What Happens to Your Brain During a Panic Attack

April 7th is World Health Day.

I remember my first panic attack very vividly. The drive to the emergency room felt like it took forever, and I was certain that this was what dying felt like. Although I didn’t die that night, the feelings I felt that night haunted me for a long time. While anxiety continues to be present in my life, I haven’t experienced another panic attack until last year. Like most of everyone, 2020 was challenging—and my stress and anxiety manifested as panic attacks so frequently that I ended up losing count.

It didn’t take me long to realize that my fear of potentially experiencing another panic attack was one of my main triggers of why they began in the first place. Being afraid put me in a frozen state. Every day felt like an internal battle with myself, doing whatever I could to make sure the fear didn’t win. I decided I needed to get to the bottom of what truly terrified me. Although those around me would tell me I was fine and there was nothing to be scared of, once I began learning about panic attacks and the way they work, I was ready to reclaim my mind as my own and not that of fear.

Panic attacks aren’t uncommon and my experience is one of many. So if the above story resonates with you, we spoke with a few psychiatrists to learn what exactly happens to us during a panic attack and what to do about it.

What is a panic attack?

According to Danielle Johnson, MD, a panic attack is an episode of intense fear or discomfort with four or more of the following symptoms:

• Accelerated heart rate.
• Sweating, trembling, or shaking.
• Shortness of breath.
• Feelings of choking.
• Chest pain or discomfort.
• Nausea or abdominal pain.
• Feeling dizzy, unsteady, lightheaded, or faint.
• Chills or heat sensations.
• Numbness or tingling sensations.
• Derealization (feelings of unreality).
• Depersonalization (being detached from oneself).
• Fear of losing control.
• Fear of dying.

Oftentimes people use anxiety attacks and panic attacks interchangeably, but they’re not the same. “Some people have a lot of anxiety in elevated amounts and on top of that, they may have periods where it seems more intense,” explains Diana Samuel, MD. “With panic attacks, you have to have those physical symptoms.”

While the above list includes the most common symptoms, it’s important to keep in mind that panic attacks can vary from person to person, according to Dr. Samuel. However, one thing is certain: “They can be very debilitating,” adds Dr. Samuel. For me, after a panic attack, I’m left feeling physically exhausted and ready for a nap (to be fair, I’m always ready for a nap). “If after a panic attack you feel exhausted, drained, and have the ability to relax, then it’s okay to take time for yourself to recover. Listen to your body,” Dr. Vania Manipod, D.O, tells HelloGiggles. It’s essential to validate one’s experience and give yourself the extra care necessary to recharge.

What happens during a panic attack?

When experiencing a panic attack, there is “decreased activity in a part of the brain called the prefrontal cortex [which] leads to overactivation in the other parts of the brain, the amygdala, and the periaqueductal gray,” says Dr. Johnson. The prefrontal cortex is responsible for receiving and processing information from other parts of the brain to adapt accordingly. It’s the part of our brain that helps us focus our attention, predict, plan, coordinate, and even manage our emotional reactions.

Dr. Johnson describes the amygdala as the part of our brain that mediates fear and supports emotional processing and the periaqueductal gray provokes the body’s defensive responses, such as freezing or running. In other words, the parts of our brain that process and respond to potential threats takes over, so even if we aren’t in any real physical danger, our brain has convinced our body that we are.

What causes panic attacks?

According to Dr. Manipod, “There are occasions where [panic attacks] may result from a combination of numerous factors such as medical conditions that have similar symptoms as panic attacks (i.e. asthma exacerbation), in addition to other factors such as stress, lack of sleep, etc.”

However, during one of my job’s all-staff Zoom meetings, we went into breakout groups where I participated (even turned on my camera) and didn’t break a sweat. Once we all returned to the main meeting, I suddenly felt myself out of breath. My hands began to sweat excessively, my heart was racing, and I felt an urge to run outside. I realized I was beginning to have a panic attack and couldn’t explain why, as I felt calm up until that moment.

All of this confusion made me feel shame and hopelessness. Can a panic attack happen out of nowhere? “Yes, there may be no actual trigger [at] the moment and can happen out of nowhere,” explains Dr. Manipod. Dr. Samuel shared that in her practice, she has seen both. “That’s what I think makes them so scary; you cannot predict when they might happen,” she says.

How to prevent panic attacks:

While it’s difficult to guarantee never having a panic attack again because of the different factors that can lead to one, there are actions we can take to decrease stress and anxiety. For example, “If you have recurrent panic attacks, seek help,” suggests Dr. Johnson. “Psychotherapy is an effective treatment. If they are severe, you might also require medication, so talk to your primary care physician or [another] provider.”

She also says it’s important to reduce or eliminate substances that can worsen attacks like caffeine, alcohol, and/or nicotine. And of course, making sure you’re getting enough sleep and moving your body throughout the day can do wonders.

When my panic attacks became frequent, I started to avoid things I thought would trigger them. While it’s important to identify any triggers, avoidance can do more harm than good. “Being able to face [your triggers] might help desensitize you to them and eventually reduce the fear/anxiety surrounding them,” explains Dr. Johnson. Complete avoidance of anything related to the episode can then develop into a disorder. “If it does reach that point, know that you’re not alone and there are mental health professionals who can support you,” says Dr. Manipod. Try taking baby steps and if experiencing the actual physical symptoms is something you fear, Dr. Manipod suggests making an appointment with your doctor to rule out any possible medical conditions, which can provide some reassurance.

Although panic attacks have an unpredictable nature, this doesn’t mean you have zero power over them or that you have to live in constant worry. For me, having a sort of “emergency plan” helps. I let someone I trust know what I’m feeling, either in person or on the phone. Letting someone know makes me feel less alone.

Sometimes, I have to try out different things until I find the remedy for that moment. That can be going for a walk, deep breathing exercises, or even crying. Most of the time, I just need to ride it out, repeating to myself “I have gotten through this before, I will get through this again,” recognizing that the panic attack always has an end. Once I understood the psychology behind a panic attack, it was easier for me to identify what was happening in real-time. This allowed me to not feed into the fear and regain my confidence.