Understanding and treating panic attacks

Updated December 20, 2019.

Your heart starts pounding, your head begins to spin, nausea hits, and you start gulping air in big, heaving breaths. Even if you’ve had a panic attack before, it doesn’t make the fear and helplessness you feel any better — it can even make it worse.

Panic disorder is more common than you might think — 2.4 million people in the US, or nearly 2 percent of the adults between 18 and 54 suffer from panic attacks. Symptoms usually don’t begin until early adulthood, and women are twice as likely as men to get them.

The fear of having a panic attack can be debilitating for some, bleeding into aspects of their social and professional lives — but there’s hope. Understanding what’s happening to your body and how to cope will get you on the road to recovery.

Your body has built-in coping mechanisms for many situations, particularly perceived threats to your safety. When threatened, your sympathetic nervous system, which handles fear and stress, tells your body to release adrenaline. Your heart rate and breathing speed up, your pupils dilate, and your muscles tense up. When the danger passes, your parasympathetic nervous system, which regulates your state of calm, kicks in and brings you back to normal.

During a panic attack, your body’s defenses kick into gear even though there’s no imminent threat. Compounding this elevated state, your parasympathetic nervous system fails to engage and calm you down.

Panic attacks can be triggered by a stressful situation, but they can also occur randomly. Symptoms include feelings of sudden terror, loss of control, and a feeling of dying. These may last for 10 minutes or longer. During a panic attack, you begin to hyperventilate, which causes your body to release more carbon dioxide than it can produce, dropping carbon dioxide levels in your blood. This leads to irregular heartbeat and dizziness. People often mistake a panic attack for a heart attack.

Common physical symptoms include:

• Sudden terror
• Elevated heart rate
• Dizziness, light-headedness, fainting
• Sweats or chills
• Tingling sensation in extremities
• Shortness of breath
• Chest pain
• Nausea

People who experience panic attacks regularly suffer from panic disorder, which may compound their anxiety about when the next one will hit. How or why people develop panic disorder isn’t completely understood, but contributing factors include:

• Big life changes, such as marriage, pregnancy, losing a job, or buying a house
• Traumatic events, such as the death of a loved one or a breakup
• Extended periods of anxiety
• A family history of panic disorder
• Depression
• Alcohol or drug abuse

The first step is to acknowledge that you’re having a panic attack and accept the feeling. Then practice these immediate coping techniques:

• Relax your breath by practicing 4-7-8 breathing — inhale through your nose for 4 counts, hold for 7, and exhale through your mouth for 8. Or use a breathing app such as Breathing Zone to help decrease your breathing rate. Don’t try to take deep breaths — this will only make the hyperventilation worse.
• Sit or lie down and relax your muscles. Try progressive muscle relaxation. Flex the muscles in your feet and toes, then release. Flex the muscles in your calves, then release. Flex the muscles in your thighs, then release. Continue doing this with each muscle group, moving up your body until you get to your head.
• Talk yourself out of it. Reassure yourself with thoughts like: It’s just a panic attack; this feeling will end; it’s okay to be scared. Or tell yourself to stop. Say, “Stop!” out loud to distract you from your racing thoughts.
• Develop a plan for onset of a panic attack. Remove yourself from a public situation by ducking into a bathroom and practice breathing.

Work with a therapist to talk about what might be triggering these episodes and develop coping mechanisms. Your therapist might try cognitive behavioral therapy to get to the root of the thoughts that are causing this panic. One way of developing a coping mechanism is paradoxical intention: You face your fear by purposefully triggering a panic attack in a safe environment to help you build the tools to cope with them.

Other ways to relieve panic disorder are to reduce the stress in your life as a whole via exercise, good nutrition, yoga, and meditation.

If you experience sporadic panic attacks, your health care provider may prescribe benzodiazepines like Xanax and Klonopin for you to take at the onset of an attack. These medications help to decrease the symptoms within 30 minutes to an hour. Many patients feel better just having the medication on hand and don’t even need to take it. These medications are taken as needed only — not daily, as they can become addictive.

If you are experiencing frequent or intense panic attacks or have developed symptoms of panic disorder that are interfering with your day-to-day life, your provider may prescribe SSRIs like Lexapro or Effexor. These medications are taken daily and some patients experience short-term side effects. They also take a little longer to work (sometimes three to six weeks to experience the full effect).

Remember: Medication can reduce the symptoms related to panic attacks, but it doesn’t treat the problem. If you take medication, it’s important to do so in conjunction with therapy and lifestyle changes.