SymptomMental health & sleep
Panic Attacks: Symptoms and What to Do
Panic attacks are sudden surges of intense fear that peak within about 10 minutes, with physical symptoms such as a pounding heart, chest tightness, shortness of breath, shaking, dizziness and a feeling of dying or losing control. They are frightening but not dangerous, and usually pass within 20 to 30 minutes. Slow breathing and riding out the wave help. A first attack with chest pain should be checked to rule out a heart problem, and repeated attacks respond well to treatment.
Also called: Panic attack, anxiety attack, acute anxiety episode, panic episode
At a glance
- What it is
- A sudden wave of intense fear with strong physical symptoms, peaking within minutes.
- How long
- Usually 5 to 20 minutes, rarely more than 30 minutes.
- Common triggers
- Stress, caffeine, lack of sleep, crowded places, or no obvious trigger.
- Dangerous?
- Not physically, but heart problems, asthma and other conditions must be ruled out the first time.
- Help
- Slow breathing and grounding during an attack; CBT and medicines for repeated attacks.
When to get help
Call 911 or go to the ER
- Chest pain or pressure spreading to the arm, jaw or back, especially with sweating, nausea or breathlessness, and particularly if you have heart risk factors or have never had a panic attack before
- Severe breathlessness, blue lips, or wheezing that does not settle
- Fainting, or a heartbeat that stays very fast or irregular after the anxiety eases
- Thoughts of suicide: call or text 988 (US)
See a doctor within a day or two
- Your first-ever episode of this kind, to rule out a physical cause
- Attacks with new palpitations, weight loss and heat intolerance (possible overactive thyroid)
- Attacks starting after a new medicine, stimulant or stopping alcohol, benzodiazepines or antidepressants
Book a routine appointment
- Repeated attacks, or constant worry about having another one
- Avoiding places, travel or activities because of fear of panic
- Using alcohol or drugs to cope with anxiety
Usually safe to manage at home
- An occasional attack in a known stressful situation that settles with slow breathing, in someone already assessed by a doctor
What a panic attack feels like
Panic attacks come on suddenly, sometimes out of the blue, even during sleep. The body's alarm system (the fight-or-flight response) fires without a real danger. Adrenaline floods the body and produces a mix of these symptoms:
- pounding, racing or skipping heartbeat
- chest pain or tightness
- shortness of breath or a feeling of choking or smothering
- sweating, hot flushes or chills
- trembling or shaking
- dizziness, lightheadedness or feeling faint
- nausea or stomach churning
- tingling or numbness, often in the hands, lips or face
- feeling detached from yourself or that the world is unreal
- fear of losing control, going crazy, or dying
Doctors define a full panic attack as at least four of these symptoms, peaking within minutes. Attacks with fewer symptoms are called limited-symptom attacks.
How to stop a panic attack
You cannot always stop an attack instantly, but you can shorten it and reduce the fear.
- Name it. Tell yourself, "This is a panic attack. It is uncomfortable, but it will pass and it cannot hurt me."
- Slow your breathing. Breathe in gently through your nose for 4 seconds, and out slowly through pursed lips for 6 seconds. Longer out-breaths calm the nervous system. Avoid gulping air or breathing into a paper bag.
- Ground yourself. Notice 5 things you can see, 4 you can touch, 3 you can hear, 2 you can smell and 1 you can taste.
- Relax your muscles. Drop your shoulders, unclench your jaw and hands.
- Stay where you are if it is safe. Leaving teaches your brain the place is dangerous. The attack will peak and fall within minutes.
- Afterwards, drink some water, rest and do something calming. Avoid caffeine and alcohol.
Panic attack vs heart attack
| Feature | Panic attack | Heart attack |
|---|---|---|
| Age and risk | Often younger, any health | More often older, with risk factors such as smoking, diabetes or high blood pressure |
| Chest pain | Sharp or stabbing, often localized, may move | Pressure, squeezing or heaviness, may spread to arm, jaw or back |
| Onset | Sudden, often with fear first | During exertion or at rest |
| Duration | Peaks within 10 minutes, eases within 20 to 30 | Persists or worsens beyond a few minutes |
| Other symptoms | Tingling, fear, feeling unreal | Sweating, nausea, breathlessness, faintness |
If you are unsure, call 911 or your local emergency number. It is always better to have chest pain checked. See heart attack.
What causes panic attacks
- Stress and life changes: bereavement, exams, work pressure, relationship problems.
- Anxiety disorders: panic disorder, generalized anxiety disorder, social anxiety, phobias and PTSD.
- Stimulants: caffeine, energy drinks, decongestants, nicotine, cannabis and cocaine.
- Withdrawal from alcohol, benzodiazepines or some antidepressants.
- Physical conditions that mimic panic: an overactive thyroid, heart rhythm problems, asthma, low blood sugar and, rarely, adrenal tumors.
- Family history and a naturally sensitive alarm system.
One attack vs panic disorder
About one in ten adults has a panic attack in a given year, and many have only one or two. Panic disorder is diagnosed when attacks are recurrent and unexpected and are followed by at least a month of persistent worry about more attacks or changes in behavior to avoid them. Some people go on to avoid places where escape feels hard, called agoraphobia. Our panic attack condition page explains causes, diagnosis and treatment in detail.
Getting help
See a doctor after your first attack, or if attacks keep happening. They may check your heart rhythm, blood sugar and thyroid to rule out physical causes.
Effective treatments:
- Cognitive behavioral therapy (CBT): the most effective long-term treatment. It teaches you to reinterpret body sensations and gradually face feared situations.
- Medicines: SSRIs or SNRIs taken daily reduce attacks over weeks. Benzodiazepines act fast but are generally for short-term use only because of dependence risk.
- Lifestyle: regular exercise, enough sleep, less caffeine and alcohol.
Frequently asked questions
What does a panic attack feel like?
A panic attack feels like a sudden rush of terror with a racing heart, chest tightness, breathlessness, shaking, sweating, dizziness, tingling and a strong sense that something terrible is happening, such as dying or losing control. It usually peaks within 10 minutes and fades within half an hour.
How long do panic attacks last?
Most panic attacks peak within about 10 minutes and end within 20 to 30 minutes, though you may feel shaky or drained for hours afterwards. Repeated waves can make an episode seem longer. Symptoms that last much longer may not be panic and should be assessed.
Can a panic attack hurt you?
A panic attack is not physically dangerous, even though it feels like an emergency. Your heart and lungs can handle the adrenaline surge. However, the first attack, or chest pain in someone with heart risk factors, should be checked to rule out a heart problem.
How can I tell if it is a panic attack or a heart attack?
Panic attacks often come with intense fear, tingling and sharp chest pain that peaks within minutes and then eases. Heart attacks more often cause crushing pressure spreading to the arm or jaw, with sweating and breathlessness, and do not settle. If in doubt, call 911.
What triggers panic attacks?
Common triggers include stress, caffeine, lack of sleep, alcohol hangovers, crowded or enclosed places, and reminders of past trauma. Many attacks have no obvious trigger. Fear of the sensations themselves, such as a fast heartbeat, often sets off the next attack.
Sources
This guide was written from current patient and clinical guidance, including:
- National Institute of Mental Health (NIMH): Panic disorder, when fear overwhelms
- American Psychiatric Association: What are anxiety disorders
- NHS: Panic disorder
- Anxiety and Depression Association of America: Panic disorder
- American Heart Association: Warning signs of a heart attack