Panic Disorder and Panic Attacks

What is Panic Disorder/Panic Attacks?

In the United States, roughly 50% of people with panic disorder experience both unexpected and expected panic attacks.

Panic disorder is diagnosed by mental health professionals and given to people who experience recurrent unexpected panic attacks which often times stop you from performing every-day tasks.

Unexpected panic attacks are those that appear out of the blue.  The term recurrent refers to the fact that an individual has had more than one unexpected panic attack in their lifetime. 

Expected panic attacks, in contrast, are those that people experience when there is an obvious cue or trigger, such as a specific phobia or generalized anxiety disorder.

The length of time for panic attacks vary by individual. Typically, the attacks reach their peak within 10 minutes or less and then symptoms begin to subside. Panic attacks rarely last for more than an hour, with most lasting for around 20 to 30 minutes.

If you are prone to experiencing racing thoughts, negative emotions, and experience anxiety, you may be at risk for being diagnosed with panic disorder. Experience of sexual or physical abuse in childhood, smoking, and interpersonal stressors in the months before the first panic are also risks for developing the disorder.

Genetics are believed to also play a role in predisposition to having panic disorder, although the exact genes, that are implicated are not yet known. Individuals with a parent or parents diagnosed with anxiety, depression, or bipolar disorder are also thought to be at a higher risk of developing panic disorder.

What Does a Panic Attack Feel Like?

Panic attacks are not life threatening but can feel extremely terrifying for the individual experiencing the attack. Some people mistake panic attacks for heart attacks and many believe that they are dying. Others feel a mixture of self-doubt or impending doom. Others feel an overwhelming sensation of emotion and cry.  Some can also find the episodes extremely embarrassing and refrain from telling their friends, family, or a medical professional. 

While panic attacks cause a variety of physical issues and many people reporting feeling like they are about to die when experiencing one, you cannot die from a panic attack.

What are the Symptoms of Panic Disorder?

According to the DSM-V book, the symptoms of panic attacks are:


  • Suicidal Thoughts 
  • Fear or losing control or “going crazy”
  • Fear of dying
  • Fear of events that have not happened
  • A sense of being detached from yourself or your surroundings, or observing yourself from outside your body


  • Shortness of breath
  • Crying 
  • Nausea 
  • Palpitations, pounding heart, or accelerated heart rate
  • Sweating
  • Trembling or shaking
  • Feelings of choking
  • Chest pain or discomfort
  • Feeling dizzy, unsteady, light-headed, or faint
  • Chills or heat sensations
  • Numbing or tingling sensations (commonly referred to as “pins and needles”)

Panic attacks may also be caused by medical conditions and other physical causes. If you’re suffering from symptoms of a panic attack, it’s important to see a doctor to rule out the following possibilities:

  1. Hypoglycemia- also known as low blood sugar. Feelings of sugar dropping mau mimic a panic attack. 
  2. Mitral valve prolapse, a minor cardiac problem that occurs when one of the heart’s valves doesn’t close correctly
  3. Hyperthyroidism (overactive thyroid gland)
  4. Stimulant use (amphetamines, cocaine, caffeine)
  5. Medication withdrawal

How to Stop a Panic Attack?

No matter how scared you may feel during your panic attack, it’s important to know that there are many techniques you can practice to help yourself reduce the severity of your symptoms and to distract your mind. The following self-help techniques can make a big difference to helping you overcome panic:

  • Practice The Boxed Breathing Technique

Shortness of breath is a common symptom of panic attacks that can make you feel frantic and out of control. Acknowledge that your shortness of breath is a symptom of a panic attack and that this is a temporary feeling. Then practice the boxed breathing technique. Begin by taking a deep breath in for a total of four seconds, hold for four seconds, and release it for a total of four seconds, hold for four seconds. Keep repeating this pattern until your breathing becomes controlled and steady. Focusing on the count of four not only will prevent you from hyperventilating, but it can also help to stop other symptoms in their tracks.

