Many people have experienced a panic attack, and an estimated six million people in the U.S. have panic disorder, a chronic condition characterized by spontaneous panic attacks, according to the Anxiety and Depression Association of America. What causes panic attacks? Are some people more prone to them than others? And how can you be sure it’s a panic attack and not a heart attack? Read on for the answers to these and other questions.
What is a panic attack?
A panic attack is a sudden surge of fear and anxiety that usually comes out of nowhere and can last for several minutes or longer. Symptoms may include sweating, nausea, chest pain, racing heartbeat, shortness of breath, dizziness, feeling faint, and a sense of impending doom.
People with panic disorder have sudden and repeated panic attacks, and they often worry about and dread the possibility of having another attack. In some cases panic disorder can make it difficult to carry out normal routines like going to school or work, going to the grocery store, or driving—which in turn can lead to isolation, discouragement, and feelings of shame.
What causes panic attacks? Are they more common in certain people or age groups?
The underlying cause of panic attacks isn’t entirely clear and can vary from person to person. Factors that may play a role include genetic predisposition, environmental stressors such as childhood abuse, and the side effects of some drugs (both prescription and illegal) or dietary supplements. On the neurological front, researchers are exploring whether certain regions of the brain, including the hypothalamus and the amygdala, behave differently in people who are to panic attacks.
Women are twice as likely as men to experience panic attacks, possibly because of differences in hormones, brain chemistry, and how they cope with stress. The rate of panic attacks appears to be highest among people ages 30 to 39, while panic disorder is most prevalent among those ages 40 to 49, according to research published in the Journal of Affective Disorders. Panic attacks become less common after age 60.
Some research has found an association between panic attacks and certain diseases, such as irritable bowel syndrome (IBS), which may share with panic attacks a common dysregulation of the nervous system. But that doesn’t mean there’s a causal relationship. In addition, people with panic disorder often have other psychological conditions, including phobias and other anxiety disorders such as generalized anxiety disorder, PTSD, and social anxiety.
Can some symptoms of a panic attack also be caused by a heart attack?
Yes—so unless you’ve had panic attacks before and are certain that’s what you’re experiencing, you should go to the emergency room if you have panic attack symptoms that may actually be caused by a heart attack, including chest pain, shortness of breath, pain radiating in one or both arms, heavy sweating, and nausea or vomiting. Once a heart attack and other medical problems have been ruled out, your doctor may refer you to a mental health professional.
How are panic attacks treated?
Panic attacks can be treated with psychotherapy, medication, or both. A type of psychotherapy called cognitive behavioral therapy helps many people. The first-line drug therapy for panic disorder is the category of antidepressants knownas SSRIs (selective serotonin reuptake inhibitors), including citalopram (Celexa)and sertraline (Zoloft). Antidepressants and CBT appear to be equally effective for panic attacks. But there may be less of a likelihood of relapse with CBT compared with medication, since CBT teaches people strategies and skills they can use to correct harmful thought patterns and to better deal with stress, which can be a trigger for panic episodes.
Benzodiazepines such as alprazolam and lorazepam aresometimes prescribed for people with panic attacks to use as needed for symptom relief. But these should be taken only short term, since they can have serious risks, including balance problems, memory impairment, and dependence, particularly in older adults.
Originally published December 2012. Updated January 2019.
Also see Understanding OCD.