Dr Margaret answers emailers’ embarrassing problems
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Panic Attacks

Dear Dr Margaret
I have a problem where I suddenly, for no reason, begin to feel panicky, as if something bad is about to happen. I know nothing is going to happen, but I panic anyway. I become shaky and my throat goes tight and I find it hard to breathe. I don’t feel particularly under stress and am generally happy in my life. What is wrong with me?

Panic attacks that come out of the blue are surprisingly common, especially in young adults. There is an intense feeling of anxiety, with sweating, shakiness, a racing heart and a choking sensation or a feeling of being smothered. Some people feel dizzy or nauseous, or have a feeling of unreality or feel that they are losing control of their mind. Some sufferers say the symptoms are so intense that they feel they might die. An attack usually lasts only a few minutes, but can be terrifying.

In fact, what is happening in your body is normal, but is happening at the wrong time. You are experiencing a rush of adrenaline, which is putting your body into a state of readiness to deal with a sudden danger. This might be appropriate if you were confronted by a wild animal, but not when you are shopping in a supermarket. Because your anxiety has nothing to fix on, and is not diverted into any action (such as running away from the animal), it overwhelms you.

You may find that simply understanding what is happening is enough to calm you. Work out a mantra to repeat to yourself next time it happens, such as: ‘This is just a panic attack. It is not dangerous. I am waiting calmly for it to be over.’ During an attack, try not to hyperventilate (panting), because this can make symptoms worse. Breathe in slowly and deeply, and hold your breath for a moment before breathing out slowly.

If you feel you cannot cope with the attacks, or they are interfering with your life, you should see your doctor. Some people are helped by a type of psychotherapy (cognitive behaviour therapy). This aims to change misleading thought patterns that help the panic to build up. Drug therapy with an ‘SSRI’ (selective serotonin reuptake inhiibitor) is also an effective treatment, although it can make the attacks more frequent for the first week or two.

Although your description sounds like a typical panic attack, it would be worth talking it through with your doctor, because a heart condition can sometimes give similar symptoms to a panic attack.

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