MENTAL HEALTH Stress & Anxiety • Obsessive-compulsive disorder • Post-traumatic stress disorder (PTSD) • Phobias • Panic attacks • Generalized anxiety disorder • Adjustment disorders • Social anxiety disorder (social phobia) • Oppositional defiant disorder (ODD)

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It can happen anytime, anywhere — when you're alone, with others, at home, in public, even awakening you from a sound sleep. Suddenly, your heart begins to race, your face flushes and you experience shortness of breath. You feel dizzy, nauseated and out of control. Some people even feel like they're dying.

You may have experienced a panic attack — a sudden episode of intense fear that prompts severe physical reactions in your body. Many people, thinking they're having a heart attack, go to the emergency room. Others try to ignore the signs and symptoms, not realizing that they're experiencing a panic attack.

More women than men are affected by panic attacks. Some people are affected by frequent panic attacks, a condition known as panic disorder.

Although panic attacks were once dismissed as nerves or stress, they're now recognized as a potentially disabling, but treatable condition. A variety of approaches, including medications, therapy and relaxation techniques, can help you control or prevent panic attacks.

A panic attack often begins abruptly, peaks within 10 minutes and lasts about half an hour. But panic attacks have many variations. They may last hours or, on rare occasions, up to a day. You may feel fatigued and worn out after a panic attack subsides.

Signs and symptoms may include:

• Rapid heart rate
• Sweating
• Trembling
• Shortness of breath and hyperventilation
• Chills
• Hot flashes
• Nausea
• Abdominal cramping
• Chest pain
• Headache
• Dizziness
• Faintness
• Tightness in your throat
• Trouble swallowing
• A sense of impending death

Other health problems — such as an impending heart attack, an overactive thyroid gland (hyperthyroidism) or drug withdrawal — can cause similar signs and symptoms.

People who experience panic attacks often are affected by other mental health conditions, including depression, fear of public places (agoraphobia) and social phobia.

Researchers aren't sure what causes panic attacks. Heredity, stress and certain biochemical factors may play a role. Your chance of having panic attacks increases if you have a close family member who has had them.

Many researchers believe your body's natural fight-or-flight response to danger is involved. For example, if a grizzly bear came after you, your body would react instinctively. Your heart rate and breathing would speed up as your body readied itself for a life-threatening situation. Many of the same reactions occur in a panic attack. No obvious stressor is present, but something trips your body's alarm system.

You may have a condition called panic disorder if:

• Your panic attacks are frequent
• You worry persistently for a month or longer about having more attacks
• You change your behavior in response to ongoing panic attacks — for example, avoiding locations or situations in which you've previously had an attack

Panic disorder can greatly interfere with your life. It's also possible that other health problems can cause symptoms similar to panic attacks. See your doctor to determine what's causing your symptoms. Your doctor may refer you to a psychiatrist or psychologist.

Your doctor will ask you to describe your signs and symptoms, how often they occur and in what situations they occur. You'll probably undergo a complete physical exam so that your doctor can determine whether health conditions other than panic attacks are the cause of your symptoms. These other health conditions might include heart disease or an overactive thyroid. If you have no underlying health problems, your doctor may diagnose panic disorder based on your signs and symptoms and their frequency.

Panic disorder can become debilitating and destructive. Fear of recurrent attacks can lead you to adopt avoidance behavior — avoiding what most people consider to be normal situations, such as going to the mall or leaving the house alone. You can develop a fear of fear.

In children, panic attacks can interfere with normal development, disrupting your child's social life and schoolwork. Children and teenagers, for example, may not go to school or may not even leave the house in order to avoid situations in which they fear a panic attack.

Having panic disorder also increases your risk of depression, suicide, and abuse of alcohol and other drugs.

Treatment for panic attacks and panic disorder is very effective. The outlook is good if you seek help, and most people are eventually able to resume everyday activities. Treatment may involve:

• Medications. Your doctor may prescribe an antidepressant medication, such as sertraline (Zoloft), paroxetine (Paxil) or fluoxetine (Prozac, Sarafem). Antidepressant medications usually improve or eliminate the symptoms of panic attacks. To relieve anxiety, your doctor may prescribe a type of medication called a benzodiazepine, such as clonazepam (Klonopin) or alprazolam (Xanax), either alone or with other drugs. The effectiveness of benzodiazepines often varies, and they may be habit-forming (causing mental or physical dependence), especially when taken for a long time or in high doses. If you think you may have become mentally or physically dependent on a benzodiazepine medication, check with your doctor. Do not stop taking your medication suddenly. The duration of drug treatment for panic attacks depends on the severity of your disorder and your response to treatment.
• Cognitive behavior therapy. During sessions with your psychiatrist or psychologist, you learn to better understand your panic attacks and how to deal with them. In the cognitive part of the therapy, you learn to recognize things that trigger your panic attacks or make them worse. The behavioral part of the therapy involves learning ways of coping with anxiety, such as using breathing and relaxation techniques. If you're avoiding common situations because of fear of panic attacks, behavior therapy can help you overcome this avoidance, which may be limiting the quality of your life.

Learning how to relax may help you head off a panic attack. You can learn to relax through a variety of techniques, such as meditation, muscle relaxation, relaxed breathing and guided imagery (visualization).

Relaxation is more than getting away from the work-a-day grind, and it's more than the absence of stress. It's a specific, intentional action that's positive and satisfying — a feeling in which you experience peace of mind. True relaxation requires becoming sensitive to your basic needs for peace, self-awareness and thoughtful reflection and having the willingness to meet these needs.

Relaxation techniques can help lessen the discomfort and duration of the signs and symptoms of stress, such as headaches, anxiety, high blood pressure, trouble falling asleep, hyperventilation, and clenching or grinding your teeth. One simple method is to remove yourself from a stressful situation, block the world out and concentrate on your body. These steps can help you relax:

• Sit or lie in a comfortable position and close your eyes. Allow your jaw to drop and your eyelids to be relaxed and heavy, but not tightly closed.
• Mentally scan your body. Start with your toes and work slowly up through your legs, buttocks, torso, arms, hands, fingers, neck and head. Focus on each part individually. Where you feel tension, imagine it melting away.
• Tighten the muscles in one area of your body. Hold the muscles for a count of five or more before relaxing and moving on to the next area. This is a good method for releasing tension. Tighten the muscles of your face, shoulders, arms, legs and buttocks.
• Allow thoughts to flow through your mind, but don't focus on any of them. Many people find using autosuggestion to be a great help. Suggest to yourself that you're relaxed and calm, that your hands are heavy and warm (or cool if you're hot), that your heart is beating calmly, and that you feel perfectly at peace.
• Breathe slowly, regularly and deeply during the procedure. Once you're relaxed, imagine you're in a favorite place or in a spot of great beauty and stillness. After five or 10 minutes, rouse yourself from the state gradually.

To maximize the benefits of these stress-reduction techniques, be sure to also get adequate sleep, eliminate caffeine and other stimulants from your diet, and engage in regular exercise. About 30 minutes of moderately intense physical activity most days of the week can improve your psychological well-being.