There are treatments for panic attacks that you can use right away, but some therapies help if your panic attacks keep coming back. Panic attacks are quick episodes of intense discomfort or fear that often come with symptoms.
If your panic attacks keep coming back for a month or more, it may be panic disorder. If you have panic disorder, doctors generally treat your panic attacks with therapy, medication, or both. You'll also learn ways to help you stay calm in the moment.
For some people, a panic attack or two doesn't lead to anything. But if your panic attacks start to interfere with daily life, treatment can help. Even better news, some studies suggest that treating your panic disorder can help lessen depression and anxiety.
Any route you and your doctor follow, it will take time to work, so try to be patient. Following through with your treatment plan can help most people find relief. Learn how panic attacks happen, which treatments help, and where to get support.
What Are the First Steps of a Panic Attack?
Exactly how panic attacks happen is not known yet, but experts think that panic can create a loop of intense fear and physical symptoms that feed into one another. This can make the attacks feel quite overpowering and hard to ignore.
The fear center in your brain (amygdala) releases hormones called norepinephrine and epinephrine, also called adrenaline. This activates your sympathetic nervous system, your fight-or-flight response, and the symptoms that come with that.
"Panic attacks involve overwhelming feelings, combined with strong input from the sympathetic nervous system, mediated by adrenaline, that can form a runaway feedback loop," says Andrew Sylvester, MD, a psychiatrist at UCHealth and medical director for the Virtual Intensive Outpatient Program at UCHealth Mountain Crest Behavioral Health Center in Longmont. "More fear releases more adrenaline, which causes more physical symptoms, which causes more fear, releasing more adrenaline.”
You might feel your heart racing, have trouble breathing, or worry that something serious will happen to your body. The racing heartbeat or other discomforts that come with an attack can look a lot like other illnesses, such as heart disease.
Because these symptoms can feel like serious health problems, the first step is to see your primary care provider. You'll often get a complete exam to spot any other untreated medical conditions.
That way, your doctor can make sure that your symptoms aren't coming from an unknown condition. If no other medical condition shows up, you may talk to a psychologist or psychiatrist trained to detect panic attacks.
How are panic attacks diagnosed?
Your doctor, therapist, and health care team will combine observations and tests to diagnose what's wrong. Your doctor may:
- Perform a physical exam
- Run blood tests to check your thyroid or other conditions
- Order heart tests, such as an ECG, to rule out heart problems
- Suggest a psychological exam
The psychological checkup will involve looking at your symptoms, stress, family history, and alcohol or substance use. But having a panic attack doesn't always mean you have panic disorder. Doctors may consider a diagnosis of panic disorder if you:
- Have panic attacks that happen often and without warning
- Spend a month or more worrying about having another attack or change your daily habits to avoid triggering situations
- Do not have attacks caused by medications, drugs, another medical condition, or a different mental health issue
Whether you have panic attacks or panic disorder, early diagnosis and treatment can help you manage the attacks and prevent them from happening often or getting worse.
How Do You Calm Someone Down From a Panic Attack?
Whether you are the one having a panic attack or someone else, the same steps apply. To calm a panic attack, break the loop. The key is to shift from pure feeling to thinking or doing, says Sylvester. Here are six steps to help calm a panic attack.
Label what's happening
Sometimes just saying, "I'm having a panic attack" can help you feel calmer. "Labeling the attack for what it is can help you acknowledge it," says Sylvester.
Once you know what's happening, you can offer comfort and remind them that the attack will pass and ask what's helped in the past.
Change the environment
If you can, get a change of scenery to look at the sky, the trees, or the cars passing by. "If possible, relocating to a calmer, quieter environment can remove triggers that may perpetrate the attack," says Sylvester.
But if you can't leave just yet, try to look and focus on the things around you.
Ground yourself
Grounding is a way to shift your attention back to the present. To help shift your attention away from spiraling fear and back to the present moment, you can try:
- 5-4-3-2-1 method. Name five things that you see, four that you're thinking, three that you hear, two that you smell, and one that you taste.
- Do a slow body scan from head to toe.
- Focus closely on an object and describe the details such as "its size, shape, color, texture, smell, and feel," says Sylvester.
Repeat calming mantras
Talking to yourself can help you refocus. You can even write down helpful statements ahead of time.
"Encourage them to repeat soothing mantras, such as "I'm fine" or "This too shall pass" to help them get a sense of control," says Sylvester.
You can work with your therapist to come up with the most calming mantras. Keep them on-hand and repeat them while taking slow, deep breaths.
Slow your breathing
Try taking slow, even breaths from your belly. You can even lie down if it helps. Put your hand on your belly to watch it slowly go up and down. There are many ways to focus on your breath:
- Box or square breathing. It involves four steps, each lasting four seconds: inhale, hold your breath, exhale, and hold again — then repeat.
- 4-7-8 breathing. Inhale for four counts, hold your breath for seven, and exhale for eight counts.
