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Panic attack symptoms can make your heart pound and cause you to feel short of breath, dizzy, nauseated and flushed. Because panic attack symptoms can resemble life-threatening conditions, it’s important to seek an accurate diagnosis and treatment.

Panic attack symptoms can include:

* Rapid heart rate
* Sweating
* Trembling
* Shortness of breath
* Hyperventilation
* Chills
* Hot flashes
* Nausea
* Abdominal cramping
* Chest pain
* Headache
* Dizziness
* Faintness
* Tightness in your throat
* Trouble swallowing
* A sense of impending death

You may have a few or many of these panic attack symptoms. Panic attacks typically begin suddenly, without warning. Panic attack symptoms usually peak within 10 minutes and last about half an hour. But panic attacks have many variations. They may last hours or, on rare occasions, up to a day. You may feel fatigued and worn out after a panic attack subsides. One of the worst things about panic attacks is the intense fear that you’ll have another panic attack.

If you have frequent panic attacks, you may have a condition called panic disorder. Panic attacks can greatly interfere with your life — and perhaps even endanger you or others.

Panic attacks can strike at almost any time without warning — when you’re driving the school car pool, at the mall, sound asleep or in the middle of a business meeting. And you may fear having a panic attack so much that you avoid situations where they may occur. You may even be unable to leave your home (agoraphobia), because no place feels safe.

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Treatment for panic attacks and panic disorder is very effective. The goal of treatment is to eliminate all of your panic attack symptoms. With effective treatment, most people are eventually able to resume everyday activities. The main treatment options for panic attacks are medications and psychotherapy. Both are equally effective.

Medications

Medications can help reduce symptoms associated with panic attacks, as well as depression if that’s an issue for you. Several types of medication have been shown effective in managing symptoms of panic attacks, including:

* SSRIs. These medications are in the class of antidepressants called selective serotonin reuptake inhibitors. Because these medications are generally safe and have a low risk of causing serious side effects, SSRIs are typically recommended as the first choice in medication options to treat panic attacks. They include citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Prozac Weekly), paroxetine (Paxil, Paxil CR) and sertraline (Zoloft).
* SNRIs. These medications are in the class of antidepressants called serotonin and norepinephrine reuptake inhibitors. They include duloxetine (Cymbalta) and venlafaxine (Effexor, Effexor XR).
* TCAs. These medications are in the class of antidepressants called tricyclic antidepressants. While effective, they pose a risk of serious side effects, including heart and blood sugar problems. They include desipramine (Norpramin), imipramine (Tofranil) and nortriptyline (Pamelor).
* Benzodiazpines. These medications are mild sedatives. They belong to the group of medicines called central nervous system (CNS) depressants. Benzodiazepines may be habit-forming (causing mental or physical dependence), especially when taken for a long time or in high doses. These include alprazolam (Xanax), clonazepam (Klonopin) and lorazepam (Ativan).
* MAOIs. These medications are in the class of antidepressants called monoamine oxidase inhibitors. Because they can cause life-threatening side effects and require strict dietary restrictions, they’re not commonly prescribed. They include phenelzine (Nardil), tranylcypromine (Parnate), isocarboxazid (Marplan) and selegiline (Emsam).

If one medication doesn’t work well for you, your doctor may recommend switching to another or combining certain medications to boost their effectiveness. Keep in mind that it can take several weeks after first starting a medication to notice an improvement in your symptoms. All medications have a risk of side effects, and some may not be recommended in certain situations, such as pregnancy. Be sure to talk to your doctor about the possible side effects and risks.

Psychotherapy

Psychotherapy, also called counseling or talk therapy, can help you understand panic attacks and panic disorder and how to cope with them. The main type of psychotherapy used to treat panic attacks and panic disorder is cognitive behavioral therapy. Some experts recommend that you have therapy with a psychiatrist or psychologist with experience in treating panic disorder.

Cognitive behavioral therapy can help you change thinking (cognitive) patterns that trigger your fears and panic attacks. It can also help you change the way you react (behave) to anxious or fearful situations. During therapy sessions, you learn to recognize things that trigger your panic attacks or make them worse, such as specific thoughts or situations. You also learn ways to cope with the anxiety and physical symptoms associated with panic attacks. These may include breathing and relaxation techniques.

