What to do during a panic attack, and when panic needs treatment

During a panic attack, the most useful things you can do are to name it as panic, slow your breathing with a longer out-breath, and let the wave pass rather than fight it. Most attacks peak within about 10 minutes and then ease. If your symptoms are new, include chest pain, or you are not sure whether this is panic, get emergency care first. When attacks keep coming back or you start rearranging your life around them, that is the point to get treatment, and panic responds well to it.

First, rule out an emergency

Panic attacks can feel like a heart attack, and some medical problems can feel like panic. Call 911 or go to an emergency room if:

• This is the first time you have felt anything like this
• You have chest pain or pressure, especially spreading to your arm, jaw or back
• You have heart disease, high blood pressure, diabetes or other cardiac risk factors
• You faint, have trouble speaking, or have weakness on one side of your body
• Symptoms feel different from your usual panic attacks

Going to the emergency room and being told it was panic is not a wasted trip. It is the right call when you cannot tell, and it gives you information you can use next time.

What is happening in your body

A panic attack is your body's alarm system firing at full strength when there is no real threat. Adrenaline speeds up your heart and breathing, tenses your muscles and sharpens your focus on danger. Breathing faster than you need lowers carbon dioxide in your blood, which can cause tingling, lightheadedness and a feeling of not getting enough air, even though you are taking in plenty of oxygen.

The National Institute of Mental Health describes panic attacks as sudden periods of intense fear that can include a pounding heart, sweating, trembling, shortness of breath, chest pain and a feeling of impending doom or loss of control. Many people also feel detached from their surroundings or worry that they are going to die or lose their mind. These sensations are intensely uncomfortable. They are not signs that you are going crazy, and the attack itself does not damage your heart.

What to do during the attack

1. Name it

If you have had panic attacks before and this feels familiar, say to yourself, "This is a panic attack. It will peak and pass." Much of the fear in panic comes from interpreting the sensations as a catastrophe. Labeling them correctly takes some of the fuel away.

2. Slow your breathing, especially the out-breath

Breathe in gently through your nose for a count of about four, then out slowly through your mouth for a count of six or more. Let your belly rise rather than your chest. A longer exhale helps counter the over-breathing that drives dizziness and tingling. Do not force deep, gulping breaths, which can make things worse. Breathing into a paper bag is no longer recommended.

3. Ground yourself

Bring your attention to what is around you. One common method is to name five things you can see, four you can touch, three you can hear, two you can smell and one you can taste. Pressing your feet into the floor, holding something cold or describing the room out loud can also help.

4. Let it come, rather than fighting it

This sounds backward, but trying to force a panic attack to stop often intensifies it. Instead, notice the sensations, remind yourself they are temporary and let them rise and fall. If it is safe, stay where you are. Leaving the situation brings short-term relief, but repeated escape teaches your brain that the place was dangerous, which makes the next attack more likely there.

5. Relax your muscles

Tense your shoulders, hands or legs for a few seconds, then release. Repeating this through different muscle groups can ease the physical tension that comes with panic.

What to avoid

Alcohol and cannabis may seem to take the edge off, but they can worsen anxiety over time and make panic more likely the next day. Caffeine and energy drinks can trigger attacks in people prone to them. Taking a friend's anti-anxiety pill is risky, especially with alcohol. And try not to spend the hours afterward searching symptoms online, which often keeps the alarm going.

When panic needs treatment

A single panic attack, especially during a stressful period, does not mean you have a disorder. Many people have one or two in their lives. It is worth getting assessed when:

• You have repeated attacks that seem to come out of nowhere
• You spend a month or more worrying about the next attack or what it means
• You have started avoiding places, driving, exercise or situations because of panic
• You rely on alcohol, cannabis or other substances to manage it
• Panic comes with low mood, hopelessness or thoughts of self-harm

That pattern describes panic disorder, and sometimes agoraphobia, where fear of having an attack leads to avoiding places where escape feels hard.

