Panic attacks: what they are and what to do during one
A panic attack is a sudden rush of intense fear that peaks within minutes, with a pounding heart, breathlessness, chest tightness, shaking, sweating, dizziness and a feeling of dying or losing control. It is the body's alarm firing with no real danger: terrifying but not dangerous, and most attacks settle within 5 to 20 minutes. Slow breathing and staying where you are, rather than running, help it pass. Repeated attacks with constant fear of the next one is panic disorder, which responds well to CBT and SSRI medicines. First-ever chest pain, especially over 40 or with diabetes, needs emergency assessment before anyone calls it panic.
Health writers · Aslam Clinic
A is a sudden wave of intense fear, with a racing heart, breathlessness, chest tightness, trembling and a certainty that something terrible is happening, that builds to a peak within minutes and then fades. It is the body's alarm system firing when there is no danger to respond to. It feels like a heart attack, a stroke or going mad, but a panic attack on its own does not damage the heart or the brain, and it always passes.
In Pakistan many people describe it as ghabrahat, or say dil ghabra raha hai: a sudden restlessness in the chest, a sense of dread, a need to get out. The word is accurate. What people are rarely told, after the ECG comes back normal and a doctor says "kuch nahi hai, tension hai", is that the problem has a name, a well-understood mechanism and treatments that work.
What a panic attack feels like
Doctors describe a panic attack as an abrupt surge of fear or discomfort with at least four of a recognised set of symptoms. Most people have far more than four:
- A pounding, racing or skipping heart ()
- Shortness of breath, or a feeling of being smothered or choking
- Chest pain, tightness or pressure
- Sweating, trembling or shaking, hot flushes or chills
- Dizziness, light-headedness or feeling faint
- Nausea or a churning stomach
- Numbness or tingling, often in the hands, feet or around the mouth
- Feeling unreal, or detached from your own body ()
- Fear of losing control, of going mad, or of dying
Most attacks last between 5 and 20 minutes, although the shaky, drained feeling afterwards can last for hours. Some attacks come in a clear situation, such as a crowded bazaar or a lift. Others come out of nowhere, including at night, waking a person from sleep. The unexpected ones are the most frightening, because there seems to be nothing to explain them.
Why it happens: a false alarm
The is the body's emergency setting. When the brain detects danger, adrenaline pours out, the heart speeds up to send blood to the muscles, breathing gets faster, and attention narrows onto the threat. Faced with a real danger, all of this is useful. In a panic attack the same system switches on with no danger present.
What turns a surge of adrenaline into a full attack is usually a loop. The heart speeds up; the person notices it and thinks "something is wrong with my heart"; that thought is itself frightening, so more adrenaline is released; the heart speeds up further. Fast breathing lowers carbon dioxide in the blood, which causes tingling fingers, light-headedness and a tight chest — sensations that seem to confirm the fear. This leap from a body sensation to the worst possible explanation is called , and breaking it is at the heart of treatment.
Panic attacks are more likely during periods of stress, poor sleep, heavy caffeine use (strong tea and energy drinks count), after stopping alcohol or sedatives, and in people who already have another anxiety problem or depression. A single attack is common and does not mean you have an illness.
Panic attack or heart attack?
The symptoms overlap, and nobody — not you, not your family, not a doctor at the bedside — can reliably tell them apart without an examination, an ECG and sometimes a blood test. That is why the rule is simple: a first episode is checked properly. Once a heart problem has been ruled out and the pattern is clear, you do not need to go to the emergency department for every attack.
| Feature | More typical of a panic attack | Needs emergency assessment |
|---|---|---|
| Who | Often younger, with past attacks of the same pattern | First-ever episode, especially over 40, or with diabetes, high blood pressure, smoking or heart disease in the family |
| Pain | Sharp or tight, often with tingling and fast breathing | Heavy, crushing or squeezing, spreading to the arm, jaw, neck or back |
| Course | Peaks within minutes and settles within about half an hour | Persists or keeps coming back, or comes on with exertion |
| Other signs | Fear, tingling, feeling unreal | Cold sweat, grey or pale skin, vomiting, collapse |
A doctor seeing someone with panic-like symptoms will usually also consider physical causes: an overactive thyroid, low blood sugar in people on diabetes medicines, heart rhythm problems, asthma, and stimulants or withdrawal from alcohol or sedatives. The investigations should be the minimum needed to rule these out — repeated tests after they are normal tend to feed the fear rather than settle it.
