Panic Attacks

What is a Panic Attack?

The first time someone has a panic attack, they often think they are having a heart attack, stroke, or are going to die. In reality, panic attacks are not dangerous, but they can certainly feel that way. A panic attack is a sudden culmination of several symptoms. The person having a panic attack experiences intense fear or discomfort. Panic attacks can emerge from a calm or an anxious state.

Usually, the acute/the worst part of the panic resolves within about 30 minutes, but people can feel physical and mental discomfort for many hours after. A panic attack involves four or more of the following symptoms, coming to a peak within minutes:

• Pounding heart, palpitations, or fast heart rate
• Sweating
• Shaking or trembling
• Shortness of breath or feeling smothered
• Feelings of choking
• Chest pain or discomfort
• Nausea or stomach upset
• Feeling dizzy, unsteady, lightheaded, or faint
• Chills or heat sensations
• Numbness or tingling sensations (often in the extremities)
• Things not feeling real, or feeling detached from oneself
• Fear of losing control or “going crazy”
• Fear of dying

As you can see, these symptoms do in fact have overlap with serious health concerns such as heart attacks (like chest pain, heart pounding, tingling in the extremities). Thus, many folks take themselves to a hospital the first time they have a panic attack. Usually, after learning more about panic attacks and getting some treatment (therapy and/or medication) people can learn to manage without going to the hospital.

How Common is Panic Attack Disorder?

Panic Attacks are unfortunately common. Every year, over 10% of individuals in the United States experience at least one panic attack. Approximately 2-3 % of people meet the full criteria for Panic Attack Disorder. Women are 2 times as likely as men, to experience panic attacks.

What is Happening in the Body During a Panic Attack?

A part of the brain called the amygdala (which helps with emotional processing) perceives threat via 5 senses, and sends an alarm to the hypothalamus in the brain. The hypothalamus communicates to the sympathetic nervous system to get the body ready to respond to danger. The adrenal glands are activated to release epinephrine (aka adrenaline) into the body. This causes many changes such as increased heart rate (to make blood flow faster), faster breathing, airways in the lungs opening wide, and stored nutrients enter the blood to supply more energy to the entire body.

The above processes happen so fast that we are not aware of them. Our body can react before we consciously decide how we’d like to react. Sometimes this process occurs when there is no threat at all, or “out of the blue.” When there is a real danger (let’s say a snarling dog breaks out of his fence while you’re on a walk nearby) it is a useful response. You’ll be able to run and act faster than usual. When there is not a real threat (let’s say you have to give a presentation to some coworkers, or you are just sitting watching TV) this is not a useful response, and it feels very scary for the body to do all of this when it’s totally unwarranted.

How are Panic Attacks Treated?

There are a variety of different ways to treat panic attacks. Typically, a medication provider would suggest that the patient takes an SSRI (selective serotonin reuptake inhibitor). These medications help serotonin levels in the brain, which often mitigate or eliminate panic. Appropriate patients may be offered to take benzodiazepines, which are taken “as needed” when a patient has a panic attack. Some patients can recognize some triggers and signs ahead of panic, so the as needed medicine can be taken a little ahead of a full panic attack coming. (Such as prior to a presentation, a plane ride, or on an extremely stressful day in which the anxiety level is building and building).

A therapy provider may help a patient manage panic attacks via several methods. There is no one-size-fits-all approach. Psychoeducation about panic attacks will help the patient feel more in control. There are breathing and grounding exercises that can help reduce the panic symptoms when they occur. Some patients have unhelpful automatic thought patterns that might be leading to panic, which can be worked on with cognitive behavioral therapy (CBT). Some patients need to improve their basic self-care (such as getting adequate sleep, eating appropriately, and staying hydrated).  Some patients require exposure therapy, in which the patient is exposed to their triggers gradually in a safe environment. Sometimes the exposure is actually to bodily sensations felt during panic attacks (like spinning around to cause dizziness, or increasing the heart rate via exercise) so that the patient can learn to cope with the symptoms and learn that the symptoms are not dangerous over time.

When Should I Get Help for Panic Attacks?

We recommend that individuals schedule a psychiatric evaluation for Panic and/or Panic Attack Disorder, if they experience any of the following symptoms:

• Avoidance of situations due to symptoms
• Symptoms interfering with academic or occupational life
• Symptoms interfering with social life or relationships
• Panic and Anxiety affecting sleep, energy, focus, or appetite
• Feelings of hopelessness
• Subjective high levels of anxiety or stress.
• Crying episodes
• Difficulty being present with friends or loved ones, due to Panic Attacks and Anxiety.
• If one is utilizing poor coping mechanisms (alcohol or substance use, gambling, self-harm) in an attempt to cope with Panic Symptoms or Fear of Panic Attacks.
• Suicidal thoughts
  • If you have suicidal thoughts, call 911 or 988. Do not wait for an appointment.

Do You Offer Both In-office and Virtual Online Psychiatric Appointments for the Treatment of Panic Attack Disorder?

Yes, we offer both in-office and virtual online psychiatric appointments for the treatment of Panic and its symptoms.

Why Choose Rittenhouse Psychiatric Associates for Treatment of Panic Attack Disorder?

The providers at Rittenhouse Psychiatric Associates are academically oriented providers, most of whom teach, or have taught, at academic institutions. Our providers are Board Certified Psychiatrists and Psychiatric Nurse Practitioners and we have several licensed and doctoral level therapists and psychologists. We are experienced in working with individuals who struggle with various psychiatric conditions, including Panic Attack Disorder.

• Licensed Therapists and Doctoral Level Psychologists
• Board Certified Psychiatrists and Psychiatric Nurse Practitioners
• Academically Oriented providers, most of whom teach, or have taught, at local Academic Institutions, such as Johns Hopkins Hospital & The University of Pennsylvania.
• Appointments generally available within 2 weeks.
• In-office and online Virtual Appointments for the treatment of Panic Attack Disorder.
• Providers experienced in treating co-occurring psychiatric conditions.
• Providers who are welcoming to all individuals.