An anxiety attack is usually a sudden feeling of intense fear for no apparent reason. An anxiety attacks may appear suddenly and out of nowhere and it can disrupt your daily functioning.

Anxiety attack symptoms are noticed when anxiety levels peak, this manifests with the most extreme symptoms of the ‘fight or flight’ response. During the anxiety attack, the person feels unable to cope, disoriented, confused, and feels fearful in situations where other people are normally comfortable.

This response cannot be controlled by the individual even if (s)he feels there is no real reason behind the anxiety.  Anxiety attack symptoms appear when the body goes into ‘fight or flight’ mode and secretes the hormone adrenalin into the blood stream in order to activate all of the bodily systems and get them ready for the fight or flight response. Such a response is necessary under dangerous circumstances but in people suffering from anxiety attacks, this alarm mechanism goes off without sufficient reason.

How to know if you suffer from anxiety attacks:

• Do you worry excessively and feel tense about situations over which you have little or no control?
• Do the anxiety symptoms interfere with your daily activities?
• Are you under performing due to your anxiety attacks?
• Do you feel fearful about situations that appear normal to others?
• Are you pre- occupied with a sense of impending danger?
• Do you make an effort to avoid situations that may lead to an anxiety attack?
• Do you have episodes of high heart rate, sweating and unexplained panic

What are the symptoms of Anxiety attacks:

What are anxiety attacks?

Anxiety attack symptoms are exaggerated responses to imaginary threat perceived by the human body. These reactions developed during human evolution in order to protect us from danger but when no real danger is present in anxiety disorder, these physical changes are unnecessary and useless. Use the chart here to note the sensations of anxiety attacks when they occur in your body. Identifying the symptoms as and when they arise is the first step to overcoming panic attacks.

What causes anxiety attacks?

It has been noted that in people suffering from Anxiety attack symptoms ,the Amygdala,(the emotional center in the brain) which controls the anxiety response, becomes ‘reset’ at a higher than appropriate level of anxiety. When this reset happens, the body becomes used to functioning at a higher than normal level of anxiety

Triggers for anxiety attacks:

• As a result of dealing with stressful situations.
• Certain foods may trigger anxiety attacks
• Some drugs may increase your disposition to anxiety.
• Caffeine – it’s a stimulant that can make you feel anxious.
• Some decongestants are also known to trigger anxiety attacks.
• Inner self talk over exaggerating the situation
• Alcohol or drug use

What happens during anxiety attacks?

The body’s blood flow is directed away from the central part and vital organs of the body and blood is pumped towards the peripheries (the limbs), this enables the person to take evasive action and run or fight.

During the reaction the blood supply to stomach and digestive tract slow down, breathing speeds up to send more oxygen to the body, water is diverted to the muscles for energy, the heart rate rises and muscles tighten, these are some of the changes that occur in the body when anxiety attack symptoms are produced.

The terms anxiety attacks and panic attacks are sometimes interchangeably used to mean the same thing., but from a medical perspective, panic and anxiety are defined by different features.

The medical fraternity does not recognize “anxiety attack” as a separate entity in the DSM-IV-TR(classification manual). It groups several illnesses under the headline, “Anxiety Disorders.” These disorders include:

• Panic Disorder
• Agoraphobia without History of Panic Disorder
• Specific Phobia
• Social Phobia
• Obsessive-Compulsive Disorder
• Post Traumatic Stress Disorder
• Generalized Anxiety Disorder

Panic and anxiety differ in terms of the intensity of the symptoms and length of time the symptoms occur. Panic attacks have more sudden and intense symptoms, these symptoms usually occur suddenly, peak within 10 minutes and then subside. Anxiety takes longer to become intense and is not sudden in nature and it is related to excessive worry. Unlike panic attack, the symptoms of anxiety may be persistent and long lasting and may continue to days, weeks or even months.

Investigations:

No specific investigations are recommended to diagnose the condition but clinicians may feel inclined to refer the patient, or carry out tests to exclude underlying physical causes for the symptoms. Whilst it is important not to miss likely physical causes, one should not endlessly or excessively investigate the patient.

After initial exclusion of top-ranking physical causes, with the confirmation of characteristic clinical features of anxiety attacks, the absence of a physical cause is explained to the patient.

Patients presenting with anxiety attack like symptoms should receive a thorough initial evaluation that goes beyond assessment of their primary somatic complaints.

Some important factors to consider while evaluating anxiety attacks:

• Assessing history of anxiety attack:
• Is it related to worry?
• Agoraphobic avoidance
• Use of caffeine and other anxiety-provoking substances
• Substance-use history
• Medical history to eliminate organic etiology
• Psychiatric comorbidity (e.g., depression, interpersonal conflicts)
• Previous assessments and treatments (psychiatric, medical)
• Family history

Management: Treatment options for anxiety attacks:

Anxiety attacks and disorders respond well to therapy and medical treatment. Therapy is often a treatment of choice for people who don’t want to take medicines. However therapy may not be helpful in all patients and they may need to be supplemented with medication to achieve the desired results.

Therapy options for anxiety disorders:

Cognitive-behavioral therapy:

CBT (Cognitive behavior therapy) involves a therapist working with the patient to understand how thoughts and feelings influence behavior⁽¹⁾. The goal is to change negative thought patterns that lead to the patient’s anxiety and replace them with positive and more realistic thoughts.

Cognitive therapy helps patients to limit cognitive distortions by teaching patients to record their worries, listing evidence that justifies or contradicts the extent of their concerns. Through CBT patients learn that “worrying about worry” worsens anxiety and they are taught to take a proactive approach to solve their problems instead of practicing avoidance or procrastination.

Exposure therapy:

This is a form of therapy where the patient is exposed to the objects of their fear in a safe, controlled environment. Through repeated exposures to the feared object or situation, the patient develops control over the situation and no longer feels threatened by any negative outcome.

Medication for anxiety disorders:

Many medications have been used successfully to treat anxiety disorders, including benzodiazepines and antidepressants. Benzodiazepines are used to achieve a calming effect and they act in the short term whereas anti-depressants are used to achieve a long term control. Below is a list of some of the common medications and dosages used to treat anxiety disorders.

Drugs Used For Treating Anxiety attacks:

Dosage range

Tricyclic antidepressantsImipramine (Tofranil)Clomipramine (Anafranil)Nortriptyline (Pamelor)Desipramine (Norpramin)50 to 300 mg per day25 to 250 mg per day25 to 100 mg per day25 to 300 mg per daySSRIs(selective serotonin reuptake inhibitors)Fluoxetine (Prozac)Paroxetine (Paxil)Sertraline (Zoloft)Fluvoxamine (Luvox)20 to 80 mg per day10 to 50 mg per day50 to 200 mg per day50 to 300 mg per dayMAOIs (monoamine oxidase inhibitors)Phenelzine (Nardil)Tranylcypromine (Parnate)45 to 90 mg per day30 to 60 mg per dayBenzodiazepinesAlprazolam (Xanax)Lorazepam (Ativan)Clonazepam (Klonopin)2 to 10 mg per day2 to 6 mg per day1 to 3 mg per day

A treatment period of at least six to nine months is usually recommended. Some people taking medicine for anxiety attacks are able to stop after only a short time. Other people need to continue treatment for a long time, or even for their lifetime.