Here's how to manage and treat panic attacks

Tarana cannot breathe. Her heart is pounding and she is convinced it will stop any minute. She feels faint and dizzy. Her palms are cold and clammy. She is terrified and wants to get up and run. Tarana is having a panic attack.

What is a panic attack?

Most of us will, at one time or another, be stressed and panicky. Life throws us into situations such as a major examination or a life-altering interview where we will feel our hearts pounding and feel anxiety overwhelming us. This panic is specifically related to the stress of that particular situation and is, therefore, understandable.

Some people, however, get these symptoms in unexpected and unprovoked situations. When these symptoms are recurrent and the person is disabled by them, they are called panic attacks. These attacks usually last for more than ten minutes and the person may actually feel she is having a heart attack. About half the people who suffer panic attacks may also have attacks while sleeping. Nocturnal panic attacks tend to cause sufferers to wake suddenly from sleep in a state of sudden fear or dread for no apparent reason. It may take some time to calm down.

What causes a panic attack?

Nature created a ‘fight or flight' response in us to enable us to deal with stressful situations. When faced with a situation perceived to be dangerous or traumatic, our body pours out adrenaline, which makes us hyperconscious, with all our senses on high alert. Adrenaline speeds up the heart rate, slows digestion, shunts blood flow to major muscle groups, and gives the body a burst of energy and strength.

Originally named for its ability to enable us to physically fight or run away when faced with danger, the ‘fight or flight' response is now activated in situations where neither response is appropriate, like in traffic or during a stressful day at work. When the perceived threat is gone, systems are designed to return to normal function.

Unfortunately, some people are unable to control this response. When this response is set off repeatedly without any stimulus, panic attacks result. Women who are prone to anxiety and depression are also more susceptible to panic attacks.

What are the symptoms of a panic attack?

A woman having a panic attack will experience a racing or pounding heartbeat (palpitations), chest pains, stomach upset, dizziness and nausea. She may have difficulty in breathing and experience a sense of choking. She may feel hot or cold and be covered in cold sweat. She may start shaking or trembling uncontrollably. She may feel terrified and the fear of dying may be overwhelming.

Medical conditions that can mimic a panic attack

Certain medical conditions, like hyperthyroidism (where the thyroid gland is overactive), can cause a rapid and pounding heartbeat. Severe anaemia can cause the heart to race even with minimal exertion. A condition called mitral valve prolapse (a heart valve abnormality) can result in palpitations and cause intense discomfort. These conditions should be ruled out when investigating panic attacks.

How are panic attacks managed?

Women suffering from panic attacks can be proactive in preventing and avoiding them. Coffee, tea, ‘energy drinks' and colas contain caffeine, which can cause a rise in heart rate. Therefore, reducing the intake or complete avoidance of caffeine containing drinks can help. Regular aerobic exercise such as brisk walking, jogging and swimming help considerably. Stress-management techniques such as pranayama (deep breathing) and yoga have also been found to help decrease the frequency and severity of panic attacks.

Cognitive behavioural therapy is an effective form of psychotherapy, which helps those with panic disorder identify and decrease the irrational thoughts and behaviour that reinforce panic symptoms.

Helping the sufferer understand the emotional forces that may have contributed to developing symptoms has been found to be effective.

Medications for panic attacks

When panic attacks are not controlled with lifestyle modification and psychotherapy, medications can be used to control them. Specific medications called selective serotonin reuptake inhibitors (SSRI), and the selective serotonin and norepinephrine reuptake inhibitors (SSNRI) have been used successfully. Sedatives belonging to the benzodiazepine group may also be prescribed. Beta-blockers like propranolol are

sometimes used to treat the physical symptoms associated with a panic attack.

Panic attacks, though not life-threatening, can be very distressing. Lifestyle changes and seeking help early will help the sufferer deal with them and regain control over her life.

The author is an obstetrician and gynaecologist practising in Chennai and has written the book 'Passport to a Healthy Pregnancy'.