Because involuntary panic attacks can be caused by other medical conditions, such as mitral valve prolapse, thyroid problems, hyperglycemia, side effects from certain types of medications, recreational drug use (such as marijuana), stimulants, etc., it’s best to discuss your panic attacks and symptoms with your doctor to rule out any medical cause.
Some people have only one or two attacks and are never bothered again. Panic attacks can occur with other psychiatric disorders. In panic disorders, however, the panic attacks return repeatedly and the person develops an intense fear of having another attack. Without help, this "fear of fear" can make people avoid certain situations and can interfere with their lives even when they are not having a panic attack. Therefore, it is very important to recognize the problem and get help.
Panic attacks (or anxiety attacks - the terms are interchangeable) are intense episodes of fear which are so powerful that they trick you into fearing that you are dying, going crazy, about to faint, or losing control of yourself in some vital way. The symptoms of a panic attack feel so powerful and threatening that they convince you that you're in terrible danger.
Anxiety disorders are treated through medication and therapy. You might feel embarrassed talking about the things you are feeling and thinking, but talking about it, say experts, is the best treatment. A particular form of therapy is considered most effective: cognitive behavioral therapy, or CBT for short. Antidepressants — the types of medication most frequently used to treat depression — are the drugs that also work best for anxiety disorders.
As is true for other mood and anxiety disorders, the use of Selective Serotonin Reuptake Inhibitors (SSRI's; e.g.., Paxil, Prozac, Zoloft), Benzodiazepines (e.g., Xanax, Lorazepam), and Selective Norepinephrine Reuptake Inhibitors (SNRI's; e.g., Cymbalta, Effexor, Pristiq) are common medical treatments for panic disorder. Additionally, D-cycloserine is a medication that is now being explored as a way to enhance effects of CBT (e.g., Hofmann et al., 2013). These medications may have side effects and taking them can lead to tolerance, withdrawal symptoms, and dependence, so it is important that you consult with a physician before starting or stopping these medications. There is evidence that taking one of these medications in addition to receiving behavioral therapy (e.g., CBT) can significantly benefit patients with panic disorder, although seeking psychotherapy in itself is largely effective (Arch et al., 2017).
All human beings experience anxiety. In many cases, anxiety can have some beneficial and adaptive qualities such as pushing one to study for an upcoming difficult exam or propelling a person to flee from danger. Although experiencing some anxiety with life stressors and worries is normal, sometimes it can be difficult to manage and can feel overwhelming. Below we provide a list of tips and strategies to help individuals prevent anxiety from reaching a diagnosable level. Even though not everyone will struggle with a diagnosable anxiety disorder, learning strategies to aid in relief from anxiety and to manage the "normal" anxiety experienced in everyday life can help you live the life you desire.

Comorbidity is more common than not with anxiety disorders, meaning that most individuals who experience significant anxiety experience multiple different types of anxiety. Given this co-morbidity, it is not surprising that many risk factors are shared across anxiety disorders, or have the same underlying causes. There is a lot of research identifying risk factors for anxiety disorders, and this research suggests that both nature and nurture are very relevant. It is important to note that no single risk factor is definitive - many people may have a risk factor for a disorder, and not ever develop that disorder. However, it is helpful for research to identify risk factors and for people to be aware of them, as being aware of who might be at risk can potentially help people get support or assistance in order to prevent the development of a disorder.
Yes, panic attacks are real and potentially quite emotionally disabling. Fortunately, they can be controlled with specific treatments. Because of the disturbing physical signs and symptoms that accompany panic attacks, they may be mistaken for heart attacks or some other life-threatening medical problem. In fact, up to 25% of people who visit emergency rooms because of chest pain are actually experiencing panic. This can lead to people with this symptom often undergoing extensive medical testing to rule out physical conditions. Sadly, sometimes more than 90% of these individuals are not appropriately diagnosed as suffering from panic.
People often fear the worst when they're having an anxiety attack. Most of the time, there’s no underlying physical problem, such as a real heart attack. But you should get the medical all clear if you have repeat anxiety attacks, just to be sure you don’t need additional treatment. Then find a cognitive behavioral therapist with experience treating anxiety to help you through.
Biological causes may include obsessive compulsive disorder, Postural Orthostatic Tachycardia Syndrome, post traumatic stress disorder, hypoglycemia, hyperthyroidism, Wilson's disease, mitral valve prolapse, pheochromocytoma, and inner ear disturbances (labyrinthitis). Dysregulation of the norepinephrine system in the locus ceruleus, an area of the brain stem, has been linked to panic attacks.[13]
People facing anxiety may withdraw from situations which have provoked anxiety in the past.[5] There are various types of anxiety. Existential anxiety can occur when a person faces angst, an existential crisis, or nihilistic feelings. People can also face mathematical anxiety, somatic anxiety, stage fright, or test anxiety. Social anxiety and stranger anxiety are caused when people are apprehensive around strangers or other people in general. Stress hormones released in an anxious state have an impact on bowel function and can manifest physical symptoms that may contribute to or exacerbate IBS. Anxiety is often experienced by those who have an OCD and is an acute presence in panic disorder. The first step in the management of a person with anxiety symptoms involves evaluating the possible presence of an underlying medical cause, whose recognition is essential in order to decide the correct treatment.[6][7] Anxiety symptoms may mask an organic disease, or appear associated with or as a result of a medical disorder.[6][7][8][9]
Anxiety attacks can last anywhere between a few moments to 30 or more minutes. It’s also common for subsequent anxiety attacks to follow, causing the overall anxiety attack experience to last much longer as one episode is followed by another. Even though anxiety attacks eventually end, it’s common for the symptoms and after effects of an anxiety attack to linger for hours or even days, depending upon the severity of the attack and the level of stress your body is under.