In addition, working carefully with your therapist, you may re-create the symptoms of panic attacks in the safety of his or her office. This is an important step because it can help you learn to control and master the symptoms so that they don’t continue to be a source of intense fear. Doing this can also help you overcome fear of certain situations that you may avoid, such as crowded malls or driving.

Your therapist may suggest weekly meetings when you first start treatment. You may start to see improvements in panic attack symptoms within several weeks, and often symptoms go away within several months.

As your symptoms improve, maintenance therapy with visits once a month can help ensure that your panic attacks remain under control. Eventually you can stop therapy when your symptoms completely go away, which may be a year or so. However, panic attack symptoms do sometimes come back. Seek prompt treatment if they do, and make sure that you’re managing any stressful life situations.

There’s no sure way to prevent panic attacks or panic disorder. However, getting treatment for panic attacks as soon as possible may help stop them from getting worse or becoming more frequent. Sticking with your treatment plan can help prevent relapses or worsening of panic attack symptoms. Practicing relaxation and stress management techniques can be helpful, too.

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If you have any symptoms of panic attacks, seek medical help as soon as possible. Panic attacks are hard to manage on your own, and they may get worse without treatment. And because panic attack symptoms can also resemble other serious health problems, such as a heart attack, it’s important to get evaluated by your health care provider if you aren’t sure what’s causing your symptoms.

In fact, many people visit the emergency department or seek care from numerous doctors or hospitals because they believe they have a serious undiagnosed physical condition. You can generally seek help first from your primary care provider for panic attack. If he or she believes your symptoms are indeed related to panic attacks, you may be referred to a psychiatrist or psychologist for treatment.

If you’re reluctant to seek treatment for your panic attacks, try to work up the courage to confide in someone, whether it’s a friend or loved one, a health care professional, a faith leader or someone else you trust. They can help you take the first steps to successful treatment.

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A panic attack is a sudden episode of intense fear that develops for no apparent reason and that triggers severe physical reactions. Panic attacks can be very frightening. When panic attacks occur, you might think you’re losing control, having a heart attack or even dying.

You may have only one or two panic attacks in your lifetime. But if you have panic attacks frequently, it could mean that you have panic disorder, a type of chronic anxiety disorder.

Panic attacks were once dismissed as nerves or stress, but they’re now recognized as a real medical condition. Although panic attacks can significantly affect your quality of life, treatment — including medications, psychotherapy and relaxation techniques to help prevent or control panic attacks — is very effective.

Symptoms

Panic attack symptoms can make your heart pound and cause you to feel short of breath, dizzy, nauseated and flushed. Because panic attack symptoms can resemble life-threatening conditions, it’s important to seek an accurate diagnosis and treatment.

Panic attack symptoms can include:

* Rapid heart rate
* Sweating
* Trembling
* Shortness of breath
* Hyperventilation
* Chills
* Hot flashes
* Nausea
* Abdominal cramping
* Chest pain
* Headache
* Dizziness
* Faintness
* Tightness in your throat
* Trouble swallowing
* A sense of impending death

You may have a few or many of these panic attack symptoms. Panic attacks typically begin suddenly, without warning. Panic attack symptoms usually peak within 10 minutes and last about half an hour. But panic attacks have many variations. They may last hours or, on rare occasions, up to a day. You may feel fatigued and worn out after a panic attack subsides. One of the worst things about panic attacks is the intense fear that you’ll have another panic attack.

If you have frequent panic attacks, you may have a condition called panic disorder. Panic attacks can greatly interfere with your life — and perhaps even endanger you or others.

Panic attacks can strike at almost any time without warning — when you’re driving the school car pool, at the mall, sound asleep or in the middle of a business meeting. And you may fear having a panic attack so much that you avoid situations where they may occur. You may even be unable to leave your home (agoraphobia), because no place feels safe.

