A panic attack is a feeling of extreme fear that comes on without warning and for no obvious reason. During a panic attack you think you are going to have a heart attack, or die, or go crazy. You feel out of control or like something terrible is going to happen. Your heart beats fast or very hard or skips beats. You shake, sweat, feel short of breath or feel dizzy. A panic attack can happen at any time, even while you are sleeping. Symptoms reach a peak in about 10 minutes and might last 30 minutes or longer.

Although we might not know what causes a panic attack, your body is making the same chemicals that it makes when you are in danger. Panic attacks and panic disorder can run in families. Stress, nicotine, caffeine, drugs and alcohol can cause panic attacks or make them worse. It is good to avoid these drugs and reduce stress if you have panic attacks.

A panic attack is not dangerous. Some of the symptoms of a panic attack are the same as the symptoms of a heart attack, hyperthyroidism or drug withdrawal. The first time you have a panic attack you should see a health-care provider. If you do not have any sign of heart or thyroid disease or any problems with drugs, your symptoms are probably caused by a panic attack.

Ten to 20 percent of people will have a panic attack at some time in their lives. Panic attacks affect women three times more often than men. If you have panic attacks and 1) worry about having more panic attacks, 2) avoid normal activities because of panic attacks, or 3) worry that you have some terrible medical illness, you have panic disorder. Panic disorder is a serious illness that can be more disabling than depression. One out of five people with panic disorder will attempt suicide. If you have panic attacks or panic disorder, discuss it with your health-care provider.

During a panic attack you might have a rapid or irregular heart beat, sweat, tremble and feel short of breath. You can have chills, hot flashes, nausea, abdominal cramping, diarrhea, chest pain, headache, dizziness, numbness or tingling. You might feel detached from yourself or like things are not real. You might think you are going to die or go crazy.

Most of the time panic attacks are treated with medicine or a combination of medicine and counseling. Treatment for panic attacks and panic disorder works very well. For some people, simply knowing more about panic attacks and panic disorder helps them learn to manage their symptoms even without drugs or counseling.

In eight to 10 visits with a counselor, you can learn to manage your panic attacks. Learning to do relaxation and breathing exercises can help stop panic attacks.

• Inhale slowly through your nose.
• Count to five, slowly expanding your stomach and then your chest.
• Hold your breath for two seconds.
• Exhale slowly through your mouth while counting to five again.
• Relax your whole body while you breathe out.
• Repeat several times until your anxiety is gone.

Antidepressants and tranquilizers or a combination of both are used to treat panic attacks. Your health-care provider will sometimes give you both medicines until you stop having panic attacks and then slowly stop the tranquilizer. It is important to take tranquilizers as directed because taking these medicines only when you need them can make panic attacks worse. You will need to stay on your medicine for up to a year after your panic attacks stop.

The Anxiety and Phobia Workbook. Edmund J. Bourne, PhD

The Anxiety Disease. David V. Sheehan, MD

Triumph Over Fear: A Book of Help and Hope for People with Anxiety, Panic Attacks and Phobias. Jerilyn Ross

For free pamphlets on panic attacks and panic disorder, call 1-800-64-PANIC