in the private sector.