Panic attacks

Overview

A panic attack is a sudden wave of fear or a sense of losing control, even when there's no real danger. The body reacts strongly: the heart races, breathing gets fast, and you may shake or sweat.

Many people have a panic attack once or twice. Panic disorder is when attacks keep happening and you spend a lot of time worrying about the next one. Some people start avoiding places where attacks happened.

Symptoms

An attack starts suddenly, often with no clear trigger.

• Sudden waves of intense fear
• Racing or pounding heartbeat
• Shortness of breath or feeling of choking
• Shaking or trembling
• Sweating, chills, or hot flashes
• Worry or anxiety about the next attack

Less common

• Chest pain
• Dizziness or feeling faint
• Nausea or stomach pain
• Numb or tingling hands, feet, or face
• Feeling unreal or detached
• Fear of dying or losing control

How it usually goes

• Start: Comes on suddenly.
• 10 to 20 minutes: Symptoms peak.
• Up to an hour: Symptoms fade, though you may feel tired.

When to get medical care

Causes

The exact cause isn't known. Panic disorder can run in families. Some experts think panic attacks are false alarms of the body's normal survival response.

Stress, big life changes, caffeine, and some drugs can trigger attacks.

Does it spread or run in families?

• It isn't contagious. You can't catch it from someone else.
• It can run in families. Tell your doctor if a parent, brother, or sister has it.

Who is more likely to get it

• Family history of panic or anxiety
• Major stress or life changes
• Other anxiety problems or depression
• Smoking or lots of caffeine

Possible complications

• Agoraphobia: Avoiding places for fear of an attack
• Depression: Can happen along with panic
• Alcohol or drug use: Using substances to cope

Diagnosis

A healthcare professional first makes sure a heart, lung, or thyroid problem isn't causing the symptoms.

Questions you may be asked

• What happens during an attack and how long it lasts
• How often attacks happen
• Whether you worry about more attacks or avoid places
• Caffeine, alcohol, drugs, and medicines
• Feelings of anxiety or depression

The exam

They'll check your heart, lungs, and blood pressure.

Tests

Tests may be done to rule out other causes:

• ECG (heart tracing): To check your heart rhythm.
• Blood tests: To check thyroid and other levels.
• Questionnaire: To see how often attacks happen and how they affect you.

Treatment

Panic disorder is treated with talk therapy, medicine, or both.

Self-care

• Breathe slowly, in through your nose and out through your mouth
• Remind yourself the attack will pass and isn't dangerous
• Ground yourself by naming things you can see, hear, and touch
• Cut back on caffeine and alcohol
• Exercise regularly and get enough sleep

Medicines

These need a prescription.

Never stop these medicines on your own. Ask your healthcare professional how to lower the dose safely.

Cognitive behavioral therapy (CBT) teaches new ways to react to the body feelings of panic. Exposure therapy slowly helps you face what you've been avoiding. Attacks often become less frequent with treatment.

How it compares

Prevention

Treatment lowers how often attacks happen:

• Keep up with therapy and medicine
• Practice slow breathing when calm, so it's easy during an attack
• Limit caffeine and alcohol
• Exercise and sleep well

Which doctor treats this

• Start with your primary care provider (family doctor or internist).
• They may send you to a psychiatrist (for medicine) and a psychologist or licensed therapist (for talk therapy).

Living with it

• Keep a regular sleep, meal, and activity routine.
• Tell one trusted person how you're doing, and plan who to call on hard days.
• Limit alcohol and drugs. They often make symptoms worse.
• In a crisis, call or text 988 any time.
• Long-term illness can affect mood. Tell your doctor if you feel down or anxious.

Support groups and helplines

• NAMI (National Alliance on Mental Illness): Free support groups and a helpline (1-800-950-6264) for people and families.
• 988 Suicide & Crisis Lifeline: Call or text 988 any time for free, private support in a crisis.

Back to school, work, or sports

• Most people can keep working or going to school.
• Ask about changes that help, like extra breaks or a flexible schedule. Workers may be covered by the ADA. Students may get a 504 plan.
• The Family and Medical Leave Act (FMLA) may let you take unpaid time off for treatment without losing your job.

Children, pregnancy, and older adults

• Teens: Panic attacks often start in the teen or young adult years. Therapy works well.
• Older adults: New chest pain or racing heart should always be checked for heart problems first.
• Pregnancy: Ask which treatments are safe.

Pregnancy and breastfeeding

• If you're pregnant or planning to be, tell your prenatal provider about this condition.
• Many mental health medicines are used safely in pregnancy. Stopping suddenly can cause a relapse.
• Don't start or stop any medicine on your own. Some are safe in pregnancy and some need to be changed.
• Ask before taking any pain reliever. The FDA advises avoiding ibuprofen and naproxen after 20 weeks unless your doctor says to.
• Mood problems can start during or after pregnancy. Postpartum Support International: 1-800-944-4773.
• Breastfeeding: Most medicines are fine, but ask. The NIH LactMed database lists what's known about each one.

For caregivers

• Listen without judging, and let them know you care.
• Encourage treatment, but don't force it unless they're in danger.
• If they talk about suicide, call or text 988 with them.
• Take breaks and ask for help. Caregivers need care too.

Outlook

Panic attacks are not life-threatening, and panic disorder is very treatable. Most people have fewer and milder attacks with therapy, medicine, or both.

Myths and facts

Getting ready for your visit

A diary of attacks helps a lot.

What to bring

• When attacks happened, what you were doing, and how long they lasted
• Caffeine, alcohol, and medicines you use
• Any heart or thyroid problems in your family

Questions to ask

• Could something else be causing this?
• Should I try therapy, medicine, or both?
• What should I do during an attack?
• How long does treatment take?

Research studies

Research studies test new ways to find and treat health problems. Some are looking for volunteers. Talk with your doctor before joining one.

Search ClinicalTrials.gov for studies on Panic attacks