Panic disorder is characterized by repeated, unexpected panic attacks, as well as fear of experiencing another episode. A panic disorder may also be accompanied by agoraphobia, which is the fear of being in places where escape or help would be difficult in the event of a panic attack. If you have agoraphobia, you are likely to avoid public places such as shopping malls, or confined spaces such as an airplane.
A licensed mental health specialist with a doctorate degree (PhD) in clinical psychology who treats emotional, mental and behavioral problems. Clinical psychologists are trained to provide counseling and psychotherapy, perform psychological testing, and provide treatment for mental disorders. They generally do not prescribe medications, however, Illinois, Louisiana, and New Mexico are the only states that allow psychologists to prescribe. It is common for clinical psychologists to work in conjunction with a psychiatrist and /or a PCP who provides the medical treatment for the patients while the psychologists provides the psychotherapy. Clinical psychologists can be found at hospitals, schools, counseling centers and group or private health care practices.
Panic attacks are often confusing for the sufferer. They are usually sudden and are accompanied by extremely intense physical sensations, leaving one to believe they may have a serious medical condition. Because the physical symptoms associated with a panic attack are similar to certain serious medical conditions, it is important to rule out any medical causes.

Test anxiety is the uneasiness, apprehension, or nervousness felt by students who have a fear of failing an exam. Students who have test anxiety may experience any of the following: the association of grades with personal worth; fear of embarrassment by a teacher; fear of alienation from parents or friends; time pressures; or feeling a loss of control. Sweating, dizziness, headaches, racing heartbeats, nausea, fidgeting, uncontrollable crying or laughing and drumming on a desk are all common. Because test anxiety hinges on fear of negative evaluation,[26] debate exists as to whether test anxiety is itself a unique anxiety disorder or whether it is a specific type of social phobia.[27] The DSM-IV classifies test anxiety as a type of social phobia.[28]
As with most behavioral illnesses, the causes of panic attacks are many. Certainly there is evidence that the tendency to have panic attacks can sometimes be inherited. However, there is also evidence that panic may be a learned response and that the attacks can be initiated in otherwise healthy people simply given the right set of circumstances. Research into the causes of panic attacks is ongoing.

Agoraphobia is often comorbid with panic disorder — meaning people often suffer from both conditions at the same time. It's an intense fear of not being able to escape whatever place you're in, and can often lead to an avoidance of leaving the house. People with agoraphobia can fear situations where this anxiety might flare up, and typically don't feel comfortable or safe in public, crowded places. 
Panic attack symptoms and heart attack symptoms can seem similar because their signs and symptoms can be similar. Most medical professionals, however, can quickly tell the difference between their symptoms as heart attacks have distinct symptoms that aren’t panic attack like. If you are unsure of which is panic attack symptoms and which is heart attack symptoms, seek immediate medical advice. If the doctor believes your symptoms are those of a panic attack, you can feel confident his or her diagnosis is correct. Therefore, there is no need to worry about a heart attack.
If you're having lots of panic attacks at unpredictable times and there doesn't seem to be a particular trigger or cause, you might be given a diagnosis of panic disorder. It's common to experience panic disorder and agoraphobia (a type of phobia) together. People who experience panic disorder may have some periods with few or no panic attacks, but have lots at other times.
Anxiety disorders differ from normal feelings of nervousness or anxiousness and involve excessive fear or anxiety. Anxiety disorders are the most common of mental disorders and affect more than 25 million Americans. But anxiety disorders are treatable and a number of effective treatments are available. Treatment helps most people lead normal productive lives.
Anxiety disorders fall into a set of distinct diagnoses, depending upon the symptoms and severity of the anxiety the person experiences. Anxiety disorders share the anticipation of a future threat, but differ in the types of situations or objects that induce fear or avoidance behavior. Different types of anxiety disorder also have different types of unhealthy thoughts associated with them.
Complementary and Alternative Therapies can be used in conjunction with conventional therapies to reduce the symptoms of anxiety. There is a growing interest in these types of alternative therapies, since they are non-invasive and can be useful to patients. They are typically not intended to replace conventional therapies but rather can be an adjunct therapy that can improve the overall quality of life of patients.