- Diaphragmatic or belly breathing. Lie on your back, put your hand on your belly, breathe in through your nose to let the air fill up your belly. Watch the air push your hand up, then exhale and watch your hand fall.
Slowing your breathing down can help interrupt the adrenaline-driven cycle, says Sylvester.
Use cold water
A sip or splash of cold water may help pull you back into your body. Even putting a bit of cold water on your hands can help. The relaxing, cool water may help you feel safer, more present, and more in control as the panic passes.
Are there complications of panic attacks?
Panic attacks themselves aren't harmful. But if attacks last longer or worsen, certain behaviors can lead to health disorders as you deal with them. Dealing with panic attacks can be hard and take a toll on your emotional and physical life.
"The attacks themselves don't directly lead to other physical or mental health conditions," says Sylvester. "But how you respond to and cope with your recurrent panic attacks can lead to other serious behavioral health disorders."
You may develop health problems such as:
- Agoraphobia (fear of open or public spaces)
- Anxiety disorders
- Bipolar disorder
- Depression
- Heart disease
- Irritable bowel syndrome
- Lung problems
- Posttraumatic stress disorder
- Obsessive-compulsive disorder
- Substance abuse
- Thyroid problems
"Problematic coping mechanisms such as refusing to leave the home and using alcohol, cannabis, or other substances to prevent or cope with panic attacks can lead to social isolation, depression, and substance use disorders," says Sylvester.
Reach out to see your doctor if your panic attacks become frequent, disrupt daily life, cause substance abuse, or if you're socially withdrawn. Seeing your doctor sooner about early treatment can help you spot health challenges and prevent these issues.
When to call the doctor
A panic attack and a heart attack can look similar, and some people who get panic attacks can also have ideas about self-harm or suicide.
"Patients with panic disorder alone show a higher risk of developing suicidal ideations and engaging in suicidal behavior," says Sylvester. "Those ideas can significantly increase when panic disorder is combined with other mental health conditions such as substance abuse, depression, or bipolar disorder."
Get medical help right away if you have these symptoms:
- Thoughts about suicide or self-harm
- Chest pain
- Shortness of breath
- Nausea
- Pain in your back or jaw
If you can't get to an emergency room right away, you can also call the Suicide & Crisis Lifeline at 988 any time of the day or week. A licensed counselor can help.
How Does Counseling Help With Panic Attacks?
Counseling, also called "talk therapy," can help you find out what panic attacks are, why you're having them, and how to manage them. You'll sit down with a therapist and talk about your attacks.
Your treatment will focus on the feelings, thoughts, and situations that cause your attacks. You and your therapist will work on ways to handle panic attacks when they happen.
How does talk therapy work for panic attacks?
Talk therapy can teach you how to think and react in a calmer way during a panic attack and to safely face the physical sensations with relaxation techniques. You'll learn why you're having panic attacks, how to manage them, and how to ease the physical effects.
There are many types of therapy to treat panic attacks, but the two most common are:
Cognitive behavioral therapy (CBT). The goal of CBT is to teach you that it doesn't matter if you have a panic attack. You'll learn to replace your fear with newer information and other sensations. You and your therapist may:
- Look at the thoughts and reactions that can trigger panic
- Go through exercises where you experience mild versions of panic symptoms in a safe setting to help your mind and body respond more calmly over time
- Go on field trips and face situations you've been avoiding, showing you how to handle them without intense fear
Exposure Therapy (ET). This therapy exposes you to panic triggers in a safe, controlled space to help you face your fear regularly, over time. You might even make a log of physical symptoms and sensations so you can recreate them during your sessions.
Your therapist might:
- Slowly and safely introduce you to situations or sensations that usually trigger panic — this can be done in your imagination or real life
- Practice exposure in small steps to help make the situations feel safer
- Use relaxation tools, such as breathing exercises, along the way to help keep anxiety under control
These approaches focus on giving you practical skills that gradually help you regain a sense of control over your reactions and how you respond to panic triggers. Once you understand what's happening, those triggers have less power to cause trouble.
You'll learn to handle panic attacks more confidently and get through the attacks safely by confronting your fears head-on.
Which Medication Helps With Panic Attacks?
Many medications can help with panic attacks, but your doctor may suggest starting with a selective serotonin reuptake inhibitor (SSRI). Medication can be part of your treatment plan if panic attacks are starting to interfere with your day-to-day life.
Antidepressants
Often the first choice, antidepressants can ease your symptoms and make panic attacks easier to handle. Your doctor may suggest one medication or a combination, depending on what works best for you.
Your doctor may suggest an SSRI such as:
- Fluoxetine (Prozac)
- Paroxetine (Brisdelle, Paxil, Paxil CR, and Pexeva)
- Sertraline (Zoloft)
But if these SSRIs aren't helping you, your doctor may give you a serotonin-norepinephrine reuptake inhibitor (SNRI), tricyclic antidepressant, or monoamine oxidase inhibitor. And depending on your other medical conditions, you may get a medicine that acts faster.
