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Panic attacks


Expert reviewer, Dr Liz Russell, Consultant Psychiatrist
Next review due February 2023

A panic attack is a period of intense fear and overwhelming mental and physical feelings. Panic attacks usually reach their peak within 10 minutes and can last between 20 and 30 minutes. Up to a third of people get a panic attack at some point in their life. Panic attacks can start when you’re in your mid-teens but they more often start when you’re in your mid-20s. They usually happen during the day but can happen at night too.

Panic attacks can happen unexpectedly or they may be triggered by a particular situation. They may happen to you just once or repeatedly over time. While they’re unlikely to cause any lasting physical harm, panic attacks can be very distressing.

If you need help now

This page is designed to provide general health information. If you need help now, please use the following services.

  • Samaritans
    116 123 (UK and ROI) This helpline is free for you to call and talk to someone.
    www.samaritans.org
  • NHS Services has a list of where to get urgent help for mental health.
  • Mind website. Click on the yellow ‘Get help now’ button at the top left of the page. This is a tool that is designed to help you understand what’s happening to you and how you can help yourself.

If you think you might harm yourself or are worried someone else might come to immediate harm, call the emergency services on 999.

Personal experience: Lucy’s story

Sometimes hearing from someone who has experienced a condition can help you to understand it better. Here, Lucy shares her experience of living with panic attacks and how it has affected her.

I started to have panic attacks in my last year of university. I found the pressure of this and my mother being diagnosed with a serious health condition extremely stressful. I would wake up in the middle of the night with an irregular heartbeat and gasping for breath.

As I got older, I developed a phobia of heights and would then have panic attacks going up very tall escalators on the tube and crossing bridges. My hands and feet would sweat. I also thought something very bad was going to happen to me and that I might fall.

A panic attack is truly scary but also exhausting. It takes all your energy as your body goes into fight or flight mode, and adrenalin starts pumping very quickly around your body.

At first, I thought I was going a bit crazy and would do anything to avoid heights. But I would still fly as I love going to other countries.

I went to my doctor to seek help, who suggested that I have cognitive behavioural therapy (CBT). This helped me to understand what was happening to me. And through a series of exposure exercises (where you confront your phobia) you learn to control your anxious thoughts.

I also stopped drinking caffeine, which can make you feel a bit on edge, and kept a diary of my thoughts. This helped me to understand my anxiety disorder.

While I'm not completely cured, I now feel that I can confront heights when I'm feeling strong or when I have friends with me.

My advice to other people experiencing panic attacks would be to go and see their GP or a CBT therapist. Mediation and yoga are also effective in helping to keep anxiety at bay.

Causes of panic attacks

Around one in every eight people who have panic attacks says a major negative event happened in their life. But it’s not always possible to explain exactly what causes panic attacks. For some people, panic attacks are triggered in particular situations that make them anxious; for others they seem to happen for no reason.

People who get panic attacks may also have anxiety or depression. Panic attacks can also happen if you’ve had problems with alcohol or illegal drugs.

Symptoms of a panic attack

How a panic attack feels can vary from person to person and the sensations can be both physical and mental. You may feel overwhelmed and unable to control how you’re feeling. You might also constantly worry about having other panic attacks, or the consequences of having one, and might avoid situations in which you’ve had them.

Some of the most common panic attack symptoms include:

  • being short of breath or feeling that you’re choking
  • having a rapid heartbeat
  • feeling faint, lightheaded or dizzy
  • trembling or shaking
  • feeling sick
  • feeling hot or cold
  • feeling numbness in your skin
  • feeing afraid that you’re going to die
  • having the feeling of a tight chest

You might get symptoms other than the ones listed here. The symptoms of a panic attack can be so intense that some people think they’re having a heart attack. It’s important to remember that although these symptoms are upsetting, they’re aren’t dangerous and are unlikely to cause any lasting physical harm.

Diagnosis of panic attacks

Your GP will ask you about your symptoms and how you’ve been feeling.

If your GP believes your symptoms could be caused by a physical health problem, they’ll refer you for tests. For example, if you’ve had chest pains, they may arrange an electrocardiogram (ECG) test to rule out any heart problems.

Panic attacks are a type of anxiety. If you’ve had at least two unexpected panic attacks followed by at least a month of worrying about having another one, your GP may diagnose you with panic disorder. People with panic disorder often feel very worried about having more panic attacks, or very anxious that they may have a physical illness. While panic attacks are common, panic disorder is not.