  • Use Muscle Relaxation Techniques

Muscle tension is another symptom you may experience during a panic attack. It is inevitable that you may feel that you have lost control of your body. Muscle relaxation techniques allow you to gain back some of your control. A simple exercise you can follow is as follows: Start by clenching your fist and holding this clench until the count of 10. Once you get to 10, release the clench and let your hand relax completely. Next, try the same technique in your feet and then gradually work your way up your body clenching and relaxing each muscle group: legs, glutes, abdomen, back, hands, arms, shoulders, neck, and face.

  • Repeat a Mantra

While this may seem a tad awkward in practice, however repeating an encouraging, positive mantra to yourself during a panic attack can help lessen the symptoms. Try repeating something as simple as “I am okay” or “I’m not going to live a long life. I just need to breathe.”

  • Spell out Words

Pick an object that you see in front of you. Ask yourself “what is this object?” And then answer that question by spelling it out. For example, you see a lamp. Ask yourself, what is that? And answer “l-a-m-p”. Spelling words can be a distraction and diminish your symptoms. 

How to Treat a Panic Attack

Treating Panic Attacks can help reduce the intensity and frequency of your symptoms and improve your function in daily life. The two main treatment options are psychotherapy and medication management. Both treatment types may be recommended, depending on your preference, your history, the severity of your symptoms and whether you have access to therapists and medical professionals who have special training in treating panic disorders.


Talk therapy, also known as Psychotherapy, is considered to be effective, and the first choice treatment for panic attacks and panic disorder. Talk therapy can help you understand your panic attack symptoms, and learn coping exercises to continue improving functions of daily life. 

Cognitive behavioral therapy, or CBT, can help you learn, through your own experience, that panic symptoms are not dangerous. While meeting with your therapist, your sessions will help you slowly re-create the symptoms of a panic attack in a safe, repetitive manner. Once the physical sensations of panic no longer feel like a threat or dangerous to you, the attacks will begin to resolve. Successful treatment can also help you overcome fears of situations that you’ve avoided because of panic attacks.

Results from talk therapy treatment can take time and effort on your part. You may start to see panic attack symptoms reduce within several weeks, and often symptoms decrease significantly or go away within several months. You may schedule occasional maintenance visits to help ensure that your panic attacks remain under control or to treat recurrences.

Medication Management 

Meeting with a mental health Medical Professional can be another way to reduce symptoms associated with panic attacks. A few types of medication have been shown to be effective in managing symptoms of panic attacks, including:

  • Selective serotonin reuptake inhibitors (SSRIs)/ Antidepressants. These medications are generally safe with a low risk of serious side effects, SSRI antidepressants are typically recommended as the first choice of medications to treat panic attacks. SSRIs approved by the FDA for the treatment of panic disorder include fluoxetine (Prozac), paroxetine (Paxil, Pexeva) and sertraline (Zoloft). 
  • Serotonin and norepinephrine reuptake inhibitors (SNRIs). These medications are another class of antidepressants. The SNRI venlafaxine (Effexor XR) is FDA approved for the treatment of panic disorder.
  • Benzodiazepines. These sedatives are central nervous system depressants. Benzodiazepines approved by the FDA for the treatment of panic disorder include alprazolam (Xanax) and clonazepam (Klonopin). Benzodiazepines are generally used only on a short-term basis because they can be habit-forming, causing mental or physical dependence. These medications are not a good choice if you’ve had problems with alcohol or drug use. They can also interact with other drugs, causing dangerous side effects.

If one medication doesn’t work well for you, your doctor may recommend taking an in-office DNA test to determine which medications will be most effective for you. Switching to a medication that the DNA test suggests can boost effectiveness of your treatment. 

Please keep in mind that it can take up to 6 weeks after you first started a medication to notice an improvement in symptoms.

All medications have a risk of side effects, and some may not be recommended in certain situations, such as pregnancy. Meet with your doctor about possible side effects and risks. 

It is highly recommended that your treatment combines talk therapy with medication management in order to achieve optimal effectiveness and decreasing your symptoms.