How to Handle COVID-19 Panic Attacks

Photo Credit: by Tim Dennell, flickr.com

The COVID-19 pandemic has caused panic in all strata of society, there is little doubt about that. Whether it’s hoarding of toilet paper or overreacting to every COVID-related news item on social media, panic seems to be everywhere right now. But can COVID-19 go so far as to actually increase medical panic attacks? If you are finding that you’re suffering from panic attacks thanks to COVID-19, how do you handle your COVID-19 panic attacks?

What Is Panic?

A panic attack and panic itself are different things. Most of us have experienced panic at some point in our lives, but few of us have actually experienced a panic attack.

According to Dictionary.com, “panic” is defined as:

“a sudden overwhelming fear, with or without cause, that produces hysterical or irrational behavior, and that often spreads quickly through a group of persons or animals.”

For example, if you think of a crowd of people that hears a loud bang, some people may think the noise is a gunshot, and then start to panic, screaming and running through the crowd, knocking down others in an attempt to escape. The fear of a gunshot is certainly understandable, but the panic response of screaming and knocking down others is not necessarily as rational.

As mentioned earlier, panic can also cause things like panic buying, panic selling, or many other irrational behaviors.

What Is a Panic Attack?

A panic attack, on the other hand, is different. A panic attack is a medical event that has a specific cluster of symptoms.

The following are likely symptoms of a panic attack:

• Palpitations, pounding heart, or accelerated heart rate

• Sweating

• Trembling or shaking

• Sense of shortness of breath or smothering

• Feeling of choking

• Chest pain or discomfort

• Nausea or abdominal distress

• Feeling dizzy, unsteady, lightheaded, or faint

• Derealization (feeling detached from the world) or depersonalization (feeling detached from oneself)

• Fear of losing control or going crazy

• Fear of dying

• Numbness or tingling sensations

• Chills or hot flashes

A panic attack is technically described as the acute onset of intense fear or discomfort that reaches a peak within minutes and includes at least four of the above-listed symptoms. It is also possible to have a “limited-symptom” panic attack which is similar to a full-blown panic attack but with fewer than four of the above symptoms.

Unlike feelings of anxiety, panic attacks usually reach their height within 10 minutes and then start to subside. According to the Anxiety and Depression Association of America,

“Due to the intensity of the symptoms and their tendency to mimic those of heart disease, thyroid problems, breathing disorders, and other illnesses, people with panic disorder often make many visits to emergency rooms or doctors' offices, convinced they have a life-threatening issue.”

Understandably, panic attacks tend to be extremely frightening and those who suffer from them tend to have anxiety about having another one. It is because of this anxiety that people may go to great lengths to avoid having another panic attack. For example, a person may avoid anything that reminds them of previous situations in which panic attacks occurred. These changes may be so strict as to be lifestyle-limiting. For example, a person may refuse to take the subway due to a previous panic attack happening in a subway tunnel and have no way to get around their home city. In severe cases, a person may even refuse to leave his house for fear of experiencing another panic attack.

A person who suffers from panic attacks may be diagnosed with panic disorder. Panic disorder is diagnosed when a person has four or more attacks in a four-week period, or one or more attacks followed by at least one month of fear of another panic attack.

How Is COVID-19 Linked to Panic Attacks?

It is known that panic can be triggered by (among other things) illness and interpersonal conflict or loss. And, of course, with the rise of COVID-19, the associated quarantine and the associated job losses, many people are experiencing illness, conflict and loss – perhaps all at once. It is no wonder, then, that COVID-19 is linked to panic attacks.

Panic attacks are also linked to cough-like symptoms and dyspnea (shortness of breath). In other words, if a person who is prone to panic attacks experiences cough-like symptoms or shortness of breath for any reason, it may induce a panic attack. Additionally, panic attacks are linked to catastrophic interpretations of changes in physiological sensations, such as respiratory rhythm. In other words if a person interprets his physical sensations as being catastrophic (such as being symptoms of a heart attack) that is likely to precipitate a panic attack as well.

Unfortunately, a pandemic like COVID-19 produces situations in which both of these links occur readily. So COVID-19 can induce a panic attack because of either an actual symptom of COVID-19 such as a shortness of breath, or even a perceived symptom such as a cough merely produced by dust in the air due to the anxiety around getting COVID-19. Of course, not everyone experiences panic attacks in these situations, however, some people are prone to this type of reaction.

Panic attacks are also linked to a perceived increase in carbon dioxide in the brain due to respiratory issues. This may be because of actual increased carbon dioxide in the brain (for example, due to acute shortness of breath) or because the brain simply errantly sends out a “suffocation signal,” which is more likely in those who suffer from panic attacks.

