CNN

Panic attack symptoms can make your heart pound and cause you to feel short of breath, dizzy, nauseated and flushed. Because panic attack symptoms can resemble life-threatening conditions, it's important to seek an accurate diagnosis and treatment.

Panic attacks typically include a few or many of these symptoms:

• A sense of impending doom or death
• Rapid heart rate
• Sweating
• Trembling
• Shortness of breath
• Hyperventilation
• Chills
• Hot flashes
• Nausea
• Abdominal cramping
• Chest pain
• Headache
• Dizziness
• Faintness
• Tightness in your throat
• Trouble swallowing

Panic attacks typically begin suddenly, without warning. They can strike at almost any time — when you're driving the school car pool, at the mall, sound asleep or in the middle of a business meeting. Panic attacks have many variations, but symptoms usually peak within 10 minutes and last about half an hour. You may feel fatigued and worn out after a panic attack subsides.

One of the worst things about panic attacks is the intense fear that you'll have another panic attack. If you have had four or more panic attacks and have spent a month or more in constant fear of another attack, you may have a condition called panic disorder, a type of chronic anxiety disorder.

With panic disorder, you may fear having a panic attack so much that you avoid situations where they may occur. You may even be unable to leave your home (agoraphobia), because no place feels safe.

When to see a doctor
If you have any panic attack symptoms, seek medical help as soon as possible. Panic attacks are hard to manage on your own, and they may get worse without treatment. And because panic attack symptoms can also resemble other serious health problems, such as a heart attack, it's important to get evaluated by your health care provider if you aren't sure what's causing your symptoms.

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.

It's not known what causes panic attacks or panic disorder. Things that may play a role include:

• Genetics
• Stress
• Certain changes in the way parts of your brain function

Some research suggests that your body's natural fight-or-flight response to danger is involved in panic attacks. For example, if a grizzly bear came after you, your body would react instinctively. Your heart rate and breathing would speed up as your body prepared itself for a life-threatening situation. Many of the same reactions occur in a panic attack. But it's not known why a panic attack occurs when there's no obvious danger present.

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.

Symptoms of panic disorder often start either in late adolescence or early adulthood and affect more women than men.

Many people have just one or two panic attacks in their lifetimes, and the problem goes away, perhaps when a stressful situation ends.

Factors that may increase the risk of developing panic attacks or panic disorder include:

• A family history of panic attacks or panic disorder
• Significant stress
• The death or serious illness of a loved one
• Big changes in your life, such as the addition of a baby
• A history of childhood physical or sexual abuse
• Undergoing a traumatic event, such as an accident or rape

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.

Left untreated, panic attacks and panic disorder can result in severe complications that affect almost every area of your life. You may be so afraid of having more panic attacks that you live in a constant state of fear, ruining your quality of life.

Complications that panic attacks may cause or be associated with include:

• Development of specific phobias, such as fear of driving or leaving your home
• Avoidance of social situations
• Problems at work or school
• Depression
• Increased risk of suicide or suicidal thoughts
• Alcohol or substance abuse
• Financial problems

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.

If you've had signs or symptoms common to a panic attack, make an appointment with your primary care provider. After an initial evaluation, your doctor may refer you to a psychiatrist or psychologist for treatment.

Here's some information to help you prepare for your appointment, and what to expect from your doctor.

What you can do in advance

• Make a list of your symptoms, including when they first occurred and how often you've had them.
• Write down your key personal information, including traumatic events in your past and any stressful, major events that occurred before your first panic attack.
• Write down all of your medical information, including other physical or mental health conditions with which you've been diagnosed. Also write down the names of any medications you're taking.
• Ask a trusted family member or friend to be present for your appointment, if possible. Sometimes it can be difficult to soak up all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your doctor.

Questions to ask your doctor at your initial appointment include:

• What do you believe is causing my symptoms?
• Is it possible that an underlying medical problem is causing my symptoms?
• Do I need any diagnostic tests?
• Should I see a mental health specialist?
• Is there anything I can do now to help manage my symptoms?

Questions to ask if you are referred to a mental health provider include:

• Do I have panic attacks or panic disorder?
• What treatment approach do you recommend in my case?
• If you're recommending therapy, how frequently will I need therapy sessions, and for how long?
• Would family or group therapy be helpful in my case?
• If you're recommending medications, are there any possible side effects?
• For how long will I need to take medication?
• Is my condition likely temporary or chronic?
• How will you monitor whether my treatment is working?
• What can I do to reduce the risk of my symptoms recurring?
• Are there any self-care steps I could take to help manage my condition?
• How much do you expect my symptoms will improve with treatment?
• Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend visiting?