What to do during a panic attack
- Stay where you are if it is safe. If you are driving, pull over and park. Leaving the situation feels like it saves you, but it teaches your brain that the place was dangerous, which makes the next attack there more likely.
- Slow your breathing down. Breathe in gently through your nose for a count of about three or four, and out slowly through your mouth for a little longer. Slow, not deep gulps. This reverses the over-breathing that causes tingling and dizziness.
- Name it. Say to yourself: "This is a panic attack. It is adrenaline. It feels awful, but it cannot hurt me, and it will pass."
- Let the sensations come rather than fighting them. Trying to force the feelings away tends to intensify them. Treat them like a wave you are riding out.
- Put your attention on something outside you — the ticking of a clock, the items on a shop shelf, the feel of your feet on the floor — rather than scanning your chest.
- Afterwards, carry on with what you were doing if you can, rather than going home to lie down.
Panic disorder and agoraphobia
Panic disorder is diagnosed when attacks keep coming unexpectedly and, for at least a month, the person lives in fear of the next one or changes their life to avoid it. It is common: in the United States about 2.7% of adults have it in a given year, and it is roughly twice as common in women as in men. It usually starts in the late teens or early adulthood.
Left untreated, the avoidance tends to spread. A person who had an attack in a wedding hall stops going to weddings; then avoids crowded markets; then will only leave the house with a family member; then stops going out at all. This pattern is : fear of places where escape might be difficult or help unavailable. brings short-term relief, which is exactly why it keeps growing. The same goes for smaller "safety behaviours" — always carrying water, sitting near the door, checking your pulse — which stop you ever learning that the attack would have passed anyway.
Treatment that works
Panic disorder is one of the most treatable anxiety problems. NICE, which sets UK treatment standards, recommends a stepped approach: self-help based on CBT principles for milder problems, then or an antidepressant.
- CBT for panic, typically 7 to 14 hours in total, teaches how the panic loop works, tests the frightening predictions, and gradually brings on the feared sensations (for example by running on the spot or spinning in a chair) so that the body learns they are harmless. This is a form of , and it also means returning step by step to the places being avoided.
- such as sertraline, escitalopram, citalopram and paroxetine are the first-choice medicines. They take several weeks to work — usually two to six, and the full effect can take longer — and some people feel slightly more jittery in the first week or two, which usually settles. They are not addictive, but they should not be stopped suddenly; a doctor will reduce them gradually when the time comes.
- If an SSRI does not suit or does not help after about 12 weeks, a doctor may try another antidepressant such as venlafaxine, imipramine or clomipramine.
Faith and treatment are not in conflict. Many people find prayer, dhikr or recitation calming, and that is a real support. It works alongside treatment rather than instead of it, and needing treatment for panic is no more a sign of weak iman than needing treatment for asthma.
When to get help
A GP or physician can start treatment, and psychiatry departments at district (DHQ) and teaching hospitals see panic disorder routinely. Online CBT with a qualified clinical psychologist is an option where there is none nearby.
How family members can help
- Stay calm and stay with the person. Speak slowly and simply: "It's a panic attack, it will pass, breathe slowly with me."
- Do not crowd round, fan them or pour water on them — a ring of worried relatives makes it worse.
- Do not rush them out of the room or home unless there is a medical reason to go to hospital.
- After a first episode with chest pain, take them to be checked. After that, support them in seeking treatment rather than making repeated emergency visits.
- Encourage them to keep going to the places they fear, gently, rather than doing everything for them.
Common questions
Still not sure what to do?
Reading about a symptom only goes so far. A doctor who can ask you questions and examine you will get further in ten minutes than any article can.
