Are they Panic Attacks-Turned Leaf Psychiatry can help!

A panic attack can feel like a medical emergency. Your heart may race, your chest may tighten and you may feel unable to breathe. You might become dizzy, start shaking or suddenly believe that you are losing control, having a heart attack or dying.

Although panic attacks feel dangerous, they are often caused by the body's survival alarm activating when no immediate danger is present. The symptoms are real—but they are also treatable.

Turned Leaf Psychiatry provides personalized evaluation and treatment for panic attacks, panic disorder and related anxiety conditions.

What Is a Panic Attack?

A panic attack is an abrupt surge of intense fear or discomfort that reaches its peak within minutes. It may happen unexpectedly or be triggered by a situation, memory or physical sensation.

Common symptoms include:

• Racing or pounding heartbeat
• Sweating, trembling or shaking
• Shortness of breath
• Feeling of choking
• Chest pain or tightness
• Nausea or abdominal discomfort
• Dizziness or feeling faint
• Chills or sudden heat sensations
• Numbness or tingling
• Feeling detached from yourself
• Feeling that your surroundings are unreal
• Fear of losing control
• Fear of dying

Symptoms often peak within approximately 10 minutes, although exhaustion, shakiness and anxiety may continue afterward. Some people begin avoiding exercise, driving, crowds, stores or unfamiliar places because they fear having another attack.

What Happens in the Brain?

A panic attack can be compared to a smoke alarm sounding when there is no fire. The alarm system is working, but it has interpreted a harmless or mildly uncomfortable sensation as an immediate threat.

The 2024 review by Guan and Cao explains that panic involves several interconnected brain regions:

• The amygdala identifies possible threats.
• The insula monitors breathing, heartbeat and other internal sensations.
• The hypothalamus activates stress hormones and the autonomic nervous system.
• The brainstem regulates breathing, heart rate and sensitivity to carbon dioxide.
• The periaqueductal gray helps coordinate escape and defensive responses.
• The prefrontal cortex normally evaluates and regulates the fear response.

During a panic attack, an ordinary sensation—such as a faster heartbeat, dizziness or mild breathlessness—may be interpreted as evidence of danger. That interpretation increases fear and further intensifies the physical symptoms.

Researchers have also proposed a "false suffocation alarm." In some people, changes in carbon dioxide, breathing or blood acidity may activate the brain's suffocation-sensitive pathways even though the person is receiving adequate oxygen.

What Happens in the Body?

Once the brain detects danger, the sympathetic nervous system activates the fight, flight or freeze response. Adrenaline and related signals prepare the body to survive by increasing heart rate, accelerating breathing, tightening muscles, producing sweat and directing blood toward the large muscles.

A 2023 systematic review and network meta-analysis by Wang and colleagues included 4,008 participants and found reduced heart-rate variability among people with panic disorder. This supports the involvement of the autonomic nervous system, which controls automatic functions such as heartbeat and breathing.

Rapid or repeated deep breathing may also reduce carbon dioxide levels. This can cause dizziness, tingling, chest tightness and feelings of unreality. When these sensations are interpreted as dangerous, the person becomes more frightened and breathes faster, creating a self-reinforcing panic cycle.

The 2024 systematic review by Moraes and colleagues also identified possible changes involving serotonin, GABA, glutamate, norepinephrine, orexin, brain lactate and the body's hormonal stress system. This research confirms that panic attacks involve genuine brain and body processes—they are not imaginary or a sign of weakness.

When Does It Become Panic Disorder?

Having one panic attack does not automatically mean that someone has panic disorder.

Panic disorder may be diagnosed when a person experiences recurrent, unexpected panic attacks and at least one attack is followed by one month or longer of:

• Persistent worry about additional attacks or their consequences; or
• Significant behavioral changes intended to prevent another attack.

The symptoms must not be better explained by a substance, medication, medical condition or another mental-health disorder.

Because panic symptoms may resemble cardiac, respiratory, endocrine, neurologic or medication-related conditions, a careful clinical assessment is important. New or unusual chest pain, fainting, severe breathing difficulty, neurologic changes or symptoms substantially different from previous attacks require prompt medical evaluation.

What Treatments Can Provide Relief?

The Brazilian Psychiatric Association's recent panic-disorder treatment guideline reviewed evidence for psychological and medication-based treatments.

Cognitive Behavioral Therapy

Panic-focused cognitive behavioral therapy helps patients understand the panic cycle, reconsider catastrophic interpretations and gradually return to avoided activities.

Interoceptive exposure may also be used to safely recreate feared sensations, such as a mildly increased heart rate or dizziness. Over time, the brain learns that these sensations are uncomfortable but not necessarily dangerous.

Antidepressant Treatment

SSRIs are commonly used as first-line medications for panic disorder. Options may include sertraline, escitalopram, fluoxetine, paroxetine or citalopram. Venlafaxine extended-release is an SNRI with evidence supporting its use in panic disorder.

People with panic disorder may be sensitive to early medication activation. Treatment is therefore often started at a low dose and increased gradually when appropriate.

Benzodiazepines

Benzodiazepines may be very beneficial when first starting treatment because they can provide acute, short-term relief while longer-term treatments begin to work.

Turned Leaf Psychiatry recognizes that these medications can serve an important therapeutic purpose when used appropriately, prescribed carefully and monitored closely. Because benzodiazepines can cause sedation, tolerance, physiological dependence and withdrawal, their benefits and risks should be evaluated individually. They should be taken only as prescribed and should not be stopped suddenly without medical guidance.

What Can You Do During an Attack?

If you recognize the symptoms as panic and no medical emergency is present:

• Remind yourself: "This is a panic response. It will pass."
• Breathe gently—try inhaling for four seconds and exhaling for six.
• Relax your shoulders, jaw and hands.
• Focus on objects, sounds and physical sensations around you.
• Avoid repeatedly checking your pulse or oxygen level unless medically necessary.

How Turned Leaf Psychiatry Can Help

Turned Leaf Psychiatry offers innovative, personalized and evidence-based care for panic attacks, panic disorder and anxiety-related conditions.

Services may include:

• Comprehensive psychiatric evaluation
• Assessment for panic disorder and co-occurring conditions
• Medication evaluation and management
• Education about the panic cycle
• Individualized treatment planning
• Therapy referrals when appropriate
• In-person and telehealth appointments
• Continued monitoring and follow-up

If panic attacks are disrupting your work, school, sleep, relationships or ability to leave home, you do not have to manage them alone.

Contact Turned Leaf Psychiatry to request an appointment and begin developing a personalized plan for relief.

Turned Leaf Psychiatry: Innovative | Personalized | Evidence-Based

This information is educational and does not replace an individualized medical evaluation. Call 911 or visit the nearest emergency department for an emergency. Call or text 988 if you are experiencing a mental-health or suicide crisis.