Panic Attack

Medically Reviewed By William C. Lloyd III, MD, FACS

What is a panic attack?

A panic attack is a sudden attack of anxiety. It is a period of extreme panic—you may feel frozen in place—lasting 5 to 30 minutes. Symptoms of panic attack include throat tightening, chest pressure, rapid heart rate, dizziness, sweating, and numbness. Panic attacks can happen due to stress, an anxiety disorder, or for reasons unknown.

During a panic attack, you may feel like you are in a dream, like you have no control over your body, or you are “going crazy.” Panic attacks happen unexpectedly and symptoms peak within about 10 minutes. Sometimes, panic attacks can be mistaken for heart attacks or other potentially fatal events.

Some people may use the term “anxiety attack” vs. panic attack, but there is a difference. Panic attacks are a recognized diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). They may develop without warning or something may trigger a panic attack, such as being on the top floor of a building when you have a fear of heights. An anxiety attack is a period of excessive worry, fear or dread. You cannot stop thinking about it. Someone having an attack of anxiety may experience physical symptoms, but they are typically not as severe as a panic attack. The DSM-5 does not recognize anxiety attack as a diagnosis; rather, anxiety (and periods of heightened anxiety, or “anxiety attack”) is a symptom of many psychiatric disorders. A person may experience both anxiety and panic attacks.

The cause of panic attacks is not known. Panic attacks and anxiety disorders may be hereditary, but twin studies suggest environmental factors also play a role. They may be linked to a chemical imbalance in the brain. Women are more likely than men to have panic attacks. People who have experienced a panic attack and live in fear of having one may have panic disorder, a type of anxiety disorder.

Every year, an estimated 11% of Americans experience a panic attack, and 2 to 3% go on to develop panic disorder, in which a person has repeated panic attacks and lives in fear of having a panic attack. Panic disorder is typically diagnosed before age 30. It is a type of anxiety disorder.

There is no cure for panic attacks, but most people who experience them respond to treatment. The goal of treating panic attacks is to lessen their frequency and severity. Patient education is an essential component to any treatment strategy.

Usually, treatment includes psychotherapy and medication. Medications may include antidepressants and anticonvulsants (seizure medications). It is also important to get enough sleep, eat a balanced diet, and exercise regularly to lessen your likelihood of having a panic attack.

Seek immediate medical care (call 911) for serious symptoms, such as sweating, severe difficulty breathing, and chest pain or pressure, which may be combined with pale or blue lips, fast heart rate, and anxiety. While these are symptoms of a panic attack, they may also be symptoms of a heart attack.

Seek prompt medical care if you are being treated for an anxiety disorder and are experiencing panic attacks.

What are the symptoms of a panic attack?

Symptoms of a panic attack include sudden, intense feelings of panic. Panic attacks may last anywhere from 5 to 30 minutes. It may take up to an hour to recover from a panic attack.

Common symptoms of a panic attack

You may experience panic attack symptoms daily or just once in a while. At times any of these panic attack symptoms can be severe:

Serious symptoms that might indicate a life-threatening condition

In some cases, life-threatening heart attacks can actually be mistaken for panic attacks. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including:

  • Bluish coloration of the lips or fingernails

  • Chest pain or pressure

  • Difficulty breathing

What causes panic attacks?

The underlying cause of panic attacks is not known. They can occur randomly, without warning, or can be triggered by situations or things that are stressful or make you anxious. Panic attacks and anxiety disorders may be hereditary. In other cases, panic attacks may be related to a brain injury or infection. Studies in twins suggest that both environmental and genetic factors are involved.

Anxiety disorders, including panic disorder, are thought to be related to chemical imbalances in the brain. When brain chemicals (neurotransmitters) in charge of your feelings and moods are not properly regulated, you can experience abnormal feelings or behaviors. If the imbalance is not addressed, you may develop an anxiety disorder, such as panic disorder.

There is evidence the brain is wired differently in people who experience panic attacks. These people may have overexcitable areas that make them more likely than the general population to experience panic attacks or develop panic disorder.

What are the risk factors for a panic attack?

A number of factors increase the risk of developing panic attacks. Not all people with risk factors will get panic attacks. Risk factors for panic attacks include:

How do you prevent panic attacks?

Panic attacks are multifactorial, so there is no simple way to prevent them. In many cases, a panic attack starts “out of the blue.” A psychotherapist can help you identify possible triggers of your panic attacks, then teach you effective coping and management strategies to prevent an attack.

A healthy lifestyle and other practices can potentially lessen the severity and frequency of panic attacks. Tips include:

  • Avoid caffeine and other stimulants.

  • Eat healthy meals at regular intervals.

  • Exercise regularly.

  • Get enough sleep so you feel rested when you wake up.

  • Learn and practice relaxation and stress management techniques.

  • Manage your stress levels.

  • Participate in psychotherapy or other types of evidence-based therapy.

