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What Are Panic Attacks?

Panic attacks are unmistakable. You're involved in some ordinary aspect of life when suddenly your heart begins to pound and you hyperventilate, sweat and tremble. You fear you are having a heart attack, going crazy, or even dying. Then, 10 minutes or so later, it's gone. What just happened?

Unfortunately, there is no clear answer. You have had a panic attack. Panic attacks are fairly common, usually beginning between ages 15 and 25. If you have recurrent panic attacks — and for a small minority of sufferers, they recur again and again, and if a persistent fear of subsequent attacks occurs — or if you change your behavior significantly because of such attacks, you have panic disorder. Between attacks, sufferers live in dread of the next one.

Many people with panic disorder relate an attack to what they were doing when it occurred. They may assume that the restaurant, elevator or classroom caused the attack, and decide to avoid that situation. In these cases, panic disorder may lead to agoraphobia — the fear of leaving home or being in public places — though the relationship between the two conditions is unclear.

What Causes It?

The underlying cause of panic disorder is not clear. There is evidence of both a genetic and a biochemical basis. There is also an association with phobias, such as school phobia or agoraphobia, as well as with depression, alcohol or cigarette abuse, suicide risk and seasonal affective disorder — a type of depression that occurs only during winter months.

The sudden feeling of terror or doom often brings on hyperventilation — uncontrollable, rapid, shallow breathing. This in itself can cause many of the other physical symptoms by upsetting the balance of oxygen and carbon dioxide in the bloodstream.

Panic disorder may begin after a serious illness or accident, the death of a close friend, separation from the family, or the birth of a baby. Attacks may also accompany the use of mind-altering drugs. Most often, however, a panic attack comes "out of the blue." It may even begin during sleep.

Some medical problems and medications can cause panic attacks, including some antidepressants at high dosage. Panic disorder that begins after age 40 suggests depression or another underlying medical disorder.