“I'm 27 years old, newly married, happily employed—and for two months this fall I was petrified to leave my house. I have panic disorder,” writer Kara Baskin divulged last year in a first-person account in the Washington Post. Kara describes debilitating heart palpitations that began the week of her college graduation, when she had what she calls an “out of body” panic experience while painting her fingernails one evening. Her heart began racing and she felt as if she were watching her body “from above.” And then, as quickly as her symptoms began, they ended. But those 10 minutes had seemed like an eternity—and that’s often how women who experience panic attacks describe them. Heart pounding. Hands sweating. Knots-in-the-stomach anxieties. Feelings of overwhelming dread. Fear that strikes you cold to the bone. A very real need to flee danger. Only it’s not a mugging or robbery in progress—it’s a panic attack.


If you’ve ever had a panic attack, you’ll never forget it—so say patients who seek treatment. Panic attack (PA) is an anxiety-related disorder that wreaks havoc on your life and health.

The fight-or-flight survival response causes a cascade of stress-related chemicals to pour into your bloodstream, including adrenaline, cortisol, glycogen, and norepinephrine, as your body chooses its response: run, fight or hide. An attack can wrench you from a deep sleep or hit you out of the blue in the midst of an ordinary day. A stressful situation, like giving a speech or interviewing for a new job, can trigger an attack, but for some women, an attack arises without an identifiable trigger or warning. PA can also be a recurring symptom in a variety of other anxiety conditions such as social anxiety and panic disorders, leaving you dreading that it will happen again and at the worst possible time.

PA can be a frightening experience, with a variety of unpleasant and foreboding sensations that can mimic the symptoms of a heart attack or other life-threatening medical conditions—although PA on its own is never life threatening. According to the latest Diagnostic and Statistical Manual of Mental Disorders, panic attacks begin abruptly, include four or more symptoms, and reach a peak in about 10 minutes. The length of time may vary, however, with each individual. PA is also relatively common: one out of every 75 people worldwide will experience PA at some time in their life. Sadly, only one in five will actually seek treatment.

Women are twice as likely as men to experience PA, probably because hormones may play a part in its onset. For example, the hormonal changes of perimenopause, in which progesterone levels fall, may result in increased feelings of anxiety leading to PA. Chronic stress, with its constant stream of hormones, can lead to adrenal fatigue, which is often diagnosed in conjunction with chronic anxiety and PA.

Yo-yo dieting, sleep deprivation and overindulgence in caffeine and other stimulants can also play a part in PA. If your coping reserves are low, you’re more likely to suffer an attack. Heredity may also play a role in PA. Genetic studies in twins suggest that anxiety disorders, including PA, may run in families. For example, an identical twin has a 31% chance of developing panic disorder if her twin is diagnosed with it. Researchers are now focusing on the genes that regulate serotonin (a neurotransmitter in the brain) in the hope of finding a specific physiological cause for PA, so they can more accurately predict who might be most vulnerable. Because PA sufferers often show more sensitivity to hyperventilation as a trigger for their attacks, researchers speculate that there could be a suffocation false alarm response: Hypersensitivity to changes in carbon dioxide levels may lead to hyperventilation and a subsequent PA.

The good news is that if you’re diagnosed with PA, your healthcare provider has several types of medications that could help, including antidepressants, anti-anxiety medications or a combination of both. Depression often accompanies PA, and antidepressants are effective in reducing anxiety because they affect the neurotransmitters in our brain that are involved in anxiety disorders. Anti-anxiety drugs such as benzodiazepine may be prescribed in conjunction with an antidepressant because they act quickly to give symptom relief in the short term while the antidepressant has to build up over days or weeks to full effectiveness.

Healthcare providers sometimes go “off-label,” using beta blockers, anticonvulsants, and antihistamines—these drugs aren’t specifically approved for PA, but they do seem to help some women. The National Institute of Mental Health (part of the National Institutes of Health) recommends cognitive-behavioral therapy (CBT), a form of psychotherapy, or a combination of medication and therapy. Researchers have recently found, however, that CBT alone can be as effective in treating PA as the combination approach. The lesson here? It’s important for you to work closely with your care provider to find the right therapy that works for you.

You can also consider alternative therapies, such as acupuncture, aromatherapy, psycho-neuro-linguistics, (a form of mind/body therapy), stress management and relaxation response training, hypnosis or hypnotherapy and nutritional supplements. All of these show promise. Remember Kara? She writes that she’s now in treatment, learning to replace “my destructive patterns of thinking and reacting, with the goal of replacing those patterns with more productive ones ... and feeling better than I have felt in years.” She believes that researching her illness gave her the courage to seek treatment. Remember that knowledge is power, so if you or someone you know suffers from PA, talk to your healthcare provider—there’s no need to panic—help is right within your reach.

About the Author: Jan Demasters, PhD, RN, CSP, is a well-known expert on managing stress and is founder of Total Health Concepts in St. Louis. She emphasizes that panic attacks usually peak in about 10 minutes. “If your symptoms are severe, or last longer than a few minutes, play it safe and call for help to make sure it truly is PA and not some other health problem,” she advises.