If you've never suffered one, consider yourself lucky because panic attacks are extremely traumatic incidents, one of the most scary experiences you can have. ICGP's Dr. Iain Morrison, talks us through the distressing phenomenon.
These are among the most horrible experiences patients can suffer, with terrifying shortness of breath, tightness in the chest, pounding heart-beat, pins and needles, sweating, dizziness, dryness in the mouth and other symptoms suggestive of a heart-attack or stroke. Some patients report feeling that they are about to collapse or that they need to get outside for air. Different patients report different combinations of these symptoms initially, but fear leads to an escalation, so it's a very vicious circle. Adrenaline primes us for flight or fight when we are scared so, when we can see no outside threat, we fear a threat from within, which only increases our adrenaline levels and so on.
Panic attacks can occur as isolated one-off events or they may be part of an underlying anxiety disorder. And, as with any traumatic experience, patients often feel stressed, shaken and tired even the day after recovery. When patients suffer from recurring panic attacks to the point that their lives are affected, they are deemed to suffer from Panic Disorder.
Presented with these symptoms, especially if it's the patient's first panic attack, the GP has to decide on whether or not to rule out a serious underlying medical condition, like a genuine heart problem. This is often not an easy call and a prudent referral to A&E for a second opinion may be the doctor's route of choice. As panic attacks have a significant psychological input, the patient's regular GP, being familiar with the patient's history and family history, will have a distinct edge when making this judgement call.
Factors that may lead the GP to suspect panic attack:
- Sudden onset – especially in young, otherwise fit patients; less so in older or people with underlying health issues.
- Symptoms commencing when patient was at rest, with mind idle. People whose minds are occupied have less panic attacks. Some patients report waking up at night convinced they are dying.
- Patient subconsciously 'fearing' a heart attack or stroke because of family history of sudden death. Of course, family history also makes them more likely candidates for real heart attacks and strokes.
- Underlying depression/anxiety disorder. Sometimes there may be a history of poor sleeping, chronic tiredness, low mood/sadness, chronic tension and a feeling of "being on edge all the time."
- Some 'body-aware' people are over-sensitive to 'minor' body changes, which may trigger a panic attack.
- Some ostensibly strong patients may have been leaned on to such an extent by others during a crisis or bereavement, that their own physical and emotional reserves have been depleted to the point that they "crash" months later.
Despite the fact that finding out that they have suffered neither a heart nor a stroke ought to be very good news indeed, many patients are not pleased to be told they've had a panic attack; it seems to smack of a 'mental' condition. But actually there is major psychological involvement. Certainly, the same underlying neurochemical problems encountered in depression and generalised anxiety illnesses are also associated with panic attacks, and panic attacks often respond well to medications used for depression. Psychologically, a traumatic experience may be lodged in someone's subconscious and the fear of this can be triggered randomly and lead to a panic attack out of the blue.
There is no single treatment for panic attacks as their causes are so varied. Simply telling the patient not to panic is rarely effective as panic, by definition, is not under anyone's command, neither patient's nor trusted doctor's. Controlling breathing where the patient is hyperventilating is vital and the first priority; some may respond to an instruction as simple as blowing slowly into a paper bag. Once the panic levels decrease - and it is vital to reassure the patient that they always do, a fact which, in itself gives some relief - discussion and exploration of the reasons why may give lasting relief. On a longer term basis, relaxation therapies like Yoga can be very beneficial, provided they are kept up.
Recurrent panic attacks and Panic Disorder need deeper investigation and may need psychotherapy and/or medication.
The GP has to decide on whether or not to rule out a serious underlying medical condition.