Panic attack is a condition of intense fear (fear of dying, losing control...), anxiety, and distress that begins suddenly, escalates rapidly, and is often accompanied by a strong sense of danger or the thought that something terrible is about to happen.
“I’m having a heart attack, I think I’m dying!”
Panic attack is a condition characterized by unexpected episodes that arise spontaneously and create fear and discomfort. Together with the intense anxiety and worry experienced by the patient, the constant feeling of being in danger forms the clinical appearance of the disorder.
Some people struggle to express their emotions or cannot express them at all. Especially when negative emotions cannot be expressed verbally or physically, they may accumulate in the subconscious and be triggered by even the slightest stress, leading to panic attacks or other psychological disorders. Panic attacks often appear without any clear reason, and one of its most typical features is the fear of death. During an attack, the person’s heartbeat accelerates just like during a heart attack, they feel as if their breath is insufficient, start taking deep, frequent breaths, and present a clinical picture similar to a heart attack. But no need to worry! Because this is not a heart attack — it is just a panic attack! Your life and health are safe, relax…
Just like a heart attack: palpitations, sweating, shortness of breath, dizziness, chest pain, and tightness may occur!
What Are the Symptoms of a Panic Attack?
Panic attack symptoms are as follows:
- Palpitations, feeling like the heart is pounding or about to burst,
- Sweating, hot flashes, sometimes chills,
- Trembling,
- Difficulty breathing, fear of choking, shortness of breath,
- Dizziness, feeling like they will faint,
- Nausea, belching, abdominal pain,
- Shortness of breath, taking deep breaths because the air feels insufficient,
- Chest tightness and chest pain,
- Feeling unreal, detachment from self, difficulty perceiving,
- Thinking the environment is not real (derealization),
- Fear of death,
- The thought and feeling of going crazy,
- Intense fear of harming someone else,
- Numbness, tingling in the body, etc.
Is There Treatment for Panic Attack?
Many panic attack patients do not consider or accept that their symptoms may have psychological origins, and therefore often go to hospital emergency departments. Because the symptoms may be confused with life-threatening conditions such as a heart attack or respiratory failure, all diagnostic tests are performed, but none confirm these serious disorders. At this point, panic attack is considered, and the patient is referred to a specialist psychiatrist or psychologist.
Once panic attack is diagnosed, it is treatable. Patients often prefer visiting emergency services during panic attacks. However, this behavior causes panic disorder to become more deeply rooted and leads the person to fear fear itself.
The individual with panic disorder must first know that this is a psychological condition and that they are not having a heart attack. Then, by slowly taking deep breaths through the nose and exhaling through the mouth for a certain period of time, they should try to calm themselves. Their focus should not be on the body or the sensations. Although it may be difficult to apply these techniques during a panic attack, when applied, these methods help the person calm down, and as they realize they can control the situation, they feel more relieved and understand that the disorder is manageable.
What Is the Difference Between Panic Attack and Panic Disorder?
Panic attack and panic disorder are connected but different conditions. Panic disorder can be summarized as avoidance behaviors seen in individuals who experience one or more panic attacks. Behaviors such as avoiding leaving home, not staying alone, constantly taking precautions, and avoiding situations that might cause excitement may indicate panic disorder. Panic disorder limits the person’s life, reduces their sense of trust toward themselves and others, and prevents them from enjoying life.
This intense anxiety episode may last from a few minutes to a few hours, with a clear beginning and end. It typically peaks within about 10 minutes and gradually decreases afterward.
Panic attack symptoms (DSM-4-TR, 2000): At least 4 of the symptoms below occur within 10 minutes:
- Palpitations, awareness of heartbeat, or increased heart rate
- Sweating
- Trembling or shaking
- Shortness of breath or a feeling of choking
- Feeling of breathlessness
- Chest pain or discomfort
- Nausea, abdominal pain, or belching
- Dizziness, lightheadedness, feeling like falling or fainting
- Derealization (feelings of unreality) or depersonalization (feeling detached from oneself)
- Fear of losing control or going crazy
- Fear of dying
- Paresthesias (numbness or tingling sensations)
- Chills, shivering, or hot flashes
Panic attack can occur in three types: unexpected, situational (always triggered in certain environments such as seeing a dog, social settings…), or situationally predisposed (likely but not always triggered in certain environments).