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Here are a few suggestions on how you and your loved ones can help to prevent the onset or escalation of ppd-related symptoms:

Surround yourself with family, friends, loved ones. Talk to your loved ones about how you’re feeling and don’t be afraid to ask for help if you do not feel able to perform your daily tasks – you don’t have to be super-mom!

Attend a moms-only support group. Many women report that being surrounded by other mothers was immensely successful in curbing their symptoms of depression. Because the baby blues are so common, this is a great opportunity for mothers to share their experiences and know they’re not alone.

Don’t expect too much from yourself. Becoming a mother, especially when it’s for the first time, can be extremely stressful. Don’t push yourself and set reasonable limits for what you are able to achieve.
Take care of yourself! Be sure to make time for yourself and make your own well-being a priority. Getting out of the house for a little while each day (without your child!) may help you to keep your focus and regain composure.

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If any of the following symptoms endure for more than two weeks after childbirth, women should seek medical attention:

* Feelings of anxiety, guilt, sadness, worthlessness, restlessness or irritability
* Sleep disturbances
* Lack of interest in social or other activities you previously enjoyed
* Lack of feeling or feelings of resentment, anger or fear about motherhood, your partner or your child
* Trouble focusing
* Eating more or less than usual
* Unexplained, uncontrollable weeping
* Headaches, chest pains of other physical symptoms with no other apparent reason

In some cases, mothers may also contemplate suicide or even fantasize about harming their children as well as themselves. Unlike those suffering from postpartum psychosis, women experiencing postpartum depression are highly unlikely to commit such acts.

Who is at Risk?

Although there is no certain cause of postpartum depression, there are known risk factors for acquiring ppd. If you have experienced any of the following, you and your family should be extra vigilant in monitoring your mood levels during and after pregnancy:

* Previous incident of postpartum depression (this puts you at a 50-80% greater risk).
* Family history of depression or being treated for depression before pregnancy. A family history of bipolar disorder or psychosis also puts you at a greater risk for developing postpartum psychosis.
* Social isolation, lack of support or a life changing event such as divorce, death or loss of employment.
* Difficult pregnancy that caused disruption to normal routine (for example, being bedridden).
* Having a history of severe PMS or PMDD.
* History of thyroid problems

What are the Treatment Options?

For those suffering from postpartum depression, medical treatment options will most likely include:

* Psychiatric evaluation and/or individual or group therapy
* Antidepressants or other medications. Some doctors may recommend a mother take antidepressants for more severe symptoms of ppd, however, women should understand the risks involved in taking such medications if she is pregnant or breastfeeding.

Although it is recommended that women experiencing symptoms of postpartum depression seek medical attention, some alternative treatments include:

* A diet rich in omega-3 fatty acids. Recent studies have shown that these polyunsaturated fatty acids may be an effective treatment for those suffering from a range of depression related mood disorders.
* Some naturopaths suggest that certain blood tests may detect postpartum depression before its symptoms have been manifested. They suggest that women experiencing poor circulation, dizziness, unusual bleeding or clotting during their period or pale complexion be tested for blood deficiencies. Treatment options include acupuncture, herbal supplements and dietary or lifestyle changes.

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For many women, childbirth is the most meaningful moment of their lives. But at a time when a mother is supposed be filled with joy and love, some women may experience feelings of anxiety, fear, guilt or depression. Although it is not known exactly how many women suffer from depression, it is widely viewed as the most common complication of childbirth.

Postpartum Depression and the “Baby Blues”

The “baby blues”, which occurs when a woman experiences signs of depression after childbirth, is viewed as a common effect of pregnancy. In fact, anywhere between 50-80% of women report feeling sad, anxious, weepy or generally emotionally unstable before or after the birth of their baby. Fluctuating levels of the female sex hormones estrogen and progesterone is responsible for this.

During pregnancy the levels of these hormones increase dramatically. Therefore, after pregnancy, as the hormones return to their normal amounts, women may become susceptible to depression or mood disorders – just as our moods may be affected during PMS for the same reason. In fact, the baby blues may be marked by some of the same symptoms of postpartum; however, its duration is much shorter. The baby blues generally peaks 3-5 days after childbirth and will endure no longer than two weeks.

