Every man has panicked before. Maybe you feel a wave of terror as your car spins out of control on black ice, before you give a big presentation to your boss’s boss, or when your girlfriend mutters the words, “We need to talk … ”
It’s an unsettling, alarming feeling that may leave you trembling, sweating, or extremely upset, but it’s probably not a full-on panic attack. Here’s the difference.
What a Panic Attack Feels Like
When you have a panic attack— a sudden onset of intense fear or discomfort that usually peaks within 10 minutes and fades within an hour—your brain’s fear circuits run haywire.
Scientists believe that’s due to a malfunction of nerve cells in your brainstem, which sends heart-pumping adrenaline and other hormones surging through your body.
As your heart speeds up, you begin to hyperventilate and breathe in more carbon dioxide.
This alters the acidity of your blood, triggering a cascade of chemical reactions that shift calcium in and out of your cells, says Elias Shaya, M.D., chief of psychiatry for MedStar Good Samaritan and MedStar Union Memorial Hospitals in Baltimore.
These shifts cause tingling or numbness, shaking, dizziness, nausea, sweating, chills or hot flashes, and a pounding or racing heart. Muscle spasms induce aches in your chest and gut.
Your throat and airways tighten, leaving you choking and struggling to breathe.
Mentally, you might feel detached, as though you’re looking down from above. Fears of death, and losing control, or “going crazy” dominate your thoughts.
These symptoms are so severe and alarming that they drive many sufferers to the emergency room, convinced they’re having a heart attack, says Dr. Shaya.
In order to be considered a true panic attack, an episode must include at least four of the hallmark symptoms listed above.
When Panic Attacks Pop Up
Some people have their first attack after a traumatic event or even a minor life transition, such as a layoff or an engagement, says Patricia Allen, M.S.N., a psychiatric mental health nurse practitioner at Summit Behavioral Health.
In other cases—especially in young, otherwise healthy men—they strike “out of the clear blue sky,” even during sleep, Dr. Shaya says.
That means the misfiring of nerve cells in your brain can occur from an overreaction to a minor event, or just randomly.
Some people have one or two episodes and that’s it. But in other cases, you might develop “anticipatory anxiety,” or intense fears of another attack, says Jeremy Coplan, M.D., professor of psychiatry at SUNY Downstate Medical Center.
Worries like these that persist for a month or more qualify you for a diagnosis of panic disorder. Untreated, this raises your risk of developing agoraphobia, or an intense fear of situations from which you can’t escape. As a result, about one-third of people with agoraphobia eventually become housebound.
What To Do If You Think You’re Having a Panic Attack
If you think you’re having a panic attack, have someone drive you to the emergency room, an urgent care center, or to your doctor if he or she can squeeze you in quickly. (Find out When You Should Go to the ER or Just See Your Doctor for other health conditions, too.)
Since the symptoms so closely mimic those of a heart attack, you’ll want a workup to rule out ticker trouble, Allen says.
Next, your doctor will review your drugs, prescription or over-the-counter.
Some medications, such as stimulants for ADHD or thyroid treatments, can trigger panic attacks. Overdoing it on caffeine, using cocaine, or even withdrawing from heavy drinking can also rev up your fight-or-flight response and cause panic-like symptoms, Dr. Shaya notes.
If your doctor diagnoses a panic attack or panic disorder, it’s important you get treatment. People with panic disorder have a 30 percent greater risk of attempting suicide, a study in the journal Depression and Anxiety found.
Treatment includes antidepressant or antianxiety medication, cognitive behavioral therapy, lifestyle changes like exercise, or a combination of all three.
Your doctor might also recommend exposure therapy—say, driving over increasingly lengthy bridges if you’re scared of heights, or hyperventilating—to intentionally provoke symptoms of a panic attack before calming yourself back down with deep breathing and self-talk. This would all be done under close supervision of your doctor.
“That demystifies the attack, and gives you a sense of control,” Dr. Shaya says.