Abrupt surges of intense fear or discomfort that peak within minutes can be signs that it is not just anxiety. Panic attacks manifest in different ways but the feeling of sudden, overwhelming terror is a constant. These can hamper you mentally and physically as well as hinder your social life, even make you lose opportunities. Even though this disorder can be quite overwhelming and frightening, the symptoms can be managed and improved with treatment. So what exactly triggers a panic attack and what does it look like?

TC46 connected with Psychiatrist Dr Kedar Tilwe of Fortis Hospital Mulund & Fortis Hiranandani Hospital, Mumbai. Here, he shares some major causes, the diagnostic process and alternative therapies that help curb panic attacks.

1. What are panic attacks & what do they look like?

Panic attacks are episodes of intense anxiety that last typically for half to 1 hour in duration. They can be characterized by a general sense of unease and panic; often associated with palpitations, restlessness, feelings of impending doom, and giddiness. Sometimes there may be an obvious precipitating factor, but many times there is no discernable cause.

2. What are the signs of an oncoming and ongoing panic attack & how does the body react to it?

Sudden onset of unease, discomfort, and worries along with at least four of the following symptoms which lasts for half to one hour. The symptoms include: 

  • Palpitations
  • Fear of impending doom
  • The coldness of extremities
  • Dryness of mouth
  • Chest or abdominal discomfort
  • De-realization
  • De-personalization
  • Paresthesia (abnormal sensation of the skin)

3. What are some potential triggers for a panic attack?

The potential triggers can be medical, psychological, or drug-induced. Cardiac conditions especially mitral valve regurgitation or prolapse, thyroid disturbances especially hyperthyroidism, neurological conditions, and metabolic disturbances are some of the conditions associated with panic attacks. Panic attacks are known to be a part of the spectrum of symptoms in almost all major psychiatric conditions including anxiety, depression, psychosis, stress disorders, and even Obsessive Compulsive Disorder. Excess intake of coffee and consumption of tobacco in any form are some of the known panicogens.

4. What are the major causes of panic attacks & how can you identify them?

The first step is to rule out medical causes commonly associated with the precipitation of panic attacks like hypoglycemia, blood pressure fluctuations, cardiac conditions, neurological conditions and metabolic thyroid disorders. If an obvious psychological stressor is present directly before the precipitation of the attack, then it is better to discuss this with a mental health professional. A talk with a Psychiatrist or a Psychologist can also help you identify and deal with any obvious mental health concern which may be precipitating the panic attack.

5. Are panic attacks serious or are they a common occurrence among the majority of the population? When should you visit the doctor?

Almost one-third of us will experience a panic attack at some point during our lifetimes. Identifying and resolving the reason for precipitation for the attack is of critical importance. However, if the attacks continue repeating or when the very thought or anticipation of a panic attack causes anxiety and worries in us, is when you should consult a doctor.

6. How is a panic disorder diagnosed?

Panic Disorder is a condition in which a person suffers from repeated panic attacks and this is associated with ‘anticipatory anxiety’ (anxiety at the anticipation of panic attacks) or with phobic avoidance of situations that can precipitate a panic attack. A common associated condition with panic disorder is that of Agoraphobia in which there is a phobia for places from where help may not be readily available such as crowds while travelling, closed spaces, and even open grounds.

7. What is the best treatment for panic attacks?

Identification and treatment of precipitating cause is the best management of a panic attack. Symptomatic relief can be quickly possible by intervention with medicines, but this should be taken under the supervision of or as prescribed by a doctor. If psychological stress is precipitating a panic attack or if the patient is suffering from panic disorder, the treatment with psychotropic medicines under supervision will help reduce the sufferings quickly and effectively.

8. What is the prognosis for panic disorder?

When the proper precipitating triggers are identified, and if treated with the necessary intervention, the prognosis for panic attacks is good and usually may not reoccur. But if there are multiple factors involved or when proper management does not occur, then there can be scenarios in which panic attacks occur repeatedly and lead to the precipitation of panic disorder.

9. How can I prevent or stop a panic attack? Does therapy help (without medications)?

Identifying the cause can help anticipate and thus prevent a panic attack. Instant relief is also possible with the help of proper medicines, but should only be taken after constitution with a doctor. Lifestyle alterations such as reducing coffee intake or stopping tobacco & alcohol consumption will also be of great benefit. Therapies such as Cognitive Behavioral Therapy (CBT), Rational Emotive Behavior Therapy (REBT), and mindfulness training can be of immense benefit in preventing panic attacks.

10. What are some mental exercises & routines that can help minimize panic attacks? How does yoga help with panic attacks?

Mindfulness techniques such as mindful breathing exercises, meditation, five sense relaxation exercises, mindful eating and mindful visualization can be of help if practised regularly. Relaxation techniques such as progressive muscle relaxation can also prove beneficial.

Regular supervised practice of Yoga, relaxation and meditation exercises such as Vajrasana, Padmasana (Sukhasana), Makarasana, Kokilasana, Parvatasana, Pranayama allows us to focus our attention, slow our breathing and relaxes our muscles; enabling us to calm our mind and thus allows us to deal with panic attacks.

11. What natural remedies or alternative remedies do you recommend for panic attacks?

Alternative therapies such as Aromatherapy and Animal-Assisted Therapy may help some in reducing symptom severity during a panic episode but usually are recommended as an ancillary treatment or when a clear cause has been identified.