Panic attack continues like a vicious cycle: A trigger occurs (for example, a bodily sensation like shortness of breath), this sensation creates the automatic thought “What is happening to me?”, this thought frightens the person and causes physical reactions (hyperventilation, increased heart rate, dry mouth…), focusing on these sensations increases the symptoms, catastrophic interpretations arise (I’m dying, I’m having a heart attack…), and the panic attack develops. As physical reactions increase, the person becomes more focused on them, worsening the cycle.
To prevent another attack, the person starts taking precautions that restrict their life: frequently going to the emergency room for an EKG, constantly monitoring their heartbeat, avoiding environments where attacks occurred, never doing anything alone, measuring blood pressure repeatedly, avoiding planes, cars, ferries, etc.
With Which Psychological Disorders Can Panic Attack Occur?
- Depression
- Social phobia
- Generalized anxiety disorder
- Obsessive-compulsive disorder
- Post-traumatic stress disorder
- Specific phobias
A common feature of anxiety disorders is that the patient perceives danger as extremely large while perceiving their coping ability as extremely small.
Factors that may lead to the first panic attack include: normal bodily states (fatigue, orthostatic hypotension, hypoglycemia, menstrual cycle...), ordinary physical illnesses (flu, gastroenteritis, allergies...), hormonal imbalances; drug-substance effects (excessive alcohol consumption, adrenergic medications, excessive caffeine, hallucinogens or other psychoactive substances); frightening thoughts; or anxiety caused by general tension (exam period, pregnancy, divorce…).
What Can Someone With Panic Attack Do?
The person should first undergo physical examinations to ensure there is no physiological illness. If no physical issue is found, they should seek professional mental health support. Panic attack is a condition that can be treated more effectively with psychotherapy together with medication if necessary. Cognitive behavioral therapy has been empirically proven to be effective in panic attack treatment (recovery rates reported by Beck et al. at 92%; Clark et al. at 84%). Psychotherapy sessions focus on assessment, psychoeducation, cognitive restructuring aimed at catastrophic beliefs, behavioral techniques (eliminating avoidance and safety behaviors), redirecting attention from the body to the environment, relaxation, and breathing training. Regular psychological therapy has effects on the prefrontal cortex and hippocampus, reducing contextual fear and cognitive misinterpretations.
Why Spring Depression and Panic Attack?
We usually look forward to the start of daylight saving time and eagerly await the arrival of spring. We want to escape heavy coats and winter clothing. The thought of spring coming lifts our spirits and brings joy.
However, statistics show that suicide rates are lowest in winter and highest in spring. Especially April and May significantly affect people. Why do April and May affect people so much? Although these months mark nature’s awakening and increased sunlight — which should make us feel more uplifted — why do they impact people enough that some even end their lives?
Spring is transition and change.
Seasonal changes affect our emotional states. This is because there are biological components and chemicals in the brain responsible for happiness or sadness and depression. The secretion of these chemicals may change. Especially during these months, anxious individuals and panic attack patients may have more frequent attacks or feel more anxious due to seasonal transitions. Patients with bipolar disorder (manic-depressive illness) may experience intensified manic episodes in these months.
The psychological structure and biological system go through an adaptation process. Every external influence is perceived by the organism as intervention, and the organism produces a reaction.
Chronic depression and anxiety patients are particularly affected.
Studies have found some connections between depression and allergies.
At minimum, allergic individuals are observed to be more likely to experience depression.
Allergy-related headaches, fatigue, and insomnia increase susceptibility to depression. Many studies indicate that allergic individuals experience depression twice as often as non-allergic individuals.
A 2000 study conducted in Finland on twins also found a high risk of depression among allergic individuals.
A 2003 study on the Finnish population found a connection between allergies and depression.
Feeling depressed is equivalent to feeling weak and unmotivated. A depressed person often experiences anhedonia (inability to feel pleasure), lethargy, and fatigue, making suicide attempts less likely. However, during spring, people feel more energetic due to sunlight, but being energetic does not necessarily mean feeling well. Therefore, in April and May, some depressed individuals who are predisposed to suicide may act on these thoughts because they now have the physical energy to attempt it. Depressed individuals often do not make attempts during their deepest depressive state but rather when they begin to emerge from it — because they regain enough energy to carry out the act.
Spring depression has been observed more frequently in women aged 30–40. Such seasonal depressions increase further in northern countries and affect individuals more severely.
To reduce the impact of spring depression, spending time outdoors, benefiting from sunlight, engaging in physical activity, and spending time with people who make you feel good can help you get through this period more comfortably.
