The first five conditions classified as “anxiety disorders” are:

• panic attacks
• obsessive-compulsive disorder (OCD)
• post-traumatic stress disorder (PTSD)
• phobias (for instance, agoraphobia or fear of open spaces), and
• social phobia.

Each of these has some particular distinguishing elements that set it apart and can be further categorized to have their own anxiety disorder symptoms. But some people who suffer from unusual degrees of worry or anxiety don’t fit into any of these categories. If their anxiety is severe enough to be considered an illness, they are likely to be diagnosed as suffering from “Generalized Anxiety Disorder” or GAD.

The determining factor in whether someone’s anxiety is severe enough to be called a disorder is largely a matter of degree. Everyone has anxieties—about money, relationships, job loss, their health. Anxiety is a perfectly normal response to the unavoidable demands of modern life. The person who never feels anxious is pretty abnormal, in fact.

But some people feel way too much anxiety. And most of the time their anxiety doesn’t seem to be related to any rational cause of concern. Other people do not react with the same intensity or length of concern that the person suffering from generalized anxiety disorder feels. But when you’re tense and worried, you may not have the perspective to know whether your worries are baseless or exaggerated. How can you tell if your fears are extreme enough to be considered a disorder?

Mental health specialists have assembled a checklist of the symptoms which indicate when a person’s anxiety level goes beyond what is considered normal and should be regarded as a mental health concern.

First of all, anxiety is considered to be excessive if you have these feelings almost every day for six months or longer, and if they center on more than one area of concern—you’re not just worrying about your health, but also about work, and school, and the weather, and the economy, etc.

• Secondly, you can’t turn it off. No amount of rational thinking or distraction can disrupt the nagging preoccupation for long.
• The anxiety is severe enough to interfere with your normal activities, making it hard for you to function and meet your responsibilities.
• You also have had at least three of the following physical symptoms persistently for several months:
  • Difficulty sleeping
  • Difficulty concentrating or feeling mentally blank
  • Irritability
  • Extreme restlessness or jumpiness, feeling “on edge”
  • Fatigue
  • Muscular tension

Sometimes people with anxiety disorder don’t even worry about anything in particular—they just have a constant feeling that something is wrong or is going to go wrong. Relaxation becomes difficult or impossible, and a number of other physical symptoms can start to affect them—hot flashes, stomach disorders, headaches, breathlessness.

Taken to an extreme, these can lead beyond generalized anxiety into panic attack. But for many people the level of discomfort is manageable, and for the most part they get along all right from day to day. But even so, the quality and enjoyment of their lives is significantly impaired. Over time, generalized anxiety can lead to depression and substance abuse. In fact, both depression and anxiety have been linked to brain chemistry imbalances, and may be related illnesses.

In the United States alone, an estimated four million people are suffering from generalized anxiety disorder. Anxiety can be treated, however, if you are informed and know the symptoms. Particularly if you find that anxiety is making you depressed, contributing to drinking or drug problems, or causing suicidal thoughts, you should see a doctor for a thorough examination, diagnosis, and treatment. But if the checklist above fits your experience, don’t wait until you reach those extremes before seeking help.

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There are ways of treating people who suffer from panic attacks. Various kinds of medication are available, and there are a number of therapeutic approaches that can help people gain control of their experience and lessen the intensity or even prevent a full blown attack. Unfortunately, too few of the people who are prone to this disorder realize that help is available and reach out for treatment.

Behavioral therapy can be helpful for many people. In this approach the person may be taught to deliberately relive or invoke some of the symptoms they have experienced. If they can learn to do this deliberately, the symptom itself becomes less frightening. Once the victim recognizes under controlled conditions that in fact he or she is not actually in danger of dying, the fear of that particular symptom will decrease and become less of a trigger to cause or intensify future panic attacks.

Another therapeutic approach focuses on learning to relax. At the first indication of an attack onset, the person is trained to direct the attention toward internal tensions—relaxing first in the head and upper body, and gradually through the entire body. Learning and practicing breath control is another key element of relaxation therapy, since rapid breathing and pounding heart are primary symptoms. Conscious deep slow inhalation and exhalation can help bring those reactions under control.

