The biology of panic attacks

Panic attacks are fascinating. I once had a patient who missed 6 appointments prior to finally getting to my office. She had agoraphobia and panic attacks.

Panic attacks are treatable. This article discusses the merits of SSRIs and behavioral therapy. I have had success with both – Biology of fear

Scientists are closing in on the brain regions that may be involved in panic attacks. In a study published earlier this year, researchers showed for the first time, using PET scanning technology, that people who get panic attacks have one-third fewer of a certain kind of serotonin receptor in their brains. Serotonin is a key regulator of mood.

The good news is that, terrifying as they are, panic attacks are not in themselves harmful and rarely last more than a few minutes, although they can lead to dysfunctional behavior such as drinking, avoiding normal life activities and unnecessary visits to the emergency room.

“Anywhere from 60% to 80% of people with panic attacks are vastly improved by cognitive behavioral therapy or medications or both,” said Dr. Chris Hayward, an associate professor of behavioral sciences and psychiatry at Stanford University School of Medicine.

But perhaps the best strategy is to combine medication and behavioral therapy, said Dr. Joe Bienvenu, a psychiatrist at Johns Hopkins School of Medicine. Even after panic attacks are controlled by drugs, people often “have not learned that they will not have more,” he said. “This really requires going there and dealing with this anticipatory fear.”