panic that comes and goes

Overview

Panic that comes and goes means having sudden, intense waves of fear that appear without warning and then fade away. These waves are called panic attacks. When they keep happening, doctors may call it panic disorder. The fear is real, but it is not dangerous to your heart or your life, and it can be managed.

It is very common. Around 1 in 4 people will have a panic attack at some point in their life, and about 1 to 3 in 100 people develop panic disorder.

It can start at any age, but it often begins in the late teens or early twenties. Women are twice as likely as men to experience it, but men and people of all backgrounds can have it too. Children and older adults also experience panic attacks.

Symptoms

Common symptoms

• Sudden intense fear or dread, like a terrible feeling something bad is about to happen
• Racing or pounding heartbeat
• Sweating, shaking, or trembling
• Shortness of breath or feeling smothered
• Chest pain or tightness
• Dizziness, light-headedness, or feeling faint
• Tingling or numbness in your hands, face, or feet
• Feeling detached from your body or the world
• Hot or cold flushes
• Feeling sick to your stomach

Symptoms in children

• They may complain of a stomach ache or headache instead of saying they feel scared
• They may cling to parents or refuse to go to school
• They may become irritable, tearful, or have outbursts
• They may say they feel like they are 'going crazy'

Symptoms in older adults

• They may feel chest tightness, breathlessness, or dizziness more strongly
• They may worry they are having a heart attack or a stroke
• They may be less likely to talk about fear and more likely to ask about physical symptoms
• They may feel shaky, weak, or unsteady on their feet during an attack

Causes

Main causes

• Long-lasting stress, such as pressure at work or money worries
• A major life event like losing a loved one, moving, or becoming a parent
• An over-sensitive 'fight or flight' response in the body that turns on too easily
• Changes in brain chemistry that make you more alert to danger
• Low blood sugar, too much caffeine, or certain medicines or drugs

Risk factors

• Another family member who has panic attacks or anxiety
• A history of difficult childhood experiences or trauma
• A natural tendency to be anxious or to notice body sensations
• Ongoing stressful life circumstances
• Having depression or another anxiety disorder

When to see a doctor

See a doctor urgently if:

• See a doctor or mental health professional as soon as possible if panic attacks are becoming more frequent, or you are avoiding places or situations because of them.
• Get urgent same-day care if you are struggling to cope, feel unsafe, or have thoughts of self-harm.

Book a routine appointment if:

• See your doctor for a check-up after a panic attack to rule out physical causes like heart or thyroid problems.
• Make a regular appointment if panic attacks happen occasionally but you want support to manage them.

Diagnosis

A doctor will ask about your symptoms, when they happen, and how they affect your life. They will also listen to your heart and check your breathing to look for medical causes. There is no swab or scan for panic disorder, so an honest conversation is the most important test.

Tests that may be done

• A physical examination to check your heart, lungs, and blood pressure
• Blood tests to check your thyroid and rule out anaemia or other problems
• An electrocardiogram (ECG) to record your heart's rhythm
• A mental health questionnaire to understand your thoughts and feelings

What to expect at your appointment

During the appointment, the doctor will explain what panic attacks are and reassure you that they are not dangerous. They may ask you to keep a diary of your symptoms. You can write everything down and bring a friend or family member for support.

Treatment

Treatment helps your brain and body learn that panic attacks are not dangerous. The most effective approach is talking therapy, and sometimes a doctor may discuss temporary medication as well. The right plan depends on how often the panic happens and what is causing it.

Self-care at home

• Practice slow breathing: breathe in for a count of four, and breathe out for a count of six. Do this for a few minutes.
• Remind yourself out loud: 'This is panic. It is uncomfortable but not harmful. It will pass.'
• Use grounding: look around and name five things you can see, four you can touch, three you can hear, two you can smell, and one you can taste.
• Carry a small note with a phrase that helps you, like 'This has ended before and it will end again.'
• Cut back on caffeine, energy drinks, and alcohol, which can trigger panic.
• Share what is happening with a trusted person. Keeping it hidden makes it stronger.

Medical treatments

Your doctor or psychiatrist may offer cognitive behavioural therapy (CBT), which helps you change unhelpful thoughts and behaviour patterns. They might also suggest a course of counselling if stress is playing a big role. For some people, a doctor may prescribe a medicine that helps manage anxiety, but this is always discussed carefully, never as a quick fix, and it works best with therapy and self-help.

Living with this condition

Living with panic that comes and goes means learning to ride the wave. Each attack usually peaks and fades within 10 to 20 minutes. Between attacks, try not to let worry about the next one take over. Remind yourself that uncomfortable does not mean dangerous.

Lifestyle tips

• Keep a regular sleep schedule and aim for seven to nine hours, even at weekends.
• Reduce caffeine, alcohol, and nicotine, as all three can trigger panic symptoms.
• Make time for daily quiet moments, such as breathing exercises, listening to music, or walking.
• Gradually do the things you have been avoiding, one small step at a time.
• Plan things to look forward to, no matter how simple.

Diet and exercise

Try to eat balanced meals at regular times, because low blood sugar can feel like panic. Drink water through the day. Regular exercise — even a brisk walk — helps the body burn off stress chemicals and improves sleep. Aim for movement most days, but listen to your body and start gently.

Mental health and emotional wellbeing

Panic can make you feel embarrassed or alone, and you might start to avoid places where you had an attack. This can shrink your life and lead to low mood. Remember that panic is a medical condition, not a personal failure. It deserves the same compassion as any other health problem.

Prevention

You cannot always stop a first panic attack, but you can reduce how often they happen and stop them from becoming a disorder. The best protection is to face feared situations gradually, keep stress in check, learn calming skills early, and ask for help if panic is starting to control your life.

Complications

If left untreated

• Avoiding everyday places such as shops, buses, or work, which can lead to agoraphobia
• Feeling isolated and alone because the panic feels impossible to explain
• Low mood or depression
• Drinking alcohol or using other substances to cope
• Sleeplessness and tiredness that make everything harder
• In rare cases, thoughts of self-harm or suicide

Long-term outlook

The outlook is genuinely positive. Most people who get help — especially with cognitive behavioural therapy — become free of attacks or manage them so well that they no longer interfere with life. Recovery takes time and effort, but panic is a wave, not a life sentence. With the right support, people return to work, travel, and deep connections again.

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