When to seek care for panic

Overview

A panic attack is a sudden wave of intense fear or discomfort that reaches a peak within minutes. It can feel like you’re losing control, having a heart attack, or even dying. Panic attacks are not dangerous, but they can be very frightening.

Yes, panic attacks are very common. Many people experience one or two panic attacks in their lifetime. Panic disorder affects about 2-3% of people each year.

Panic attacks can affect anyone, but they often begin in late adolescence or early adulthood. Women are more likely than men to develop panic disorder.

Symptoms

Common symptoms

• Sudden, intense fear or dread
• Racing or pounding heart
• Sweating, trembling, or shaking
• Shortness of breath or a feeling of choking
• Chest pain or discomfort
• Nausea or stomach upset
• Dizziness, lightheadedness, or feeling faint
• Chills or hot flashes
• Numbness or tingling sensations
• Feelings of unreality or being detached from yourself
• Fear of losing control or 'going crazy'
• Fear of dying

Symptoms in children

• Children may complain of stomachaches or headaches during a panic attack.
• They may cry, cling to a parent, or refuse to go to school.
• They might have trouble explaining what they are feeling.

Symptoms in older adults

• Older adults may experience fewer physical symptoms during a panic attack, but may still feel intense fear.
• They might worry the symptoms are due to a serious medical condition, like a heart problem.
• They may be less likely to report panic attacks due to stigma or confusion with other health issues.

Causes

Main causes

• The exact cause of panic attacks is not fully understood, but they likely result from a combination of genetic, biological, and environmental factors.
• Panic attacks can be triggered by stress, traumatic events, or major life changes.
• Some people’s brains may be more sensitive to signals of danger, causing a 'false alarm'.

Risk factors

• Family history of panic attacks or panic disorder
• Experiencing a traumatic event, such as abuse, accident, or loss
• High levels of stress, including work, financial, or relationship stress
• Certain personality traits, like being more prone to anxiety or negative emotions
• Major life changes, such as getting married, having a baby, or starting a new job
• Having another mental health condition, like depression or social anxiety

When to see a doctor

See a doctor urgently if:

• If panic attacks are accompanied by chest pain, severe difficulty breathing, or feeling like you might pass out, seek emergency care.
• If you have thoughts of harming yourself or others during a panic attack, call your local emergency number immediately.

Book a routine appointment if:

• Talk to your GP if you have had a panic attack and are worried about having another.
• See your doctor if panic attacks are affecting your daily life, such as keeping you from going to work or socialising.
• If avoidance behaviours (like not leaving the house) develop, it is important to seek help early.

Diagnosis

Your GP will ask about your symptoms, how often they happen, and how they affect you. They will also check for any physical causes that might mimic panic attacks, such as heart or thyroid problems.

Tests that may be done

• Physical exam and listening to your heart and lungs
• Blood tests to check for conditions like an overactive thyroid or low blood sugar
• Electrocardiogram (ECG) to check your heart's rhythm
• Questionnaires about your symptoms and anxiety levels

What to expect at your appointment

Diagnosis is based on your description of symptoms and ruling out other conditions. Your doctor may refer you to a mental health specialist for further assessment. The process is collaborative and focused on finding the right support for you.

Treatment

Treatment for panic attacks and panic disorder is very effective. It usually involves talking therapies, sometimes with medication as a short-term option. The goal is to help you manage symptoms and reduce the fear of having another attack.

Self-care at home

• Learn about panic attacks – understanding that they are not dangerous can reduce fear.
• Practice slow, deep breathing when you feel a panic attack starting.
• Grounding techniques, like focusing on what you can see, hear, and touch, can help you stay in the present.
• Avoid caffeine, alcohol, and nicotine, as they can trigger or worsen panic attacks.
• Get regular physical activity – it helps reduce anxiety over time.
• Stick to a regular sleep routine.

Medical treatments

Your GP may recommend psychological therapies like cognitive behavioural therapy (CBT), which is very effective for panic. In some cases, medication such as selective serotonin reuptake inhibitors (SSRIs) may be used to help reduce symptoms. Any medication would be prescribed and monitored by your doctor. Treatment is always tailored to your needs.

When is surgery considered?

Surgery is not used to treat panic attacks or panic disorder.

Living with this condition

Living with panic attacks can be challenging, but with support you can learn to cope. Many people find that symptoms improve significantly with treatment. It helps to build a routine, manage stress, and have a plan for when a panic attack happens.

Lifestyle tips

• Establish a consistent daily routine to create a sense of predictability.
• Limit or avoid stimulants like caffeine and sugar.
• Make time for relaxation, hobbies, and activities you enjoy.
• Join a support group, either in-person or online, to connect with others who understand.
• Keep a diary to track panic triggers and patterns.

Diet and exercise

A balanced diet can help stabilize your mood. Avoid skipping meals, and limit alcohol and caffeine. Regular exercise, like walking, swimming, or yoga, can reduce anxiety and improve your overall wellbeing. Even 10-15 minutes a day can make a difference.

Mental health and emotional wellbeing

Panic attacks can affect your self-esteem and lead to anxiety about future attacks. They may also increase the risk of depression. It is important to address any feelings of shame or isolation – talking to a therapist or a trusted person can help.

Prevention

It may not be possible to prevent panic attacks entirely, but you can reduce the risk by managing stress, practising relaxation techniques, and recognising early warning signs. If you have had panic attacks in the past, sticking with treatment can help prevent recurrences.

Complications

If left untreated

• Avoidance of places or situations where panic attacks have occurred (agoraphobia)
• Increased anxiety and worry about having more attacks
• Depression and social isolation
• Difficulty with work, school, or relationships
• Increased risk of substance use as a way to cope

Long-term outlook

With proper treatment, most people with panic attacks or panic disorder improve significantly. Many become free of panic attacks entirely. It may take time, but there is hope and effective help available.

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