The essential element of these techniques is teaching the panic attack victim to recognize what is happening early enough that they can begin to take control of the experience before it is completely debilitating. Then, hopefully, the first signs of an attack will not simply bring on more panic. Instead they will cue the person to remember these learned coping mechanisms and the reassuring knowledge that “this too shall pass.”

Anxiety is the general underlying cause of panic attacks for most people. There are a number of other specific psychological disorders associated with panic attacks—post-traumatic stress victims are highly vulnerable, as are people with obsessive-compulsive disorders (OCD). These illnesses share with panic attacks the unpredictable and uncontrolled intrusion into the sufferer’s mind of thoughts and fears they cannot control. OCD is actually a kind of behavioral response to panic through repetitive actions—it’s just not a healthy behavioral response, because it becomes just as uncontrollable as the panic or anxiety it seeks to allay.

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Panic attacks are sudden brief episodes of intense fear or anxiety that trigger a variety of physical reactions—rapid pulse, shortness of breath, chills and hot flashes, stomach pain and digestive upset, etc. The mystery lies in what provokes the attacks.

Some theories hold that like depression, panic attacks are caused by a chemical imbalance or malfunction in the brain. In some families, a tendency to panic disorder appears often enough to suggest that it can be an inherited trait, indicating that genetic factors may be involved. In such cases the problem often emerges at a fairly early age. At present, panic attacks that stem from such causes can’t really be “cured” in the common sense of that term–that is, the underlying chemical or genetic flaw cannot be permanently repaired.

Other people, however, develop panic attacks and panic disorder only later in life. It appears that these may be “learned” responses. Just the right—or wrong—set of circumstances can combine to induce a panic attack in someone who has never had one before or shown any tendency in that direction. And panic attacks tend to be self-perpetuating. A panic attack is such a frightening and disturbing experience that the fear of having another one often becomes the trigger that starts the cascade of symptoms.

For people who have “learned” to have panic attacks, there is a good chance that their attacks can be cured through a process of “unlearning,” or reconditioning their response patterns to the identified stimuli through behavioral or cognitive behavioral therapy.

Further research may someday determine that panic attacks can only be learned or induced in people who do share some of the underlying chemical and/or genetic factors that are believed to cause panic disorder, though perhaps to a lesser degree than more severe cases.

If we cannot yet cure panic attacks, there are three main approaches that can effectively treat them.

• Self-help or self-treatment
• Behavioral or cognitive therapy
• Medication.

Self-treatment or self-care is likely to be most helpful for people whose attacks are relatively infrequent or mild, or as a follow-up to therapy or drug treatment. Relaxation and desensitization practice are known to help people learn to recognize and cope with the triggers that set off their panic episodes, and some may be able to develop these skills on their own or with the help of support groups.

Professional therapists can help people with more severe cases or those who haven’t been able to find or master the right coping techniques on their own. Cognitive therapy can help panic attack sufferers identify and understand what their brain and body are doing in the throes of an attack. This knowledge can be a key to getting the situation under control. Behavioral treatment often involves “practicing” situations that trigger the attacks, and learning how to either avoid them or desensitize yourself to them.

Therapy and self-help may not be enough for some people, especially those diagnosed with full panic disorder. A number of medications can alleviate and sometimes even eliminate their symptoms. Anti-anxiety drugs (the benzodiazepines, like alprazolam and clonazepam) and anti-depressants (SSRIs are often the first choice) have both been shown to reduce and even eliminate symptoms.

For some people a relatively brief course of medication will get the disorder under sufficient control for therapy and self-treatment to take over. Others may need to take these drugs on a long-term basis.

Ultimately, no single approach to “curing” panic attacks is going to work for every person and every attack. There is too much individual variation in peoples’ experience, and too much scientific uncertainty about what causes these debilitating episodes. But whatever the underlying cause of a panic attack, even if a definitive cure is not likely, there is plenty of evidence that the disorder can treated and brought under control completely enough to enable the susceptible person to live and function normally, without the shadow of fear distorting their daily lives.

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There is help available for panic attacks, however, and it begins with information. The best first step a person can take is no doubt to educate himself or herself about what is happening. If you are not ready to confide in your doctor or therapist, excellent resources exist on the Internet and in public libraries that provide medically accurate information about panic disorder. In the grip of an attack, fear and physical discomfort can actually make you think you are having a heart attack, going crazy, and even about to die. The first time it happens you have no reason not to think these things. But medical descriptions and accounts of other peoples’ experiences can provide some defense. The next attack is still unpleasant, even overwhelming, when it strikes, but knowing what is happening and that it will stop gives you a start on gaining cognitive control over your experience.