In addition to the questions that you've prepared in advance, don't hesitate to ask for more information at any time that you don't understand something.

What to expect from your doctor
A doctor or mental health provider who sees you for possible panic attacks or panic disorder may ask:

• What are your symptoms?
• When did your symptoms first occur?
• How long do your attacks last?
• How often do your attacks occur?
• How often do you experience fear of another attack?
• Does anything in particular seem to trigger an attack?
• Do you avoid the locations or experiences that seem to trigger an attack?
• How would you say your symptoms are affecting your life, including school, work and personal relationships?
• Did you experience significant stress or a traumatic event shortly before your first panic attack?
• Have you experienced significant trauma — such as physical or sexual abuse or military battle — in your lifetime?
• How would you describe your childhood, including your relationship with your parents?
• Have any of your close relatives been diagnosed with a mental health problem, including panic attacks or panic disorder?
• Have you been treated for any other mental health problems?
• Have you been diagnosed with any medical conditions?
• Do you use alcohol or recreational drugs? How often?
• Do you exercise?
• Do you use caffeine?

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.

To help pinpoint a diagnosis for your symptoms, you'll likely have several exams and tests. Your doctor or other health care provider must determine if you have panic attacks, panic disorder or another condition, such as heart or thyroid problems, that resembles panic symptoms.

Tests and exams you may have include:

• Physical exam. This may include measuring height and weight; checking vital signs, such as heart rate, blood pressure and temperature; listening to the heart and lungs; and examining the abdomen.
• Laboratory tests. These may include a complete blood count (CBC) as well as thyroid tests and other blood tests. You may also have tests on your heart, such as an electrocardiogram to help determine how well your heart is functioning.
• Psychological evaluation. A doctor or mental health provider will talk to you about your symptoms, such as what they feel like, how often they occur, when they occur and how long you've had them. You'll also be asked about stressful situations in your life, fears or concerns you have, relationship problems and other issues affecting your life. You may fill out psychological self-assessments and questionnaires. And you may be asked about substance or alcohol abuse.

Diagnostic criteria for panic disorder
Not everyone who has panic attacks has a full-blown panic disorder. To be diagnosed with panic disorder, you must meet the criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.

These are the diagnostic criteria for panic disorder:

• You have frequent, unexpected panic attacks.
• At least one of your attacks has been followed by one month or more of persistent worry about having another attack; persistent fear of the consequences of an attack, such as losing control, having a heart attack or "going crazy"; or a significant change in your behavior, such as avoiding situations that you think may trigger a panic attack.
• Your panic attacks aren't caused by substance abuse or another mental health condition, such as social phobia or agoraphobia.

If you have panic attacks but not a full-blown panic disorder, you can still benefit from treatment. If panic attacks aren't treated, they can get worse and develop into panic disorder or phobias.

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.

The goal of treatment is to eliminate all of your panic attack symptoms. With effective treatment, most people are eventually able to resume everyday activities.

The main treatment options for panic attacks are medications and psychotherapy. Both are effective. Your doctor likely will recommend starting with just one type of treatment, depending on your preference and whether there are therapists with special training in panic disorders in your area.

Your doctor may recommend a combination of medication and psychotherapy if you:

• Have severe panic disorder
• Have panic disorder along with another major mental health diagnosis, such as depression or post-traumatic stress disorder
• Have already tried one type of treatment and haven't improved

Medications
Medications can help reduce symptoms associated with panic attacks, as well as depression if that's an issue for you. Several types of medication have been shown to be effective in managing symptoms of panic attacks, including:

• Selective serotonin reuptake inhibitors (SSRIs). Because these antidepressant medications are generally safe and have a low risk of causing serious side effects, SSRIs are typically recommended as the first choice in medication options to treat panic attacks. Drugs in this class that have been approved by the Food and Drug Administration (FDA) for the treatment of panic disorder include fluoxetine (Prozac, Prozac Weekly), paroxetine (Paxil, Paxil CR, Pexeva) and sertraline (Zoloft).
• Serotonin and norepinephrine reuptake inhibitors (SNRIs). These medications are another class of antidepressants. The SNRI drug called venlafaxine (Effexor XR) is FDA-approved for the treatment of panic disorder.
• Tricyclic antidepressants (TCAs). While effective, these antidepressants pose a risk of serious side effects, including heart and blood sugar problems. No TCAs are FDA-approved specifically for the treatment of panic disorder.
• Benzodiazpines. These medications are mild sedatives. They belong to the group of medicines called central nervous system (CNS) depressants. Benzodiazepines may be habit-forming (causing mental or physical dependence), especially when taken for a long time or in high doses. Benzodiazepines that have been FDA-approved for the treatment of panic disorder include alprazolam (Xanax) and clonazepam (Klonopin). If you seek care in an emergency room for signs and symptoms of a panic attack, you may be given a benzodiazepine to help stop the attack.
• Monoamine oxidase inhibitors (MAOIs). Because these antidepressants can cause life-threatening side effects and require strict dietary restrictions, they're not commonly prescribed. No MAOIs are FDA-approved specifically for the treatment of panic disorder.

