Panic Attack: Symptoms, What to Do and How to Stop Them Coming Back

Your heart suddenly pounds. You cannot catch your breath, your hands tingle, your chest feels tight, and a wave of terror washes over you: “I am going to die” or “I am having a heart attack”. If this has ever happened to you, you are not alone. Panic attacks are common, frightening, and not dangerous in themselves, although they feel exactly the opposite. Understanding what is happening is the first step to taking control.

What is a panic attack?

A panic attack is a sudden surge of intense fear or discomfort that peaks within minutes. It is the body’s alarm system, the “fight or flight” response, triggered when there is no real danger. Most attacks last 5 to 20 minutes. They can strike without warning, even during sleep. When attacks keep happening and you start to fear the next one, it is called panic disorder.

Symptoms

• Pounding or racing heart
• Chest tightness or pain
• Shortness of breath, or a feeling of choking
• Sweating, trembling and shaking
• Dizziness, light-headedness or feeling faint
• Tingling or numbness in the hands, feet or around the mouth
• Nausea or stomach upset
• Hot flushes or chills
• Feeling unreal or detached from yourself
• Fear of losing control, going mad or dying

Panic attack or heart attack?

The symptoms overlap, and if it is your first time, or you have heart disease, high blood pressure, diabetes or risk factors, do not assume it is panic. Seek emergency care and let doctors check. Read our guide on heart attack warning signs. As a rough guide, a heart attack pain typically spreads to the arm, jaw or back, builds up with effort, and is not relieved by slowing your breathing. A panic attack peaks quickly within about ten minutes, and eases. But if you are in doubt, always get checked.

Other medical causes of panic-like symptoms

• Overactive thyroid (hyperthyroidism)
• Low blood sugar, particularly in people with diabetes
• Heart rhythm problems (see palpitations)
• Too much caffeine, energy drinks, tobacco, or stimulant medicines
• Withdrawal from alcohol or sedatives
• Asthma and other breathing problems

What to do during a panic attack

• Remind yourself: “This is a panic attack. It will pass. It cannot harm me.”
• Slow your breathing. Breathe in gently through the nose for about four seconds, and out slowly through the mouth for about six. Fast breathing makes tingling and dizziness worse.
• Ground yourself. Name five things you can see, four you can touch, three you can hear. This brings attention back to the present.
• Stay where you are if safe, rather than rushing away. Sit down, relax your shoulders and unclench your fists.
• Avoid caffeine and cigarettes during and after an attack.
• Tell someone you trust, or ask them to stay with you.

Long-term treatment

• Cognitive behavioural therapy (CBT) is the most effective treatment. It teaches you to understand panic and gradually face the situations you avoid.
• Medicines: antidepressants such as sertraline or escitalopram, prescribed by a doctor, reduce panic attacks over several weeks. Beta blockers may ease physical symptoms in some people.
• Sedatives (benzodiazepines such as alprazolam) can calm quickly, but they cause dependence and tolerance and are for short, supervised use only. Please do not buy or use them without a prescription, and do not stop them suddenly.
• Lifestyle: regular exercise, less caffeine, regular meals and good sleep (see insomnia and sleep tips).
• Prayer, meditation, slow breathing and yoga can help with calming, alongside treatment.

Don’t suffer in silence

In Pakistan, many people with panic attacks go from doctor to doctor, having ECGs and tests again and again, or are told “it’s just stress” or “it’s the evil eye”. Seeing a doctor or psychiatrist for anxiety is not a sign of weakness. It is common, and treatable. See our guides on anxiety and depression too.

When to see a doctor

• Your first panic attack, or if you are unsure whether it is your heart
• Repeated attacks, or constant fear of the next one
• You avoid places, driving or work because of fear
• Low mood, hopelessness, or any thought of harming yourself. Please seek help at once from a doctor or a person you trust.
• You are using alcohol, sedatives or other substances to cope

Key takeaways

• A panic attack is a sudden wave of fear with physical symptoms. It feels dangerous, but it passes within minutes.
• If you are not sure it is panic, get your heart checked, especially the first time.
• Slow breathing and grounding help. CBT and antidepressants treat the cause.
• Avoid self-medicating with sedatives, and seek help early.

Related medicines on Medimart

• Sertraline and escitalopram: antidepressants used for panic disorder and anxiety
• Propranolol: a beta blocker sometimes used for physical symptoms

Browse anxiety products on Medimart, delivered across Pakistan. Prescription medicines are supplied only against a valid prescription and should be taken only as advised by your doctor.

This guide is for general information and does not replace advice from a doctor.