Panic attacks can be extremely uncomfortable. Your heart races, your body screams to run away, and you may hyperventilate or experience muscle tension. They can also be confusing — and, experts tell Bustle, what happens in your brain when you have a panic attack is still being uncovered. The question of what exactly happens in your brain during a panic attack can't be answered fully yet, but scientists are beginning to put together a compelling picture of the brain under this particular kind of stress, in the hopes that it can help people undergoing panic attacks in the future.
To understand panic attacks, it's necessary to understand panic itself. "There are a range of defensive responses that need to be appropriately tailored to different types of threats," Dr. John Wemmie, MD, PhD, a professor of psychiatry at the Carver College of Medicine and an expert on panic, tells Bustle. "For example, 'fight or flight' may be very appropriate when a tiger is about to eat you." This response is deeply embedded in our brains and has survived through centuries of evolution, helping humans survive all kinds of problems and issues: All aspects of panic, including fast breathing and muscle tension, are created by the body's attempts to escape or fight off trouble.
Panic attacks occur when this response occurs in the absence of a "real" threat, although the threat may be perceived as being very real.
"A panic attack is like having a car alarm go off in response to being bumped into," Dr. David A. Merrill, a neurologist at Providence Saint John's Health Center, tells Bustle. "Nothing dangerous is actually happening, but the ‘all or nothing’ response is activated."
One of the most important elements of the brain for processing fear the amygdala, which modulates our panic responses. Research has found that the amygdala might be hyperactive in people who tend to experience panic attacks. "In the absence of appropriate amygdala activity, extreme responses can be less well controlled," Dr. Wemmie tells Bustle.
When you have a panic attack, your amygdala may show a lot of activity— but, according to one theory of panic attacks, it's not the only part of the brain that does so. "According to one of the neurocircuitry models of panic disorder, the ‘fear network,' which includes the amygdala, hippocampus, thalamus, and brain stem structures, is hypersensitive," wrote Dr. Israel Liberzon and Dr. Lisa M. Shin in Neuropsychopharmacology in 2010. They add that according to this model, the frontal cortex, which is meant to inhibit the amygdala or stop its activity, doesn't do its job properly. That means the fear network is over-active and hair-trigger sensitive to potential panic. Ongoing studies are also trying to figure out whether the brain shows lower than usual prefrontal cortex activity during a panic attack.
Other areas of the brain, particularly in the brainstem, are involved in panic attacks too. When you have a panic attack, Dr. Merrill tells Bustle, "the brain sends signals from the cerebral cortex, down through the brainstem, and into the sympathetic nervous system. The sympathetic nervous system is what gets activated with an acute stress like seeing a lion jump out of the bushes or getting suddenly frightened by a loud noise." Dr. Wemmie's research has shown that some areas of the brainstem, like the periaqueductal gray or PAG, are involved in panic attacks. The PAG tends to activate when people detect a threat close to them. "In a panic attack, brainstem structures such as the PAG are probably abnormally or inappropriately over-activated," Dr. Wemmie tells Bustle.
If you do experience panic attacks, it's a good idea to seek treatment. "Without treatment we tend to start trying to avoid the perceived triggers of panic," Dr. Merrill says, which can interfere with your quality of life. There are several options, including cognitive behavioral therapy, that can help lessen panic attacks and slow the fight-or-flight excessive response in your brain.
If you or someone you know is seeking help for mental health concerns, visit the National Alliance on Mental Health (NAMI) website, or call 1-800-950-NAMI(6264). For confidential treatment referrals, visit the Substance Abuse and Mental Health Services Administration (SAMHSA) website, or call the National Helpline at 1-800-662-HELP(4357). In an emergency, contact the National Suicide Prevention Lifeline at 1-800-273-TALK(8255) or call 911.