It is in all the above ways that the circumstances surrounding COVID-19 is a perfect storm for panic attacks. Acute anxiety disorder, posttraumatic stress disorder (PTSD) and obsessive-compulsive disorder (OCD) are other mental health concerns inked to the pandemic.

What to Do If COVID-19 Is Causing Panic Attacks for You

First off, if COVID-19 is causing panic attacks for you, please know that you’re not alone. Many people who have never experienced a panic attack before, may experience one now, thanks to the above outlined “perfect storm.” Moreover, if you were prone to panic attacks before the pandemic, it’s understandable if they have increased thanks to the pressure and anxiety surrounding COVID-19. Remember, panic attacks mean you’re crazy? They just mean you’re human.

Also, whether you’ve had one panic attack or many, it’s important to realize panic attacks can be treated and often reduced or even eliminated.

Typical treatments for panic attacks and panic disorder include medication and psychotherapy.

Medication for Panic Attacks in COVID the -19 Era

In the medication category, first-line treatments for ongoing panic attacks are various types of antidepressants including:

• Selective serotonin reuptake inhibitors (SSRIs) – These are the most commonly-prescribed medications for the long-term management of anxiety disorders, including panic disorder. It may take two to four weeks to achieve control over anxiety and panic attacks. Treatment options in this category include fluoxetine (Prozac), sertraline (Zoloft), citalopram (Celexa), escitalopram (Lexapro) and others.

• Serotonin–norepinephrine reuptake inhibitors (SNRIs) – An option in this category is venlafaxine (Effexor).

• Tricyclic antidepressants (TCAs) – This category of antidepressant is an option, although not normally first-line within the antidepressant class when compared to SSRis and SNRIs as TCAs can have greater side effects. That said, they can be an option when other classes aren’t effective. Options in this category include imipramine (Tofranil) and clomipramine (Anafranil).

• Monoamine oxidase inhibitors (MAOIs) – Similar to the TCAs, MAOIs aren’t first-line when compared to SSRIs or SNRIs due to side effects but may be useful for those experiencing refractory anxiety disorders. Options in this category include phenelzine (Nardil) and tranylcypromine (Parnate).

• Other antidepressants – There are two additional medications that are may be offered to treat an anxiety disorder such as panic disorder. They do not neatly fall into a medication category and so are simply thought of as “other” or “unique.” Medications here include mirtazapine (Remeron) and trazodone (Desyrel).

Antidepressants have a great advantage in that they have a very low risk of dependence. Benzodiazepines, which are known as anxiolytics or sometimes tranquilizers, are also an option for panic attacks, but they do carry a greater risk of abuse and dependence. Benzodiazepines are often used on an as-needed basis, although can be prescribed as a daily medication as well. Benzodiazepine options include lorazepam (Ativan) and alprazolam (Xanax).

Psychotherapy for Panic Attacks in the COVID-19 Era

Psychotherapy can be used to treat panic attacks either alone or in combination with medication therapy. It is best for people who are willing to put in the work both during therapy sessions and between sessions to gain the skills needed to handle panic attacks. That said, because it tends to be successful without side effects, it should be considered for everyone.

The psychotherapy with the greatest amount of evidence is cognitive behavioral therapy (CBT). Promisingly, this therapy has higher efficacy and lower cost, dropout rates, and relapse rates than medication treatments.

With CBT, patients learn to identify their panic attack triggers as well as the nature of their panic disorder. By slowly exposing oneself to the fear or situation that induces the panic attack, CBT allows the person to tolerate the fear in slow increments, starting with a few seconds and progressing to several minutes. The notion being that the body cannot stay in a hyper adrenergic state for longer than 30 minutes, so CBT allows the body to “tolerate” the fearful situation in longer increments each time until the person becomes used to the situation causing the fear. CBT should be done only with the guidance of a medical professional trained in CBT and it involves:

• Learning how to counter anxious beliefs

• Changing behaviors that maintain anxiety

• Exposure to panic cues gradually so they can be conquered. This is called Exposure and response therapy.

• Learning how to prevent relapse

While CBT is best done in a group or one-on-one setting with a trained specialist, CBT for anxiety, including panic attacks, can also be learned via books and workbooks.

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Sources

Anxiety and Depression Association of America, Panic Disorder. Accessed November 28, 2020.

Dictionary.com, Panic. Accessed November 28, 2020.

Javelota, H. and Weinerc, L., “Panic and Pandemic: Narrative Review of the Literature on the Links and Risks of Panic Disorder as a Consequence of the SARS-CoV-2 Pandemic.” L'Encéphale, August 10, 2020.

Mémon, M., Panic Disorder. Medscape, March 21, 2018.