Postpartum (which literally means “after-birth”) depression (PPD), on the other hand, affects about 10-20% of new mothers and can begin anytime within the first year after childbirth. As of yet it is unknown how long postpartum depression can endure. The level of severity, environment as well as overall mental health may influence how long the symptoms will last.

Postpartum psychosis, which is a much more severe and dangerous form of postpartum depression is extremely rare and only affects about 3 women in every 1000. Signs of postpartum psychosis usually occur within the first few weeks postpartum.

In some cases childbirth may result in low thyroid levels, which may also be a cause of depression. There is a standard blood test than can be done to determine whether this is the case; and if it is, there are medications that can alleviate the symptoms.

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“Antidepressants may help body fight HIV and cancer” was the headline in The Independent recently. The newspaper article was on research that suggests that antidepressant drugs may help the immune system to fight off serious infection. The newspaper says the drugs could increase the activity of Natural Killer (NK) cells, a part of the immune system that targets cancerous and infected cells and induces “apoptosis” or “cell suicide”. The Daily Mirror focuses on the possible effect on cancerous cells, with a headline claiming “Big C hope for Prozac”.

Although the current research will be of scientific and medical interest, claims about the efficacy of antidepressants in HIV and cancer should not be made prematurely. This study involved laboratory research on blood samples from a specific group of women with HIV, and its findings cannot be generalised outside of this context. Much further research will be needed in people with HIV to see whether antidepressants could have any role in enhancing immunity.

At the current time, antidepressants should continue to be viewed in their role as treatments of depression, stress and anxiety - not as potential treatments for HIV or anti-cancer drugs.

Where did the story come from?

Dwight L. Evans and colleagues from the University of Pennsylvania School of Medicine carried out the research. The study was supported by a grant from the National Institute of Mental Health. The lead author is a consultant to a number of pharmaceutical companies, including the company that makes citalopram, the antidepressant that was used in the study.

The study was published in the peer-reviewed medical journal: Biological Psychiatry.

What kind of scientific study was this?

In this experimental laboratory study, the researchers investigated what controls the function of natural killer (NK) cells. NK cells are part of the immune system and protect the body from viruses and tumours. In people infected with HIV, the function of these cells progressively declines making them more susceptible to other infections and to the growth of new tumours.

It has been suggested that, possibly due to changes in the immune system, depression is a risk factor for more severe illness and increased risk of mortality in several diseases including HIV. There are three regulating systems in the human body that have been extensively studied for their potential effects on stress and depression; the serotonin, neurokinin and glucocorticoid systems. The researchers aimed to examine what effects the drugs aimed at inhibiting each of these systems would have on immune function.

In order to test this theory, the researchers recruited 51 women infected with HIV (80% black), half with depression and half without. They excluded any women with a chronic illness other than HIV, neurological disorders or history of schizophrenia or psychosis, alcohol or substance abuse, who were pregnant, or had used any antidepressant or anti-anxiety medications within the past month. More than three-quarters of the women (78%) were currently taking anti-retroviral (anti-HIV) therapy. Each woman received a full medical assessment and any diagnoses of depression or mood disorders were made using recognised criteria. During this assessment, a blood sample was taken so the researchers could look at the activity of immune cells in the sample. The samples were taken at the same time, each day in all women, to allow for any fluctuations in immune levels that can occur.

Blood samples were tested to determine the HIV viral load of each woman (the severity of infection with the virus) and to check the levels and function of different white blood cells, including NK cells, that make up the immune system. A specific subset of white blood cells that included NK cells was then purified from this blood sample, and separate samples of it were incubated with one of the drugs that acted on the regulatory systems being tested: an SSRI antidepressant (citalopram) that inhibits serotonin; a substance P inhibitor, CP-96345 (SP binds to a neurokinin receptor); and a glucocorticoid inhibitor, RU486 (mifepristone).

The researchers looked at the effects that these drugs had on the function of the NK cells. The drugs had previously been tested on blood samples from healthy donors to determine the drug concentrations needed to produce maximal NK cell activity without killing the cells.

