Panic Attack: Symptoms, What to Do and How to Prevent Them

Quick answer

Intense but harmless; slow breathing and not fighting it helps

Panic attacks reach a peak within about 10 minutes and usually fade within 20–30 minutes. Symptoms include palpitations, sweating, trembling, shortness of breath, chest discomfort, nausea, dizziness, tingling, chills, derealisation and a fear of losing control or dying. During an attack, slow breathing, grounding, staying in the situation and reminding yourself that it will pass help. Repeated attacks with persistent worry about them may signal panic disorder, for which CBT and medication are highly effective. First episodes and chest pain should be checked by a doctor.

Important. Chest pain, pain spreading to the arm or jaw, severe shortness of breath, fainting, or symptoms in someone with heart disease or risk factors should be treated as an emergency: call emergency services. If you are in crisis or thinking about harming yourself, seek help right away: in the US call or text 988, in the UK call Samaritans on 116 123, in Spain call 024, or call your local emergency number.

What is a panic attack?

A panic attack is an abrupt episode of intense fear or discomfort that reaches a peak within minutes and is accompanied by at least four of the symptoms below. It occurs when the body’s alarm system (fight-or-flight) is triggered without real danger. Around one in three people will have at least one panic attack in their lifetime, and a smaller proportion develop panic disorder.

Symptoms

Pounding or racing heart.
Sweating, trembling or shaking.
Shortness of breath or a feeling of choking.
Chest pain or tightness.
Nausea or abdominal distress.
Dizziness, light-headedness or faintness.
Chills or hot flushes.
Numbness or tingling (often hands, feet and face).
Feelings of unreality (derealisation) or of being detached from oneself.
Fear of losing control, “going crazy” or dying.

Why panic attacks happen

The body releases adrenaline, which speeds up breathing and heart rate. Faster breathing (hyperventilation) lowers carbon dioxide in the blood, causing dizziness, tingling and a feeling of breathlessness. Interpreting these sensations as dangerous (“I am having a heart attack”) feeds more fear, creating a vicious cycle. Triggers include stress, caffeine, stimulants, lack of sleep, illness, bereavement or certain situations, but attacks can come “out of the blue”.

Panic attack or heart attack?

The symptoms overlap, and when in doubt you should seek emergency care. Features favouring a heart attack include pain that builds with exertion, spreads to the arm, jaw or back, is accompanied by sweating and nausea and does not ease after 10–20 minutes, particularly in older people or those with risk factors. Panic attacks usually peak in 10 minutes and gradually subside, but a first episode should always be evaluated by a doctor to exclude medical causes such as heart rhythm problems, thyroid disease or asthma.

What to do during a panic attack

Recognise it: tell yourself “this is a panic attack; it is not dangerous and it will pass”.
Slow your breathing: breathe in through the nose for 4 seconds, out through the mouth for 6–8 seconds. See deep breathing for anxiety.
Ground yourself: name 5 things you see, 4 you hear, 3 you feel, 2 you smell and 1 you taste.
Stay where you are if you can, rather than fleeing; staying teaches your brain that the situation is safe.
Relax tense muscles and unclench your jaw and hands.
Use cold: hold a cold drink or splash cold water on your face.
Avoid fighting the sensations; accepting them makes them pass sooner.

How to help someone having a panic attack

Stay calm and speak in a quiet, reassuring voice.
Ask how you can help and avoid telling them to “calm down”.
Encourage slow breathing and guide them through it.
Move to a quieter place if possible.
Stay with them until it passes.
If you suspect a medical problem or the symptoms are severe, call emergency services.

Panic disorder

Panic disorder is diagnosed when attacks are recurrent and unexpected, followed by at least a month of persistent worry about further attacks or their consequences, or by a significant change in behaviour to avoid them (for example, avoiding exercise, driving or crowded places). It may be accompanied by agoraphobia, fear of being in situations from which escape could be difficult. It affects about 2–3% of people in a year and is more common in women.

Treatment

Cognitive behavioural therapy (CBT) for panic is the first-line treatment. It combines education, breathing retraining, cognitive restructuring and interoceptive exposure (deliberately bringing on harmless sensations to learn they are not dangerous). Most people improve within 8–12 sessions.
Medication: SSRIs and SNRIs are first-line; benzodiazepines are used only briefly because of dependence and because they can interfere with CBT.
Lifestyle: regular exercise, sleep, limiting caffeine and alcohol and avoiding stimulants.
Self-help: structured self-help books or apps.
Support groups and online communities.

Preventing panic attacks

Practise slow, diaphragmatic breathing daily, not only during attacks.
Exercise regularly and keep a consistent sleep routine.
Cut back on caffeine, energy drinks, nicotine and alcohol.
Learn relaxation techniques, such as progressive muscle relaxation.
Do not avoid places where attacks occurred; gradually return.
Seek therapy early if attacks are recurrent.

When to see a doctor

A first panic attack, to exclude medical causes.
Repeated attacks or constant fear of another one.
Avoidance of places or activities.
Chest pain, severe breathlessness or fainting (emergency).
Depression, alcohol or drug use, or thoughts of self-harm.

Three common situations

A first sudden attack at work: see a doctor to check the heart and thyroid, then learn breathing techniques.

Recurrent attacks with fear of driving: CBT with gradual exposure to driving can help.

Attacks at night waking you from sleep: they are possible; discuss treatment with a clinician and check for sleep disorders.

Key points to remember

Panic attacks are frightening but not dangerous. Learn to recognise them, slow your breathing and avoid avoidance. CBT is highly effective, and medication can help. Get a medical check for first episodes or chest pain.

This guide is for general information and does not replace an assessment by a qualified health professional.

Questions about panic attacks

These answers are general information and do not replace an examination or individual medical advice.

How long does a panic attack last?

Usually 5–20 minutes, peaking around 10 minutes, though aftershocks can last longer.

Can a panic attack kill you?

No. Panic attacks are not dangerous, although the symptoms are frightening.

How can I tell a panic attack from a heart attack?

They can feel similar; if in doubt or if you have risk factors, seek emergency care. First episodes should be medically checked.

What stops a panic attack fast?

Slow breathing, grounding techniques, staying put and reminding yourself it will pass.

Are panic attacks a sign of mental illness?

Panic attacks are common; repeated ones with persistent fear may indicate panic disorder, which is very treatable.

Do I need medication?

Many people recover with CBT alone; medication can help when symptoms are severe or therapy is not available.

Sources

This guide is for general information and does not replace medical advice. How a problem is diagnosed and treated depends on your examination and medical history. If you think you have an emergency, contact your local emergency services.