What are the symptoms and treatment options for a panic attack?

From the Guidelines

Panic attacks involve sudden episodes of intense fear with symptoms including rapid heartbeat, chest pain, shortness of breath, sweating, trembling, dizziness, nausea, and feelings of unreality or fear of dying, and the most effective treatment approach is a combination of cognitive-behavioral therapy (CBT) and selective serotonin reuptake inhibitor (SSRI) medication, as suggested by the most recent guideline 1.

Symptoms of Panic Attacks

The symptoms of a panic attack can be intense and overwhelming, and may include:

• Rapid heartbeat
• Chest pain
• Shortness of breath
• Sweating
• Trembling
• Dizziness
• Nausea
• Feelings of unreality or fear of dying These symptoms can be similar to those of other medical conditions, such as heart attacks or other cardiovascular conditions, and it is essential to seek medical attention if you are experiencing any of these symptoms 1.

Treatment Options

Treatment options for panic attacks include:

• Cognitive-behavioral therapy (CBT), which helps change thought patterns triggering attacks
• Medications such as SSRIs (like sertraline 50-200mg daily or fluoxetine 20-80mg daily) for long-term management
• Benzodiazepines (like lorazepam 0.5-2mg as needed) for immediate relief in severe cases
• Lifestyle changes, such as regular exercise, adequate sleep, limiting caffeine and alcohol, practicing relaxation techniques like meditation, and avoiding known triggers These approaches work by addressing both the physiological stress response and the thought patterns that maintain anxiety 1.

Recommended Approach

The combination of CBT and SSRI medication is the most effective treatment approach for panic attacks, and should be considered as the first-line treatment 1. This approach has been shown to be more effective than either treatment alone, and can help individuals manage their symptoms and improve their quality of life. It is essential to consult a healthcare provider for personalized treatment, as they can help determine the best course of treatment based on individual needs and circumstances.

From the FDA Drug Label

Panic disorder (DSM-IV) is characterized by recurrent unexpected panic attacks, i.e., a discrete period of intense fear or discomfort in which four (or more) of the following symptoms develop abruptly and reach a peak within 10 minutes: (1) palpitations, pounding heart, or accelerated heart rate; (2) sweating; (3) trembling or shaking; (4) sensations of shortness of breath or smothering; (5) feeling of choking; (6) chest pain or discomfort; (7) nausea or abdominal distress; (8) feeling dizzy, unsteady, lightheaded, or faint; (9) derealization (feelings of unreality) or depersonalization (being detached from oneself); (10) fear of losing control; (11) fear of dying; (12) paresthesias (numbness or tingling sensations); (13) chills or hot flushes.

The symptoms of a panic attack include palpitations, sweating, trembling, shortness of breath, feeling of choking, chest pain, nausea, dizziness, derealization, fear of losing control, fear of dying, paresthesias, and chills or hot flushes. Some key points about panic attacks are:

• They are characterized by a discrete period of intense fear or discomfort
• At least 4 of the listed symptoms must be present
• Symptoms develop abruptly and reach a peak within 10 minutes
• Treatment options include medications such as sertraline 2, alprazolam 3, and paroxetine 4.

From the Research

Symptoms of a Panic Attack

• A panic attack is a discrete period of fear or anxiety that has a rapid onset, reaches a peak within 10 minutes, and involves at least four of 13 characteristic symptoms, including:
  • Racing heart
  • Chest pain
  • Sweating
  • Shaking
  • Dizziness
  • Flushing
  • Stomach churning
  • Faintness
  • Breathlessness
  • Fearful cognitions, such as the fear of collapse, going mad, or dying
  • Derealisation (the sensation that the world is unreal) 5, 6

Treatment Options for Panic Disorder

• The treatment of panic disorder includes psychological and pharmacological interventions, such as:
  • Antidepressants (e.g., selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs))
  • Benzodiazepines (e.g., alprazolam, clonazepam, diazepam)
  • Behavioral treatments 7, 5, 8, 6, 9
• The choice of treatment should be guided by the patient's preference and should balance benefits and harms from treatment in a long-term perspective 7, 5

Efficacy and Acceptability of Treatment Options

• Low-quality evidence suggests that benzodiazepines may have a possible advantage over placebo in the short-term treatment of panic disorders 7
• Low-quality evidence suggests that SSRIs may be better tolerated than TCAs, and that benzodiazepines may have a small but significant advantage in terms of tolerability over other classes 5, 6
• Network meta-analysis suggests that most medications (including antidepressants and benzodiazepines) are more effective than placebo in the treatment of panic disorder, with diazepam, alprazolam, and clonazepam ranking as the most effective 6