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How you can help yourself

Learning to manage the anxiety that causes a panic attack may help you to prevent them from happening. The steps below may help you to do this. There are also tips and advice in our wellbeing articles: Living with anxiety – advice from a mental health nurse and How to stop worrying: six helpful ideas.

Talking about it

Simply talking to a friend or family member and voicing your worries and concerns could help. But if you’re not comfortable sharing your thoughts with someone close, there are lots of other people ready to listen and help. For example, you could consider talking to a counsellor or therapist or joining an online forum, specialist charity or support group.

Living a healthy lifestyle

Exercise triggers the release of a set of hormones known as endorphins. These have been shown to improve mood and reduce anxiety. Other aspects of a healthy lifestyle including a healthy diet and a good night’s sleep could also help. And so could avoiding stimulants such as caffeine, alcohol and nicotine.

Breathing and relaxation techniques

If you’re feeling anxious, it’s important to keep stress to a minimum and take time out to relax. Activities such as yoga, Tai chi, mindfulness and deep breathing may help you to control your thoughts and feel calmer. This can reduce stress and anxiety and could stop a panic attack happening. Hyperventilating (fast shallow breathing) is common during a panic attack. You can try and manage this through the use of deep breathing techniques, which you can learn through these practices.

Identifying triggers

You might find that something specific triggers your panic attacks – for example, they may happen at night. Or you may find that they may develop for no apparent reason. It might help to record the situations and feelings that may trigger a panic attack – you could keep a diary, for example. There are also a number of health apps such as My possible self and Catch it where you can record how you’re feeling and learn ways to manage your feelings.

It could also be useful to take note of any times you successfully avoid an attack and the steps you took to do this. Not only does this mean you might be able to try the same technique in the future, but you can acknowledge how well you’ve done.

How to manage panic attacks

It’s important to have a plan in place for when you feel a panic attack coming on, so you know what to do. You could try using some of the techniques above, such as controlled breathing or progressive relaxation. You could also try distraction techniques. This means focusing on something neutral or pleasant so you don’t get into a cycle of negative thinking that could lead to a panic attack. These ideas may help you to manage the attack – and remember, the feeling will pass. The organisation No Panic has more tips on how to manage a panic attack with relaxation and breathing techniques.

Biofeedback

It might help to monitor your body during a panic attack so you know when to put your plan into place. This can include taking note of things like your heart or breathing rate or the tension in your muscles. You could try wearing a device like a smartwatch to measure your pulse, for example. If your pulse starts to rise, you know to start doing some breathing exercises. While there isn’t strong evidence yet that this works, you may wish to give it a go.

Treatment of panic attacks

Taking treatment

Treatment could include talking therapies or counselling. Cognitive behavioural therapy (CBT) is a type of talking therapy where you focus on the way you think and behave. You learn to challenge negative emotions and develop coping strategies for these. It can be done face-to-face with a professional or through online courses. CBT has been shown to be useful in helping some people deal with anxiety and panic attacks.

Medicines

If you regularly have panic attacks, your GP may recommend a treatment for the anxiety that causes the attacks. This could include taking antidepressants or another medication to improve your mood.



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Related information

    • Anxiety, panic and phobias. Royal College of Psychiatrists. www.rcpsych.ac.uk, published February 2015
    • Panic disorders. BMJ Best Practice. www.bestpractice.bmj.com, last reviewed January 2020
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    • Panic attacks and panic disorder. The MSD Manuals. www.msdmanuals.com, last full review/revision July 2018
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    • Better mental health for all: a public health approach to mental health improvement. Faculty of Public Health and Mental Health Foundation. www.fph.org.uk, published 2016
    • Hyperventilation. Patient. www.patient.info, last edited 22 September 2015
    • Panic attacks. Mental Health Foundation. www.mentalhealth.org.uk, last updated 13 December 2018
    • Complementary and alternative medicines. Royal College of Psychiatrists. www.rcpsych.ac.uk, published April 2015
    • Bandelow B, Michaelis S, Wedekind D. Treatment of anxiety disorders. Dialogues Clin Neurosci 2017; 19(2):93–107. www.ncbi.nlm.nih.gov
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  • Reviewed by Rachael Mayfield-Blake, Freelance Health Editor, February 2020
    Expert reviewer, Dr Liz Russell, Consultant Psychiatrist
    Next review due February 2023

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