For most people, intellectual knowledge will not be enough to control the disorder. Behavioral therapy is also needed. Behavioral treatment focuses on recognizing, analyzing, and learning to control specific physical elements of a panic episode, one-by-one, step-by-step. An individual symptom (for instance, a hot flash or a rapid heartbeat) and the situational triggers that tend to bring it on (e.g., being at a party or packing for a trip) are deliberately evoked in a controlled manner so that the panic attack sufferer can experience them in isolation and practice dealing with them. This is partly a process of de-sensitization and partly a question of learning some techniques for shutting down the physical reactions. Perhaps planning ahead that you will only stay for 10 minutes or a half-hour at a party will enable you to hold off an attack. Some learned breathing exercises or relaxation techniques may help slow or halt the onset of breathlessness or a racing pulse while you are there.

When behavioral and cognitive therapy together do not bring sufficient relief, medication can modify or even prevent panic attacks for many people. In some cases, knowing that you have an anti-anxiety drug that can shut down some symptoms at the first sign of an episode or before some trigger situation (pre-party or pre-flight), can provide you with a feeling of control that will stop an attack before it starts.

If you suffer from panic attacks, you are not alone. A lot of people understand your experience and can help you deal with it—through live and online support groups and information resources, medical treatment, and behavioral and cognitive therapies. Don’t be afraid to reach out for help.

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What makes some people susceptible to these debilitating moments? A number of possibilities are at the  root of the panic attacks cause and have been theorized.

Hereditary causes. Because a tendency to panic attacks and panic disorder can run in families, there is a possibility they are influenced by hereditary factors. Certain personality traits are often found in people prone to panic attacks—particularly a lack of assertiveness and tendency to passivity. Heredity doesn’t appear to be a particularly strong predictor, however, and it’s difficult to separate nature from nurture in family histories. The attitudes and atmosphere a person grew up surrounded by could account for a good deal of the coincidence.

Biological causes. A number of diagnosable physical and mental illnesses can apparently bring on associated panic attacks. Vitamin B deficiency, hypoglycemia, and hyperthyroidism have also been linked to panic attacks, suggesting the possible operation of some chemical imbalance in the mechanism underlying panic attacks. Less surprisingly, people who suffer from phobias, OCD and post-traumatic stress disorders are also more prone to panic episodes.

Such genetic and biological factors likely lead to a long-term continuing experience of panic attacks, but there are also a number of causes for a more sudden and possibly temporary susceptibility. These are classified generally as environmental or external causes.

Stress. For instance, it’s recognized that people are more vulnerable to developing panic disorder at peak stress times in their lives. Losing a loved one through death or divorce, and other major life-changing events sometimes precede the onset of panic disorder. Stimulant drugs (legal or illegal) can also act as triggers. A number of medications actually list panic attack among their known side effects, and various drugs (including alcohol and caffeine) can interact to trigger attacks.

In cases where temporary stress or short-term drug use leads to panic attacks, it’s possible the attacks will cease once the external stressor is removed. However, these short-term external causes may simply be activating a pre-existing vulnerability that can be traced to heredity or other illnesses, and once activated the tendency may not pass.

Conditioning. Furthermore, whatever it is that causes the first panic attack—whether internal or external, lasting or temporary—the panic experience itself is so powerful and traumatic that it can easily become self-perpetuating. The situation or circumstances that the victim associates with that episode—where they were, what they were doing, eating, smelling, whatever the very first sensations were—can become triggers for the next attack. The first sensation of dizziness or a quickened heartbeat due to a totally different source can quickly summon up the association and escalate into full-blown panic. Eventually, anticipatory fear alone can bring on an attack.

With so many factors possibly contributing to the onset of panic attacks or panic disorder for any individual, identifying and treating the originating cause is difficult and even impossible in many cases. It may require exploring several different types of therapy to find help. For many, the answer may lie not in controlling the cause, but learning instead to control the symptoms.

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You have probably studied the symptoms of anxiety disorder and feel that they fit your experience pretty well—you have been worrying about a number of things for a long time, and can’t seem to shake those thoughts. Maybe you can’t even figure out what you’re worrying about—you just feel that something is wrong, something bad is about to happen. Maybe you have trouble sleeping at night and concentrating during the day, so you are having difficulty completing your work. You feel restless and irritable all the time.

