A sudden wave of intense fear, with a racing heart, breathlessness and the feeling that something terrible is about to happen. It is very frightening, but not dangerous, and it responds well to treatment.
Many people go to the emergency department during their first panic attack convinced they are having a heart attack. Understanding what is happening is part of the treatment.
What it is
A panic attack is an episode of intense fear or discomfort that peaks within a few minutes and then subsides. It can happen once, during a stressful period. Panic disorder is diagnosed when attacks recur unexpectedly and are followed by persistent fear of further attacks and changes in behaviour to avoid them.
People often start avoiding places or situations from which it would be hard to escape or get help, such as public transport, queues or crowds. This is called agoraphobia.
Symptoms
palpitations or a racing heart;
breathlessness, a choking feeling or chest tightness;
trembling, sweating, hot flushes or chills;
dizziness, feeling faint or unsteady;
tingling in the hands or around the mouth;
a sense of unreality or of being detached from oneself;
fear of losing control, going mad or dying.
Panic or the heart?
Panic symptoms overlap with those of some heart, lung or thyroid conditions. That is why, especially at the first episode, in people with cardiovascular risk factors or with chest pain, a medical assessment is important. Once other causes are ruled out, knowing that the symptoms come from panic helps reduce the fear that feeds them.
During an attack
Remember that the attack is time-limited and will pass. Breathing slowly, with out-breaths longer than in-breaths, helps counter hyperventilation. Escaping the situation brings relief in the moment, but reinforces the fear in the long run.
Assessment and treatment
The consultation characterises the attacks, the avoidance and associated conditions, such as depression or alcohol use, and reviews caffeine and medicines that may contribute. Cognitive behavioural therapy, with gradual exposure to feared sensations and situations, is the psychological treatment with the best evidence. Some antidepressants are the first pharmacological option for long-term treatment. Benzodiazepine sedatives bring quick relief but are reserved for short periods. Learn more about anxiety.
No. Although very frightening, a panic attack does not cause a heart attack or death. But symptoms such as chest pain should be assessed by a doctor, especially the first time.
How long does a panic attack last?
Symptoms peak within a few minutes and then subside. The feeling of being unwell may last longer.
Can panic attacks be cured?
Yes, panic disorder responds well to treatment. Most people become free of attacks or have rare, manageable ones.
References
National Institute for Health and Care Excellence. Generalised anxiety disorder and panic disorder in adults: management (CG113). 2011, updated.
This page is for information only and does not replace an individual medical assessment. Clinical review: Pedro Zuzarte, psychiatrist · Published and reviewed: .