Anxiety, worry, and stress are all a part of most people’s everyday lives. But simply experiencing anxiety or stress in and of itself does not mean you need to get professional help or that you have an anxiety disorder. In fact, anxiety is an important and sometimes necessary warning signal of a dangerous or difficult situation. Without anxiety, we would have no way of anticipating difficulties ahead and preparing for them.

Repeated and persistent thoughts ("obsessions") that typically cause distress and that an individual attempts to alleviate by repeatedly performing specific actions ("compulsions"). Examples of common obsessions include: fear that failing to do things in a particular way will result in harm to self or others, extreme anxiety about being dirty or contaminated by germs, concern about forgetting to do something important that may result in bad outcomes, or obsessions around exactness or symmetry. Examples of common compulsions include: checking (e.g., that the door is locked or for an error), counting or ordering (e.g., money or household items), and performing a mental action (e.g., praying).
A collection of activities focused in which an individual consciously produces the relaxation response in their body. This response consists of slower breathing, resulting in lower blood pressure and overall feeling of well-being. These activities include: progressive relaxation, guided imagery, biofeedback, and self-hypnosis and deep-breathing exercises.
Meditation may also be helpful in the treatment of panic disorders.[54] There was a meta-analysis of the comorbidity of panic disorders and agoraphobia. It used exposure therapy to treat the patients over a period. Hundreds of patients were used in these studies and they all met the DSM-IV criteria for both of these disorders.[55] A result was that thirty-two percent of patients had a panic episode after treatment. They concluded that the use of exposure therapy has lasting efficacy for a client who is living with a panic disorder and agoraphobia.[55]
Genetics and family history (e.g., parental anxiety) may predispose an individual for an increased risk of an anxiety disorder, but generally external stimuli will trigger its onset or exacerbation.[57] Genetic differences account for about 43% of variance in panic disorder and 28% in generalized anxiety disorder.[58] Although single genes are neither necessary nor sufficient for anxiety by themselves, several gene polymorphisms have been found to correlate with anxiety: PLXNA2, SERT, CRH, COMT and BDNF.[59][60][61] Several of these genes influence neurotransmitters (such as serotonin and norepinephrine) and hormones (such as cortisol) which are implicated in anxiety. The epigenetic signature of at least one of these genes BDNF has also been associated with anxiety and specific patterns of neural activity.[62]
A large brief current is passed through a wire coil that is placed on the front of the head which is near the areas that regulate mood. The transient current creates a magnetic field that produces an electric current in the brain and stimulates nerve cells in the targeted region. The current typically only affects brain regions that are 5 centimeters deep into the brain which allows doctors to selectively target which brain regions to treat. Typical sessions lasts 30-60 minutes and do not require anesthesia. Sessions are administered 4-5 times a week for about 6 weeks. Although the procedure is painless, patients may experience a gentle tapping in the area of the head where the current is being administered. Neuromodulation has very few side effects but they may include headaches, slight tingling or discomfort in the area in which the coil is placed. rTMS may be administered alone or in combination with medication and/or psychotherapy.
There are things that people with panic disorder can do to assist with their own recovery. Since substances like caffeine, alcohol, and illicit drugs can worsen panic attacks, those things should be avoided. Other tips for managing panic attacks include engaging in aerobic exercise and stress-management techniques like deep breathing and yoga on a regular basis, since these activities have also been found to help decrease panic attacks.
Panic disorder is a diagnosis given to people who experience recurrent unexpected panic attacks— that is, the attack appears to occur from out of the blue. The term recurrent refers to the fact that the individual has had more than one unexpected panic attack. In contrast, expected panic attacks occur when there is an obvious cue or trigger, such as a specific phobia or generalized anxiety disorder. In the U.S., roughly 50% of people with panic disorder experience both unexpected and expected panic attacks.
Approximately one-third of people with panic disorder will also develop agoraphobia. People with agoraphobia are afraid that they will have some anxiety symptoms or a full-blown panic attack in a place where it would be very challenging or embarrassing for them to flee. This condition can lead to avoidance behaviors, in which they try to stay away from all places or situations in which they may have a panic attack.

A collection of activities focused in which an individual consciously produces the relaxation response in their body. This response consists of slower breathing, resulting in lower blood pressure and overall feeling of well-being. These activities include: progressive relaxation, guided imagery, biofeedback, and self-hypnosis and deep-breathing exercises.
Cognitive therapy and exposure therapy are two CBT methods that are often used, together or by themselves, to treat social anxiety disorder. Cognitive therapy focuses on identifying, challenging, and then neutralizing unhelpful or distorted thoughts underlying anxiety disorders. Exposure therapy focuses on confronting the fears underlying an anxiety disorder to help people engage in activities they have been avoiding. Exposure therapy is sometimes used along with relaxation exercises and/or imagery.
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