Can you shake yourself out of this state? Are their steps you can take on your own to regain control and eliminate some of the anxiety from your life?

There are a number of self-help techniques that can help with the stresses that contribute to the buildup of anxiety for many people. The first step is a serious self-examination of the external sources of stress and pressure in your life that may be contributing to your anxiety.

Do you get enough sleep and regular exercise? Do you drink too much caffeine or take other stimulants?

Do you consciously make time each and every day for activities that give you enjoyment and relaxation? This should not be optional part of daily life. It is one of the keys to maintaining mental and physical health. If your mind and your body are tense and overloaded, they will both become less efficient and the more stressed you are likely to be. Mental play and physical exercise are not indulgences; they are necessities, particularly for anyone experiencing high levels of stress and anxiety.

Do you need help—emotional help dealing with your feelings or practical help with work or household responsibilities? If you feel isolated or hopelessly behind and unable to complete your tasks, you will likely feel an ever-increasing anxiety. Know your limits and reach out to others for support. Eliminate the non-essentials. Enlist others in the family or the workplace to share your tasks.

Confide in your friends and family. If you are alone, develop new social activities to reduce your isolation. You don’t have to transform yourself into a gregarious new person to join a reading group or a yoga club, but both can give you more human contact, mental relaxation and even physical exercise which will help you to a more balanced and healthy inner and outer life. Seek out a support group for anxiety sufferers. Knowing you are not alone can be a great help, and they may have invaluable practical advice as well.

If you have evaluated your life and none of these factors seem to be the cause of your persistent anxieties, or if you’ve tried these approaches and still feel constantly worried, it’s probably time to seek a professional diagnosis and treatment.

A physical examination should check for diagnosable physical illnesses like hypoglycemia, asthma, thyroid imbalance, or sleep apnea, which can cause anxiety as a side effect. Some medications list anxiety as a possible side effect as well, and certain non-medical supplements are also known to cause or worsen anxiety.

Once physical causes have been considered and ruled out, your next resort is to seek out a therapist who may be able to help you understand the causes of your disorder and develop a strategy for treating it. Many different therapeutic avenues are available, and it may take some trial and error to find the most effective approach for your case.

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Fortunately, anxiety disorder is highly treatable, but it’s quite likely you will need professional advice to locate the right treatment or combination of treatments for your situation.

The first step with any anxiety-related disorder should be to consult your physician in order to explore the possibility that your anxiety is caused by some organic illness or physical problem. Many conditions include anxiety among their symptoms or secondary effects, including epilepsy, sleep apnea, and Alzheimer’s. Anxiety is also a fairly common potential side of effect of a number of drugs and drug combinations. If any of these are the source of your anxiety, the treatment would need to take that into account.

Once a doctor has ruled out other causes, you may be left with the frustratingly vague diagnosis: “generalized anxiety disorder.” Some physicians might start you right out with anti-anxiety or anti-depressant medications, both of which have been found to be effective in helping people suffering from anxiety. Your doctor may recommend that you meet with a therapist or counselor who specializes in anxiety disorders before resorting to drug treatment or in conjunction with your medication. Most experts agree that the best results are achieved through a combination of psychological and pharmacological treatments.

In both of these areas there are several choices and possibilities. It may take some experimentation and some trial and error to find the particular medications, dosages, and therapeutic techniques that work best for you.

Medication is usually recommended as a first resort only for cases of severe anxiety disorder that is actually interfering with normal life. Drug therapy should be continued only as long as necessary, since the medications of choice also have undesirable side effects or can be quite addicting.

Two major classes of drugs are generally considered in treating anxiety disorder. The benzodiazapines are the most commonly prescribed. These are the “anti-anxiety” drugs—Xanax, Librium, Valium and Ativan. They tranquilize the body as well as the mind, and can have a sedative effect, in addition to being habit-forming. They work very quickly, however, and for milder cases can be used occasionally “on-demand.” A number of different anti-depressants are also used to treat anxiety. Most of them function by regulating the neurotransmitters serotonin and/or norepinephrine, chemicals in the brain thought to be linked to anxiety disorders. To be effective, anti-depressants need to be taken daily for extended periods.