If one medication doesn't work well for you, your doctor may recommend switching to another or combining certain medications to boost their effectiveness. Keep in mind that it can take several weeks after first starting a medication to notice an improvement in your symptoms. All medications have a risk of side effects, and some may not be recommended in certain situations, such as pregnancy. Be sure to talk to your doctor about the possible side effects and risks.

Psychotherapy
Psychotherapy, also called counseling or talk therapy, can help you understand panic attacks and panic disorder and how to cope with them. The main type of psychotherapy used to treat panic attacks and panic disorder is cognitive behavioral therapy. Your doctor also may recommend a type of psychotherapy called psychodynamic psychotherapy.

• Cognitive behavioral therapy. Cognitive behavioral therapy can help you change thinking (cognitive) patterns that trigger your fears and panic attacks. It can also help you change the way you react (behave) to anxious or fearful situations. During therapy sessions, you learn to recognize things that trigger your panic attacks or make them worse, such as specific thoughts or situations. You also learn ways to cope with the anxiety and physical symptoms associated with panic attacks.

  These may include breathing and relaxation techniques. In addition, working carefully with your therapist, you may re-create the symptoms of panic attacks in the safety of his or her office. This is an important step because it can help you learn to control and master the symptoms so that they don't continue to be a source of intense fear. Doing this can also help you overcome fear of certain situations that you may avoid, such as crowded malls or driving.

• Psychodynamic psychotherapy. Psychodynamic psychotherapy focuses on increasing your awareness of your unconscious thoughts and behaviors. Unlike cognitive behavioral therapy, this approach doesn't intentionally re-create panic symptoms. Instead, your therapist helps you investigate your mind to identify internal emotional conflict that may play a role in your panic and avoidance reactions.

  Based on your findings, your therapist will help you develop healthier ways to respond to conflict. Early study results suggest that psychodynamic psychotherapy focused on panic reactions may be an effective short-term treatment option for panic disorder. More research is needed to fully understand how this type of therapy compares with other treatments for panic disorder.

Your therapist may suggest weekly meetings when you begin psychotherapy. You may start to see improvements in panic attack symptoms within several weeks, and often symptoms go away within several months.

As your symptoms improve, you and your therapist will develop a plan to taper off therapy. You may agree to schedule occasional maintenance visits to help ensure that your panic attacks remain under control.

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.

Researchers have explored a number of natural remedies as possible treatments for anxiety disorders, including panic disorder. Studies to date have concluded that two alternative therapies, in particular, have potential in the treatment of panic disorder.

• Relaxation training. Relaxation techniques include deep breathing, yoga, meditation and progressive muscle relaxation, which is accomplished by tensing one muscle at a time, and then completely releasing the tension, until every muscle in the body is relaxed. Studies have found that these techniques may be as effective or nearly as effective as cognitive behavioral therapy for some people with panic disorder.
• The nutritional supplement inositol. This oral supplement, which influences the action of serotonin, may reduce the frequency and severity of panic attacks.

Talk with your doctor before trying any natural therapies. These products can cause side effects and may interact with other medications. Your doctor can help determine if they are safe for you.

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.

While panic attacks and panic disorder benefit from professional treatment, you can also help manage your symptoms on your own. Some of the lifestyle and self-care steps you can take include:

• Stick to your treatment plan. Facing your fears can be difficult, but treatment can help you feel like you're not a hostage in your own home.
• Join a support group for people with panic attacks or anxiety disorders so that you can connect with others facing the same problems.
• Avoid caffeine, alcohol and illegal drugs, all of which can trigger or worsen panic attacks.
• Practice stress management and relaxation techniques. Meditation, yoga and guided imagery may be good options.
• Get physically active, since aerobic activity may have a calming effect on your mood.
• Get sufficient sleep — enough so that you don't feel drowsy during the day.

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.

There's no sure way to prevent panic attacks or panic disorder. However, getting treatment for panic attacks as soon as possible may help stop them from getting worse or becoming more frequent. Sticking with your treatment plan can help prevent relapses or worsening of panic attack symptoms. Practicing relaxation and stress management techniques may be helpful, too.

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.