What Are the Signs of An Anxiety Attack?

Anxiety attacks start gradually with increasing feelings of anxiety and stress along with sweating, racing heart, or other physical symptoms. They are less sudden and severe than a panic attack.

Anxiety attacks are a form of heightened anxiety that starts gradually and involves feelings of increased anxiety or stress, along with physical symptoms. 

An anxiety attack is different from a panic attack, which comes on suddenly and involves intense feelings of fear or an impending sense of doom that lasts for a short time, usually only a few minutes.

Symptoms and signs of an anxiety attack usually have a gradual onset. People who have anxiety attacks may have a low level of anxiety as a baseline that can intensify with certain triggers. 

Symptoms and signs of an anxiety attack include:

• Feeling of overwhelming panic 
• Excessive worry 
• Feeling on edge
• Irritability
• Restlessness
• Trembling or shaking
• Muscle tension or muscle twitches 
• Easy fatigability 
• Difficulty concentrating
• Problems sleeping (insomnia)
• Being easily startled
• Increased heart rate
• Pounding heart
• Sweating
• Headache
• Nausea or upset stomach
• Dizziness
• Urge to urinate 
• Diarrhea
• Feeling lightheaded
• Hyperventilation
• Feeling detached from reality
• Fear of dying

Anxiety attacks may be caused by: 

• Genetics
• Environmental factors such as early childhood trauma
• Underlying medical conditions
• Use of certain substances, such as over-the-counter (OTC) drugs, herbal supplements, and illegal drugs 

Anxiety attacks may occur due to certain triggers, such as:

• Stress
• Relationship problems
• Loss of a loved one, pet, job, or other loss
• Heart problems
• Illness
• Caffeine
• Medication side effects
• Low levels of oxygen from high altitudes, lung diseases such as chronic obstructive pulmonary disease (COPD, including chronic bronchitis and emphysema), or a pulmonary embolism (PE)

Anxiety disorders may be diagnosed with a psychological evaluation. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, provides diagnostic criteria for an anxiety disorder. 

Lab studies to help diagnose or exclude medical conditions that may cause anxiety disorders and anxiety attacks include:

• Complete blood cell (CBC) count
• Chemistry profile
• Thyroid function tests
• Urinalysis
• Urine drug screen

Tests to rule out central nervous system (CNS) disorders that can cause anxiety disorders and anxiety attacks include:

• Electroencephalography (EEG)
• Lumbar puncture
• Brain computed tomography (CT) scan
• Magnetic resonance imaging (MRI) of the brain 
• Neurologic consultation 
• Positron emission tomography (PET) scan

Tests to rule out heart conditions that can cause anxiety disorders and anxiety attacks include:

• Electrocardiography (ECG) 
• Treadmill ECG

Treatment for anxiety attacks often involves of a combination of medication and/or psychotherapy. 

Therapies used to treat anxiety disorders and anxiety attacks include:

• Behavioral therapy and cognitive behavioral therapy (CBT) 
• Interpersonal psychotherapy 
• Relaxation therapy
• Supportive psychotherapy
• Mindfulness therapy
• Computerized CBT (FearFighter) 
• Psychodynamic therapy 

Medications used to treat anxiety disorders and prevent anxiety attacks include: 

• Antidepressants
  • Selective serotonin reuptake inhibitors (SSRIs) such as paroxetine (Paxil), escitalopram (Lexapro), sertraline (Zoloft), fluoxetine (Prozac), fluvoxamine (Luvox), and citalopram (Celexa)
  • Serotonin and norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine (Effexor and Effexor XR) and duloxetine (Cymbalta)
  • Atypical antidepressants such as nefazodone (Serzone), mirtazapine (Remeron), and trazodone (Desyrel)
  • Tricyclic antidepressants such as imipramine (Tofranil) and clomipramine (Anafranil)
  • Monoamine oxidase inhibitors (MAOIs) such as phenelzine (Nardil), selegiline (Emsam), tranylcypromine (Parnate), and isocarboxazid (Marplan)
• Benzodiazepines, such as lorazepam (Ativan), clonazepam (Klonopin), and alprazolam (Xanax)
  • Often used in emergency situations
• Anti-anxiety drugs such as buspirone (BuSpar)
• Anticonvulsants such as pregabalin (Lyrica), divalproex (Depakote), and gabapentin (Neurontin)
• Antihypertensive drugs such as clonidine (Catapres), propranolol (Inderal, Betachron E-R, InnoPran XL), nadolol (Corgard), and atenolol (Tenormin)

Other treatments used for anxiety disorders and anxiety attacks include: 

• Cranial electrotherapy stimulator (CES) 

Hospitalization may be indicated to treat severe anxiety attacks, in the following circumstances: 

• Severe functional impairment (cannot meet own daily needs)
• Suicide or homicide risk
• Deficits in social skills 

Dietary changes that may help prevent or treat anxiety attacks include:

• Avoiding caffeine
• Avoiding alcohol
• Using caution with over-the-counter preparations and herbal remedies because ephedrine and certain other herbs may cause or worsen anxiety symptoms