Ideally, however, medications can be used to control your symptoms for only as long as you need while you develop some behavioral and cognitive techniques for managing your condition. Cognitive behavioral therapy helps patients develop new thought patterns that enable them to take control of and modify their feelings of anxiety. Patients can be taught to recognize and change the thought patterns and behaviors that arouse anxiety. Relaxation therapies such as yoga, a massage and progressive muscle relaxation have been demonstrated to reduce anxiety symptoms.

Analyzing and modifying the sources of stress in your life and environment can also play an important role in treating anxiety. If your life is too hectic, you consume too many stimulants (coffee, caffeinated sodas, even chocolate), you don’t exercise regularly, and your diet is unbalanced, you may be tipping yourself over the line from normal to excessive anxiety.

A combination of lifestyle changes and therapeutic training can enable many people to overcome anxiety without relying on drugs. It takes discipline and practice to maintain these treatment approaches, but the outcome of a life without constant anxiety makes them well worth the effort.

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You often cannot be inform by looking at someone that they suffer from the disorder, as this can be a disorder that manifests itself in many different ways. Signs and triggers for sufferers will range from one person to the next. When you assume it’s possible you’ll be suffering from Social Anxiousness Disorder, or just sense that something is fallacious and wish some change in your life, have a look at a few of the following triggers and signs to see if these match what you might be experiencing.

In that case, don’t be alarmed, social anxiousness dysfunction is well handled, and you can get help. On the subject of triggers for social anxiousness, any state of affairs that puts an individual within the public eye will trigger anxiety. The higher the chance that an individual can be watched or noticed, the higher the anxiety. So being the focal point, or coping with people in authority will trigger a substantial amount of anxiety.

However even the little issues in life equivalent to meeting anyone new, utilizing public restrooms, and even consuming in a public place can all be widespread triggers for social anxiety. The worry of being criticized for even the slightest situation will create a trigger that may lead to avoidance of these specific situations. Signs of social anxiety vary from psychological to physical.

A sufferer who has extreme episodes of stress and worry about a pending social situation might have a tendency to trigger their anxiety. They may worry for weeks and even months and try and decide means to keep away from these situations. Extreme intervals of self-consciousness within oneself on a regular basis per social setting will even be a symptom, as can be excessive episodes of fear.

The worry of being judged by those in public is probably the most paralyzing concern of this particular disorder. Bodily symptoms will come up as well, and are very similar to the bodily signs of many anxiety problems. A sufferer will experience breathing difficulties, shaking or trembling, stress within the muscle mass, nausea, a pounding or tightening within the chest area, and customary nervous cues equivalent to clammy fingers and shaky voice.

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This can be hard to recognize in a young child, partly because we expect them to be innocent and untouched, and also because children may not be able or willing to let you know what is happening in their minds and bodies at these times. You need to be able to spot and interpret unusual or extreme behaviors—does your child worry excessively about school assignments? Is she too much of a perfectionist, doing the same assignment over and over because it’s just not right? Does he cling and whine, constantly needing your attention and support?

One clue can be the development of obsessive-compulsive behaviors. These behaviors can arise in children as early as age two or three, though they more commonly emerge at 10 or older. For children as for adults, OCD involves an inability to shut off unwanted thought and behavior patterns. The child repeats certain actions compulsively—washing hands, checking under the bed, counting and recounting.

Children also can develop panic disorder, which tends most often to be diagnosed in adolescence. Again, in for adults, a formal diagnosis of panic disorder diagnosis is based on a person having experienced at least two full-blown attacks and continuing to experience anxiety about a possible recurrence over an extended period—a month at minimum.

Persistent phobias are another external sign that can be evidence of anxiety in children. It may be a little difficult to tell the difference between more normal though equally unfounded fears in children—many children are afraid of the dark, of loud storms, of large animals. But if the fear takes over their lives, interfering with school or play, or lasts for many months, it may need further investigation to determine whether it is an actual phobia and a sign of a deeper anxiety that would benefit from treatment.

Children are particularly susceptible to the emotional effects of powerfully stressful events—the death of a close relative or friend, a serious accident or household disaster, for instance. Such events can induce post-traumatic stress syndrome even in children, resulting in nightmares or other sleep disturbances, reduced appetite, emotional dissociation, and constant fear of recurrence.