How panic disorder is treated

Cognitive behavioral therapy. CBT for panic has strong evidence. It helps you reinterpret body sensations and includes interoceptive exposure, which means deliberately bringing on mild versions of the sensations, such as a raised heart rate, in a controlled way until they lose their power to frighten you. It is usually delivered over a limited number of sessions.

Medication. SSRIs and SNRIs are the first-line medications for panic disorder, and sertraline, paroxetine, fluoxetine and venlafaxine extended-release are FDA-approved for it. Benzodiazepines act quickly but are generally reserved for short-term use because of dependence and withdrawal risks. Our guide to anxiety medication options covers each.

Checking for medical causes. Thyroid problems, heart rhythm disorders, some medications and stimulant use can cause panic-like symptoms. A clinician may suggest lab tests to rule these out.

Sleep and caffeine both influence panic more than most people expect. Our post on sleep and mental health explains the link, and what to expect at an online anxiety visit walks through a first appointment.

Panic disorder is common and treatable, and many people who get proper treatment see meaningful improvement. Our stress and anxiety service covers assessment, therapy options and medication management.

Questions patients ask us

How long does a panic attack usually last?

Most panic attacks build quickly and peak within about 10 minutes, then ease over the following minutes. Some people feel shaky, tired or on edge for an hour or more afterward. Waves can come back to back, which can make an episode feel longer. If symptoms do not ease or feel different from usual, seek medical care.

How can I tell a panic attack from a heart attack?

You often cannot tell reliably on your own, because symptoms overlap. Chest pain spreading to the arm, jaw or back, symptoms during exertion, heart risk factors, or a first-ever episode all point toward calling 911. Being checked and told it was panic is the right outcome when you were unsure.

Does breathing into a paper bag help a panic attack?

It is no longer recommended. The idea was to restore carbon dioxide lost through rapid breathing, but it can lower oxygen levels and is risky if the symptoms are actually caused by a heart or lung problem. Slow breathing with a longer out-breath is safer and works on the same principle.

Can a panic attack hurt me?

A panic attack itself is not dangerous to a healthy heart, even though it can feel terrifying. The bigger risks come from what panic leads to, such as avoiding places, relying on alcohol or making unsafe decisions while frightened. If you have a heart condition, discuss panic symptoms with your clinician.

Why do panic attacks happen at night?

Nocturnal panic attacks wake people from sleep with the same sudden fear and physical symptoms, without an obvious trigger. They are fairly common in people with panic disorder. Sleep apnea, reflux and some medications can produce similar awakenings, so it is worth mentioning night attacks to a clinician.

What is the difference between a panic attack and an anxiety attack?

Panic attack is a clinical term for a sudden surge of intense fear that peaks within minutes. Anxiety attack is not a formal diagnosis and people use it loosely, often for a period of building worry and tension. The distinction matters because panic disorder has specific, effective treatments.

Should I leave the place where a panic attack started?

If it is safe, staying where you are while the attack passes is usually better in the long run. Leaving brings quick relief, but it teaches your brain that the place was dangerous and can make future attacks there more likely. If you are somewhere unsafe, such as driving, pull over safely first.

Can caffeine cause panic attacks?

In people prone to panic, yes. Caffeine raises heart rate and produces jitteriness, which can be misread as the start of an attack. Reducing coffee, energy drinks and pre-workout supplements is a simple step that sometimes makes a noticeable difference. If you drink a lot, cut back gradually to avoid withdrawal headaches.

Do I need medication for panic disorder?

Not necessarily. Cognitive behavioral therapy alone works well for many people with panic disorder. SSRIs or SNRIs are effective too, and some people use both. The choice depends on severity, preference, access to therapy and other conditions such as depression. A clinician can help weigh the options.

What is interoceptive exposure in panic therapy?

It is a CBT technique where you deliberately bring on mild versions of panic sensations in a controlled way, such as spinning in a chair for dizziness or running in place for a raised heart rate. Repeating this teaches your brain that the sensations are uncomfortable but not dangerous, so they lose their power to trigger panic.