They used statistical methods to look at the effects that each of the three drugs had on the NK cells of each woman’s blood sample, compared to her sample with none of the drugs present. They also looked at whether the effects on NK cells differed based on whether a woman was depressed, whether she was taking anti-retroviral therapy, or her viral load.

What were the results of the study?

Compared to the blood sample without any of the drugs, citalopram and the SP inhibitor CP-96345 both significantly increased NK cell activity. The two drugs were equally effective. The glucocorticoid inhibitor RU486 had no effect on NK activity.

Overall, there was no difference in the effect of the drugs between those women with depression and those without. The viral load and use of anti-retroviral therapy did not seem to make a difference on the effects that the drugs had on NK activity.

What interpretations did the researchers draw from these results?

The researchers concluded that, in the laboratory, an SSRI and an SP inhibitor both enhance NK activity in blood samples taken from HIV positive women. They say that clinical studies are needed to see whether NK activity can be improved in the patient, and to look at the potential role these drugs could have in delaying HIV progression or improving survival.

What does the NHS Knowledge Service make of this study?

Although the current research will be of scientific and medical interest, claims about the effects of antidepressants in HIV and cancer are premature.

- This study only involved laboratory research on blood samples. To date, there has been no investigation of the drugs’ effects on the immune system, HIV progression, or survival of living patients. These effects may differ from what happens when the drugs are applied directly to the blood sample.

- It is not possible to generalise the findings outside of this specific group, who are mostly black women with HIV. The women had different HIV viral loads, but the majority (60%) had undetectable levels and three-quarters of the 51 women were also taking current anti-retroviral therapy. The sample also didn’t include women with other chronic illnesses or any mental health conditions other than depression.

- The sample size was relatively small and could not reliably detect differing effects of each of the three drugs on NK activity between women with and without depression.

- The possible underlying mechanisms of how the antidepressant drugs could be affecting NK cells, e.g. whether they act directly on them or whether the increased activity is caused via other cell mediators, has not been studied and is unclear.

- It is only a theory that any increased NK activity caused by these drugs might help to fight cancer. The study did not investigate if this is true and the authors make no claims about any roles of these treatments in cancer prevention.

As the authors say, “These findings represent an initial step in identifying serotonin and substance P regulation of immunity in HIV infection.” Much further research will be needed in people with HIV to see whether the drugs could have any role as treatments to enhance immunity.

At the current time, antidepressants should continue to be viewed in their role as treatments of depression, stress and anxiety - not as potential treatments for HIV or anti-cancer drugs.

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Antidepressants can significantly boost immune system and beat serious infections, such as HIV and cancer.

A team of researchers from University of Pennsylvania in Philadelphia examined depressed and non-depressed women with HIV. They were receiving depression treatment with three common types of drugs: Citalopram, CP-96345, and RU486.

Citalopram is a selective seretonin re-uptake inhibitor (SSRI), CP-96345 is a substance P antagonist, and RU486 is a glucocorticoid antagonist. Citalopram and CP-96345 significantly boosted immune system, but RU486 did not lead to any major changes. The two drugs are able to boost the number of natural killer (NK) cells, which are responsible for immune system strength.

Natural killer cells are blood white cells, which mainly settle in infected cells, such as cancer cells. NK cells start releasing agents, who are able to call up cell suicide in infected cells.

The finding comes from a previous study showing that people suffering from stress and depression have significantly lowered number of NK cells. This boosts infection rate and leads to HIV progression. Antidepressants themselves can significantly boost the number of natural killer cells and help the body fight serious infections.

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Scientists suggest that a tricyclic antidepressant can reduce symptoms in adolescents suffering from irritable bowel syndrome (IBS).

The study showed amitriptyline therapy can significantly reduce IBS-related diarrhea and pain as well as improve the quality of life in such individuals.

Mattel Children’s Hospital UCLA scientists believe low doses of amitriptyline can be a treatment for neuropathic pain rather than an antidepressant or psychotropic medication.

According to the study published in the Journal of Pediatrics, peppermint oil is the only effective treatment in children suffering from IBS.

IBS patients suffer from chronic discomfort with cramping, diarrhea or constipation. The main cause of IBS is still unclear but scientists believe psychological factors or biological triggers can contribute to the disease.

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