Children have far fewer resources available to them to understand what is happening to them and reach out for help. The younger they are, the more vulnerable they are. It is vital that the adults in their lives be sensitive to and aware of the external behaviors that are a sign of internal anxieties and fears. Tears, tantrums, and periods of increased dependence are normal phases of most children’s development, but when taken to extremes and continued for long periods, these may also be signs that the child needs professional help. If you have any concern that your child is experiencing some form of anxiety disorder—whether panic attacks, OCD, or post-traumatic stress—a visit to your pediatrician is the place to start.

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If you are asking yourself this question, there’s a good chance the answer is yes. In fact, that lack of identifiable cause is one of the prime symptoms of a panic attack.

A panic attack is actually pretty easy to diagnose, since its name is self-explanatory. Like an attack, an episode of panic tends to come on suddenly and powerfully. And if “panic” means “intense fear,” some of the common symptoms of a panic attack certainly justify that label. Many people experience breathlessness, chest pain and a racing pulse that makes them feel as if they are having or about to have a heart attack. The fear of dying is indeed an intense fear.

One of the remarkable and defining characteristics of a panic attack is that while it starts entirely in the mind—as a feeling of anxiety or fear—it sets off a whole series of very physical reactions. Possible effects include pounding heart, sweating, hot flashes and chills, shaking, nausea and cramps, dizziness and fainting, hyperventilation, shortness of breath, a choking sensation, and a feeling of numbness and mental detachment.

The typical panic attack will reach a peak within 10 minutes and be over in a half an hour—though some last longer. It is such an intense and upsetting experience that it may leave aftereffects like exhaustion and continued anxiety for some time. Some panic attacks occur at night, waking the victim from a sound sleep with the full range of symptoms. These events are less common and pass more quickly, but the sleep disruption they cause can be equally debilitating.

Panic attack can easily escalate into a full-blown panic disorder. After a first attack, a vicious cycle may begin, as the victim develops a self-fulfilling fear of another attack:  since the attack is triggered by anxiety, the fear of having another attack simply feeds the cycle. The same fear can lead someone to avoid the situations or places where they experienced an episode previously, in case that was the trigger. This kind of avoidance can become an actual phobia—yet another anxiety disorder. And if you start avoiding too many situations and places, your daily life can become difficult, even dysfunctional.

Panic disorder is diagnosed in someone who has recurrent, unexpected panic attacks followed by ongoing concerns (for at least a month) about recurrence, preoccupation with what could happen during an attack (e.g., death or a heart attack), and a significant change in their actions or behaviors due to the attacks.

Some sources estimate that 12 percent of the human population will experience a panic attack in the course of their lives. Fortunately, not everyone who experiences occasional panic attacks will develop panic disorder. But the attacks alone can be a serious problem, worth seeking treatment for.

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There are two distinct stages of panic: anticipatory anxiety and the panic attack itself. Therapy can help panic sufferers break patterns of negative thought and learn how to cope and calm themselves by focusing on (1) understanding and modifying the environmental or external conditions and situations that trigger the attacks, and (2) recognizing and controlling the immediate symptoms of panic at the onset and during an episode.

Different medications also address one or both of these stages. Two general categories of drugs are used to treat panic disorder—(1) antidepressants, including tricyclics, monoamine oxidase inhibitors (MAOIs), and selective serotonin reuptake inhibitors (SSRIs); and (2) benzodiazepines or anti-anxiety drugs. Sometimes both categories will be used in combination.

The anti-anxiety drugs are particularly effective against the immediate symptoms of a panic attack. They can be taken “on demand” and work quickly to shut down an impending panic attack. And while their main impact is on active symptoms, the benzodiazepines can indirectly help reduce anticipatory anxiety, because knowing they have a tool that can likely stop an attack quickly often gives patients a greater feeling of control.

The benzodiazepines most commonly prescribed for panic attacks are alprazolam (Xanax) and clonazepam (Klonopin). Alprazolam takes 15 to 20 minutes, sometimes less, to begin shutting down the symptoms of anxiety, so for some it can be quite effective when taken at the first sign of a panic episode. Both alprazolam and clonazepam block panic attacks quickly and have relatively few side effects compared to antidepressants. On the down side, they are also quicker to create dependency in the body and can lead to withdrawal symptoms when they are discontinued.