Fast-acting relief
These benzodiazepines work quickly, which can be helpful during sudden or intense symptoms. Common options include:
- Alprazolam (Xanax)
- Lorazepam (Ativan)
But these medicines can be habit-forming, meaning your body may start to rely on them if you take them too often or for too long. So if you have substance abuse problems, your doctor may offer:
- Gabapentin (Gralise or Neurontin)
- Mirtazapine (Remeron and Remeron SolTab)
- Pregabalin (Lyrica and Lyrica CR)
You and your doctor may have to try more than one medication before finding what works best. All medications come with possible side effects. So talk with your doctor about the risks and what's safest for you, especially if you're pregnant or have other health conditions.
How Long Does It Take to Manage Panic Attacks?
Although the symptoms of a panic attack may get better after 10-30 minutes, managing attacks that keep coming back can take time. With medication, you might notice improvement after a few weeks.
For many people, panic attacks may get better or even disappear after a few months. That's because your doctor may adjust your medication, try different medicines, or combine them.
This can take several weeks before you feel the full benefits. Then you'll have occasional follow-up visits to help keep your symptoms in check and address any recurrences. You can also try lifestyle habits to help ease your panic attack symptoms.
What Else Helps With Panic Attacks?
In addition to your treatment, these everyday habits can make a difference:
- Yoga or deep breathing may relax your body and lower stress.
- Exercise can help calm your mind and offset potential side effects of medication, such as weight gain.
- Stay away from alcoholic drinks, caffeine, smoking, and recreational drugs, which can trigger attacks.
- Get enough sleep, so you don't feel draggy during the day.
You may also find chamomile helpful for easing mild anxiety and stress. It's still unclear if drinking chamomile tea can help, but it's generally safe for most people and may help you feel more relaxed.
Lifestyle habits that can help manage panic attacks
Along with your therapy and other treatments, certain everyday choices can help lower your chances of a panic attack. Here are a few things that you can try:
- Cut back or avoid things that make your anxiety worse, such as caffeine, alcohol, and smoking.
- Move your body regularly because physical exercise can make you feel less stressed and lift your mood.
- Choose nutritious foods and eat a balanced diet to support your body and mind.
- Make sure you get enough sleep to make it easier for you to handle stress.
- Find healthy ways to handle stress with techniques such as meditation, yoga, and breathing exercises.
Add these habits to your daily routine and therapy to make it easier when a panic attack comes up.
How Do You Get Support for Panic Attacks?
You can find support for panic attacks by asking your primary care provider or your mental health provider, like your therapist, psychologist, or psychiatrist. Family, loved ones, and clergy can also help provide support.
You can also find support groups through:
- Mental Health America
- Anxiety & Depression Association of America
- National Alliance on Mental Illness
- State mental health department
- Social worker
- Nonprofit organizations
Benefits of joining a panic attack support group
Support groups give you a place to connect with people who truly know what panic attacks feel like. You can share your experiences, learn new coping ways, and get support from others going through the same thing.
Being part of a group can ease feelings of isolation, help you feel less alone, and provide a safe space to talk openly about what you’re going through. Support groups can also help keep you motivated to face your fear.
Takeaways
With therapy and medication, you'll learn to calmly face your fear and safely use relaxation techniques to soothe panic attack symptoms. Talk to your doctor early about panic attack treatment and diagnosis to prevent health challenges before they start. But get medical help right away if you have thoughts about suicide, self-harm, chest pain, trouble breathing, nausea, or pain in your back or jaw.
Panic Attack Treatments FAQs
Can a panic attack cause a heart attack?
No, a panic attack can't cause a heart attack, but it can feel a lot like one. If you're having chest pain, a racing heartbeat, and shortness of breath that isn't going away, get medical care right away.
Panic attacks usually start suddenly, peak quickly, and ease within minutes. Heart attack symptoms often build slowly and last longer. It's best to let a doctor run tests to figure out if you're having a panic attack or a heart attack.
Can you pass out from a panic attack?
Yes, you might feel dizzy, lightheaded, or faint during a panic attack. These are normal fight-or-flight, physical reactions when your brain thinks you're in danger. While these sensations can be intense and uncomfortable, they aren't harmful, and you usually won't pass out.
Does drinking water help with panic attacks?
It might help to drink or sip cold water because the cold sensation can snap you back into your body. That's because feeling cold can turn on the opposite parts of your brain and nervous system — the parasympathetic nervous system.
The parasympathetic system relaxes you and can lessen the fight-or-flight response.
"If available, run your hands under water, splash your face with cold water, or drink ice water," says Sylvester. "Water sounds are soothing, and cold sensations activate the parasympathetic nervous system, which can reduce sympathetic activity contributing to the attack.”
