DEAR DOCTOR K:

In the past year I've had five panic attacks. Now I'm always worried I'm going to have another, at any moment. Is there anything I can do to prevent them?

DEAR READER:

Panic attacks can be very unsettling. All of a sudden, you are filled with extreme fear or terror. You may be short of breath, have palpitations, chest pain, sweating or feel a smothering sensation. You probably fear that you are losing control. You might even think you are about to die.

A panic attack usually lasts five to 30 minutes. But it can continue for several hours. Sometimes the attacks occur in stressful situations, but often they begin for no apparent reason. They can even wake you from deep sleep.

For my patients who suffer from panic attacks, the worst part about them is their unpredictability. If certain things seem to trigger panic attacks -- like dining in crowded restaurants -- they avoid them.

Panic attacks are surprisingly common: About 5 percent of women and 2 percent of men suffer from them at some point in their lives. In my experience, panic attacks are not always accurately diagnosed. Some of my patients tell me they've had panic attacks, but describe something different and even more common: being nervous a lot of the time. In contrast, panic attacks come like a bolt out of the blue and can end just as quickly. A mental health professional is best qualified to make a diagnosis.

Most illnesses stem from a combination of genes and the external environment. Panic attacks are no exception. They run in families. Identical twins (who share the same genes) are more likely to both have panic attacks than non-identical twins (who share only some genes).

Various imaging studies have found that the parts of the brain that control fear are different in people who suffer from panic attacks. In other words, some people are born with a higher risk of suffering panic attacks. At the same time, stressful situations (the external environment) often trigger the attacks.

Treatment often eliminates panic attacks or makes them less intense. Antidepressants known as selective serotonin reuptake inhibitors (SSRIs) are very effective for panic disorder. The SSRIs fluoxetine (Prozac), sertraline (Zoloft) and paroxetine (Paxil) are commonly prescribed.

Antidepressants can take several weeks to work, so they are often combined with a short course of anti-anxiety drugs that work more quickly. Examples of these drugs are diazepam (Valium) and alprazolam (Xanax).

Medication often works best when combined with cognitive and/or behavior therapy. Cognitive therapy teaches patients to recognize the unreasonableness of the fears that cause panic. Behavior therapy may include gradual exposure to fear-provoking situations or using breath control as a way to fight panic.

Finally, eliminating or reducing caffeine (which can promote panic attacks) is essential.

We have more information on panic disorders in our Special Health Report, "Coping With Anxiety and Phobias." You can find out more about it at my website.

With appropriate treatment, you'll find that panic disorder no longer has to rule your thoughts or your actions.

(Dr. Komaroff is a physician and professor at Harvard Medical School. Go to his website to send questions and get additional information: www.AskDoctorK.com.)

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