For 75 to 80 percent of patients, anti-depressants cause significant improvement in their symptoms. Antidepressants reduce the number and severity of panic attacks through continual action on the brain’s chemistry. The tricyclic antidepressant imipramine (Tofranil) has the longest track record for treating panic attacks, and among the MAOI antidepressants, clinical experience shows that phenelzine (Nardil) is the most effective. Recent studies show that the newer SSRI antidepressants (i.e., Prozac, Zoloft, and Paxil) have success rates equal to that of the tricyclic antidepressants.

Symptoms of panic disorder should show significant improvement within a few weeks after beginning these medications. If no improvement is achieved within two months, the patient may require either a higher dose or another medicine. Most of these drugs will need to be continued for a year or longer and then can be decreased gradually without the reemergence of symptoms. But some people may need to stay on medicines for a long time to keep their panic at bay.

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A panic attack that occurs during waking hours is considered a “cognitive” event, because while the cause of the attack may be unknown, the person is aware of what is happening and their awareness (fear and anxiety) actually triggers and intensifies the physical symptoms that define a panic attack—the shortness of breath, racing pulse, cold sweat and trembling, dizziness, nausea, etc. But a sleeping person lacks that conscious awareness and anxiety that usually sets off sleep panic attacks.

This unconsciousness of course makes it particularly difficult to analyze the cause of a nighttime panic attack. The most obvious guess might be that the panic is linked to nightmares. Scientific studies of sleep patterns says no, however, because nocturnal panic attacks usually occur during phase II of the sleep cycle and not during the REM-phase—when dreams and nightmares occur.

But while nightmares have largely been ruled out as a cause of nocturnal panic attacks, there are a number of other identified sleep disorders that might play a role in the attacks, such as gastric reflux, sleep apnea, laryngospasm, and sleep seizures.

Two of these disorders are quite common. People with gastric reflux disease, for instance, often wake up at night with a burning throat and a choking feeling, which in turn can create anxiety and palpitations…triggering a panic attack almost before the person is awake.

The other fairly common and well-known sleep disorder is sleep apnea—or more technically, “obstructive sleep apnea.” With sleep apnea, the person’s breathing actually stops momentarily, causing the blood to becomes oxygen-deprived. This triggers a rapid heartbeat and gasping and choking sensations that wake the person suddenly and are extremely similar to panic attack symptoms. Some people who don’t realize they have sleep apnea (and many don’t) may actually attribute their waking to a panic attack rather than to sleep apnea.

Laryngospasm is less familiar, but it basically involves an involuntary closing or contraction of the vocal chords, actually cutting off the sleeper’s breathing. Again the person awakes in alarm, struggling for breath but not knowing why. Recipe for a panic attack in a susceptible person.  A person undergoing a temporal lobe seizure has symptoms that fill all the requirements for a panic attack: rapid heart rate, hyperventilation, sweating, a tingling feeling and dissociation.

All of these sleep disorders are caused by diagnosable physical conditions, unlike panic attacks, which are generally assumed to be psychological events. But if nocturnal panic attacks could really be determined to be caused by physiological factors, it raises the question whether at least some daytime panic attacks are also linked to something beside a mental malfunction.

For instance, one interesting discovery is that people who have panic attacks also have higher levels of carbon dioxide in their bodies at night than “normal” people. A panic attack can actually be induced in a person with panic disorder by having them inhale CO2. The theory is that when the brain perceives this higher level of carbon dioxide, it sets off something called a “false suffocation alarm,” causing the person to develop common panic attack symptoms, like hyperventilating.

Another more purely psychological explanation for nocturnal panic attacks is that they may be linked to a basic fear of “loss of vigilance.” People with this fear find it difficult and uncomfortable to relax, because they feel too vulnerable and unprotected. When they are in the deeply relaxed state of sleep or meditation, they can actually start to feel panic.

There are many theories and possibilities for what causes nocturnal panic attacks. But for those who do suffer from them, it is important to see a doctor to determine whether they might have a treatable medical condition—like sleep apnea or gastric reflux—which is causing those episodes.

And if you are looking to discover how to relieve yourself of the dreaded panic attack, then it is time to go grab your copy of “Alleviate Panic Attacks & Change Your Life“ here: Sleep Panic Attacks – you will be glad you did!

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