Mechanism of panic attacks

Probably everyone who has experienced a panic attack has asked themselves: what the hell is that? I remember my first attacks, I had no idea what was going on. It was fear, but I had never been afraid before, so I was not able to recognize this state! Something strange was happening, my heart was beating fast, I was running out of air, but I couldn’t make the connection. It was only after many, many hours on the internet that I finally found the answer: I was afraid!

I don’t think it is possible to explain to someone who has never had an attack what it is. That’s why people who have never experienced it disregard it. Relax, it doesn’t hurt, you will be fine! They are completely devoid of imagination and empathy. Pain does not hurt either. Would they do something that hurts but doesn’t leave marks? “But pain is something else…” No, it’s not different. The only difference is that you have experienced the pain and not the panic attack. All this super extra advice of “embrace it, get over it”… I’m reminded of a friend’s son who wanted to go into the military. He was maybe 5 years old, didn’t understand why adults were afraid of it, it would probably be a super adventure and all. But when he found out that his mom wouldn’t be there to lace up his shoes, he didn’t want to, he was already scared.

I will give some attempts to explain what these attacks are and where they come from. This will probably not be a fully satisfactory answer, but no one quite knows what the hell they are.

One mechanism suggested by scientists is a drop in blood sugar, hypoglycemia. When this is combined with stress (and stress can be hypoglycemia itself and the weakness that accompanies it), the body begins to sense danger and releases adrenaline into the blood. This is meant to raise sugar levels and provide fuel to the brain to keep that brain working. But the body’s mechanism for increasing sugar levels is broken, and despite the circulating adrenaline, sugar levels do not rise – or (the twin mechanism) it rises, but the brain cells are unable to use it. The circulating adrenaline reinforces the sense of danger, the brain demands more sugar, orders even more adrenaline to be dumped into the blood, but this does nothing, the brain continues to feel “hungry”. The circle closes.

The mechanism associated with hyperventilation. If we breathe very quickly, we expel carbon dioxide from the body in too large quantities. The pH of the blood changes, a number of reactions take place, including a drastic drop in phosphorus levels (it can go down to 0.4 with a normal value of around 3), this causes the level of fear to increase and… we start breathing even faster. According to another, twin hypothesis, people with panic attacks breathe slightly faster all the time, but it doesn’t increase particularly much during the attack itself. An interesting way to stop an attack instantly is to breathe with your diaphragm, but I’ll describe that in another chapter.

Evolutionary explanation. This relates mainly to the mechanism of agoraphobia and social phobia, not to panic attacks, but I will give it as an interesting fact. We have two opposing hormones in the body, cortisol and DHEA (it’s actually much more complicated than that, but the article is meant to highlight the problem, not make the reader an endocrinologist). An excess of cortisol relative to DHEA makes us feel threatened and not take on challenges. Perhaps this is an adaptation effect; in a herd of monkeys (and we are monkeys after all) there is a division of roles. Most individuals are not allowed to do anything extraordinary. It’s possible that high cortisol levels are designed to do just that, to make us shy, not to strive for higher social standing (not to strike up conversations and so on). On the other hand, agoraphobia (fear of moving away from where we live) has an excellent evolutionary explanation. In a new place, a monkey in its natural environment is exposed to hundreds of threats: other monkeys, predators, lack of reliable food sources and so on. Moreover, it is the pack guide who should choose when to change the “home location” of the monkey pack, not a mediocre monkey with low DHEA levels.