Panic attacks: causes, symptoms and treatment

Panic attacks are brief episodes of intense anxiety. They come on suddenly, and feel overwhelming. Sufferers fear an acute danger, and their symptoms vary. Panic attacks often occur in connection with stress or other challenging situations. The exact cause cannot always be determined immediately, though. How long do panic attacks last? These states don’t usually last longer than 30 minutes, but they have also been known to last a few minutes or several hours. Some sufferers experience the symptoms of panic attacks all day long, while others only get them a few times a year. 

Panic attacks can be triggered by a number of different things.

• Stress: stress is a particularly common cause of panic attacks. Stressful situations can arise at work or in the case of family disagreements, for example. Disputes with a partner, for instance in cases of separation or divorce, can also trigger panic attacks. This kind of state can also be triggered by positive stress, however, such as anticipation of your own wedding.
• Alcohol: alcohol may also trigger panic attacks. Sufferers may misinterpret the physical reactions resulting from the consumption of alcohol, leading to an acute fear of illness.
• Caffeine: caffeine (for example in coffee) raises your heart rate. Sufferers may interpret this as a sign of a heart attack, and respond with acute panic.
• Difficult life events: difficult life events may sometimes lead to panic attacks, too. These include traumatic experiences such as the death of a loved one. Being involved in a car accident can also be traumatising. In this case, sufferers often experience panic attacks when driving, with corresponding symptoms. Equally, panic attacks may occur during pregnancy if women have previously experienced complications while pregnant.
• Nutrient deficiencies: in some cases, panic attacks can be due to a nutrient deficiency. Vitamin B and magnesium are two of the nutrients that are relevant in this regard.
• Mental health problems: panic attacks often occur in combination with other mental health problems, such as obsessive-compulsive disorder or depression.
• Physical health problems: certain physical health problems also make acute anxiety and panic attacks more likely. These include asthma, sleep apnoea and epilepsy.
• Genetic factors: researchers suspect that there may be a genetic predisposition to panic attacks, as certain families exhibit a greater likelihood of suffering from panic attacks.

By the way, about 40% of sufferers experience panic attacks during the night. It’s not clear why that is. Medical experts suspect that the triggers are the same as for panic attacks during the day. At night, dreams may also bring about physical reactions that cause fear in those experiencing them.

The symptoms of a panic attack are case-specific and their intensity may vary depending on the circumstances. The symptoms of a mild panic attack may be similar but less severe. So what are the signs of a panic attack?

• Tachycardia and heart palpitations
• Rapid, intense breathing leading to hyperventilation
• Tightness and pain in your chest
• Nausea and dizziness
• Hot flushes and sweating, sometimes alternating with chills
• Fear of dying
• Feeling like you’re going crazy or losing control
• Feeling dissociated from yourself and your surroundings (depersonalisation/derealisation)

Good to know: if people experience frequent panic attacks, at some point they develop a fear of panic attacks. Experts refer to this as “anticipatory anxiety” or “phobophobia”.

Silent panic attacks: symptoms

Silent panic attacks are not apparent to external observers. What do silent panic attacks feel like? They cause the same symptoms as normal panic attacks. Symptoms such as tremors and hyperventilation are less pronounced, however, and not obvious to others.

You should ideally seek out a doctor if you experience panic attacks once a month or even more frequently. You may have a panic disorder. If a medical professional is able to rule out physical causes, they will refer you to a psychotherapist, who will clarify the complaint in a detailed consultation. This will be complemented by clinical interviews and questionnaires (such as the Hamilton Anxiety Scale). The results are used to arrive at a diagnosis and determine a suitable form of treatment.

There are a number of different approaches to treating panic attacks. Experts apply a number of different measures in most cases. 

Instant measures in the event of panic attacks

There are various first aid measures that you can take to overcome panic attacks, including breathing techniques. Breathe in through your nose while counting to four. Hold your breath for seven counts. Then breathe out through your mouth for eight counts. What else helps with panic attacks? Abdominal breathing is another relaxing breathing exercise. Place your hands on your stomach and focus exclusively on your breathing. Breathe in, allowing the air to flow all the way down into your stomach. This will cause your stomach to rise. Then breathe out. Your stomach will fall again. Repeat this process until you feel relaxed. 

Some people also find household remedies helpful for overcoming panic attacks in acute situations. You could bite into a chilli pepper or lemon, for example. Or flick a hair tie on your wrist. Try to avoid focussing on your feelings of panic. Accept the situation without losing yourself in your emotions. 

Medication for panic attacks

The medications used to treat panic attacks are typically antidepressants, and primarily selective serotonin reuptake inhibitors (SSRIs). Doctors often prescribe citalopram or paroxetine. In some cases, they will prescribe special sedatives (benzodiazepine). However, these are only suitable for short-term use because they can lead to addiction. 

Psychotherapeutic assistance with panic attacks

Doctors usually use a combination of medication and psychotherapy to treat panic attacks. Cognitive behavioural therapy, in particular, has become established in this regard. This involves the psychotherapist investigating what happens when you suffer a panic attack. They will talk to you about how you evaluate critical situations, and work with you to develop alternative evaluation concepts.

Please note that the chances of successful treatment are good if the panic attacks are occurring in connection with a panic disorder. About 80% of sufferers make a full recovery. You stand the best chance if you start psychotherapy as early as possible.

Other measures that help against panic attacks

Making conscious lifestyle choices helps with the treatment of panic attacks:

• Eat a balanced diet that includes fresh food. The food pyramid is a helpful guide in this regard.
• Get plenty of sleep.
• Exercise daily. Go for walks, for example, or try a new sport.
• Practise mindfulness, for example by meditating, doing yoga or performing progressive muscle relaxation.
• Keep up your social relationships and take time for family and friends.
• Avoid nicotine and alcohol as much as possible.

Panic attacks have a big impact on those who suffer from them. But there are many ways to deal with them and overcome them in the long term. Accept offers of help from specialists and those around you. Remember: you’re not alone, and with the right support, you’ll get the courage to face life back.