  • Take prescribed medications for panic attacks, which may include antidepressants, benzodiazepines, and other drugs.

  • Tell your therapist or prescribing provider if your treatment is not controlling your panic symptoms or anxiety.

What are some conditions related to a panic attack?

Although panic attacks can occur on their own, they are frequently associated with another mental health condition, such as:

  • Panic disorder, marked by frequent panic attacks and fear of having more attacks, as well as disruption to daily living to avoid a potential panic attack

  • Generalized anxiety disorder, marked by excessive and uncontrollable worry causing some physical symptoms and interfering with daily functioning  

  • Social anxiety disorder (social phobia), marked by persistent fear of being watched and judged by others, with avoidance of work, school and most other social situations where you perceive this will occur

  • Agoraphobia, an anxiety disorder marked by intense fear of enclosed spaces and places where you perceive it would be difficult to escape or get help if necessary

  • Obsessive-compulsive disorder, an anxiety disorder marked by excessive rituals and repeated behaviors

  • Mood disorders, including major depressive disorder, marked by feelings of sadness and despair that interfere with daily living and persist for several months or longer

  • Post-traumatic stress disorder, marked by flashbacks, unpleasant memories, anxiety, panic attacks, and feelings of guilt or shame among many other symptoms

  • Schizophrenia, a brain disorder marked by troubled thinking and behavior, such as paranoia, hallucinations and delusions 

When should you see a doctor for panic attacks?

Occasionally experiencing the symptoms of a panic attack is not an emergency; however, the physical symptoms resemble those of other health issues, including heart problems. The symptoms are also very frightening and affect your quality of life. So, even if you think your symptoms are due to a stressful situation that has passed, you should see a doctor for a checkup and to rule out a serious condition.

If you have experienced four or more panic attacks or are afraid of having more, see a mental health professional, such as a psychologist or psychiatrist, for a professional diagnosis and treatment plan. You should also see a medical provider for panic attacks when you:

  • Avoid people and events or places

  • Cannot sleep

  • Cannot perform your daily activities, such as going to or performing at work or school, or caring for your children

  • Have thoughts of suicide or hurting yourself

  • Use alcohol or other drugs to calm your nerves

How do doctors diagnose a panic attack?

Due to the extreme physical symptoms of panic attacks, they are often misdiagnosed as physical problems. But diagnosis is improving with increasing awareness and prevalence of anxiety disorders, including panic disorder.

Your doctor will evaluate your physical health, medical and medication history, and ask you questions about your symptoms to rule out other potential causes of your symptoms. You may undergo tests to get a more complete picture of your overall health. Anxiety assessment tools can help fine tune the diagnosis and monitor treatment effectiveness.

Diagnostic tests will depend on your age, health, and medical history, to rule out other possible causes of your symptoms, such as:

Questions your doctor may ask include:

  • Did you ever have a spell or an attack when all of a sudden you felt frightened, anxious or very uneasy? 

  • Would you say you have been bothered by ‘nerves’ or feeling anxious or on edge?

  • Have you ever experienced these types of symptoms before?

  • How often do they occur?

  • When do they occur? Do certain events or activities trigger your symptoms?

  • Did you ever have a spell or an attack when all of a sudden you felt frightened, anxious or very uneasy?

  • How long do your symptoms last?

  • Have you ever been diagnosed with a mental health condition?

  • Have you experienced or witnessed trauma?

  • What medications do you take?

  • Do you take stimulants, including caffeinated beverages?

  • What improves your symptoms? (This may include exercising; deep, slow breathing; or talking to a trusted friend or relative.)

If your doctor rules out physical causes of your symptoms, you will likely be referred to a mental health professional for further screening. A psychologist or psychiatrist may conduct a range of assessments for conditions including generalized anxiety disorder or panic disorder. There are also pediatric versions of these screenings that can be performed on children with panic or anxiety symptoms.

How do you treat a panic attack?

Panic attacks are usually treated with psychotherapy, medication, or a combination of both. While there is no cure for panic attacks, these treatments are usually effective at managing symptoms, allowing you to lead a more enjoyable, healthy life.

Medications for panic attacks

Medications for panic attacks may include the following antidepressants, anticonvulsants, and antianxiety medications:

  • Selective serotonin reuptake inhibitor (SSRI) antidepressants, such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft). SSRIs are a first-line therapy.

  • Serotonin-norepinephrine reuptake inhibitors (SNRIs), such as duloxetine (Cymbalta) and venlafaxine (Effexor XR)

  • Benzodiazepines, such as alprazolam (Xanax) and clonazepam (Klonopin), on a short-term basis during a crisis. These drugs are very effective at preventing panic attacks and relieving symptoms, but they are habit-forming and can lead to abuse or addiction.

  • Monoamine oxidase inhibitors, such as phenelzine (Nardil) and isocarboxazid (Marplan)

  • Tricyclic antidepressants, such as amitriptyline (Elavil) and doxepin (Sinequan)

To avoid relapse of the anxiety disorder and panic attacks, most medical providers advise patients to continue an antidepressant for at least 12 months after symptoms improve.

Ask your doctor about each drug’s effectiveness in treating panic attacks, how long it takes to see an effect, and what to expect with side effects. Ask the doctor when to call for certain symptoms or side effects. It may take some trial and error to find the medication that works best for you. Never stop taking a prescribed medication without talking to your doctor first.

Beta-blockers for panic attacks

A doctor may prescribe beta-blockers, such as propranolol (Inderal) and atenolol (Tenormin). These drugs were developed to treat high blood pressure, but they are sometimes prescribed for anxiety because they act quickly to relieve the physical symptoms of a panic attack—rapid heart rate, chest tightness, and sweating or trembling.

Beta-blockers work by blocking the effect of stress hormones on the body. The U.S. Food and Drug Administration has not approved beta-blockers for anxiety disorders or panic attacks; beta-blockers for panic attack symptoms is an off-label use.

Psychotherapy for panic attacks

Psychotherapy for panic attacks is designed to help you recognize and manage your panic or anxiety. Types of therapy used may include:

  • Cognitive behavioral therapy

  • Desensitization or exposure therapy to help you deal with attack triggers

  • Stress management, relaxation, and deep breathing techniques

  • Talk therapy

What you can do to improve your panic attacks

If you are prone to panic attacks, you may be able to lessen the frequency and severity of your panic attacks by:

  • Avoiding stimulants such as caffeine

  • Eating regular, healthy meals

  • Finding someone to talk to about stressful situations

  • Getting enough sleep

  • Getting regular exercise

  • Practicing relaxation and stress management techniques

Complementary treatments

Some complementary treatments may help some people to better deal with panic attacks. These treatments, sometimes referred to as alternative therapies, are used in conjunction with traditional medical treatments.

Complementary treatments are not meant to substitute for traditional medical care. Be sure to notify your doctor if you are consuming nutritional supplements or homeopathic (nonprescription) remedies as they may interact with the prescribed medical therapy.

Complementary treatments may include:

  • Acupuncture

  • Biofeedback

  • Hypnosis

  • Massage therapy

  • Nutritional dietary supplements, herbal remedies, tea beverages, and similar products

  • Yoga

How do panic attacks affect quality of life?

Frequent panic attacks, no matter the cause or underlying diagnosis, can significantly decrease quality of life, leading to depression and disability. People who experience panic attacks or live in fear of them may become unable to function normally at home, school or work. They may avoid situations in which they might experience a panic attack. In extreme cases, this may include refusing to leave their home.

People with panic attacks and associated mental health disorders are at increased risk of substance abuse, which carries its own burden. People with panic disorder also have a higher lifetime rate of cardiovascular, pulmonary and digestive problems than the general population.

If you or a loved one experiences panic attacks, seeking medical care early on is vital. Find a reputable mental healthcare provider (with expertise and experience in anxiety disorders), learn about panic attack diagnostic testing, and ask questions about all potential treatment options. With early intervention, you can increase the chances of long-term treatment success and reduce the risk of complications.

What are the potential complications of a panic attack?

There is no cure for panic attacks. Usually, they are a lifelong condition, and they may lead to the development or worsening of other anxiety disorders. Sometimes, people use alcohol or other drugs to try to cope with their anxiety disorder, which can actually worsen the condition.

Complications of untreated or poorly controlled panic attacks can be serious. You can help minimize your risk of serious complications by following the treatment plan you and your healthcare professional design specifically for you. Complications of panic attacks include:

  • Absenteeism from work or school

  • Agoraphobia (fear of being in situations that might cause panic)

  • Alcohol or substance abuse

  • Development of an anxiety disorder

  • Inability to participate normally in activities

  • Medication dependence or addiction

  • Medication side effects

  • Social isolation

  • Suicide or suicidal ideation

If you, or someone you are with, is considering or planning suicide, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).

Do panic attacks shorten life expectancy?

People who have an isolated panic attack or one related to a specific event or stressful situation have a good prognosis and may never experience another attack.

For panic disorder, about 80% of people who receive treatment achieve a symptom-free period for at least six months. Relapses are common, though; most providers urge patients to continue the prescribed medicine for at least 12 months to reduce the risk of relapse. Prognosis is complicated by coexisting mental health conditions, treatment compliance, financial difficulties, and family problems, such as divorce.

Mental health disorders have long been associated with a shorter life expectancy. In one study of 7.4 million people, mental health disorders, on average, shortened life expectancy by 10 years for men and seven years for women. Heart disease, infection, cancer, diabetes, and suicide were among the causes of death. In another analysis, anxiety diagnosis was associated with a 1.5 times higher risk of death from any cause, relative to people without a mental health diagnosis.

Early diagnosis and intervention for panic attacks, which may begin in adolescence, can help prevent complications of panic attacks and greatly improve the outlook.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Sep 24
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