Panic attacks: symptoms, what to do and how they are treated

A panic attack is a surge of anxiety that is out of proportion to what is happening around you. The NHS describes sudden, intense anxiety and fear, with a rush of mental and physical symptoms that can arrive for no apparent reason.

The physical symptoms the NHS lists are a racing heartbeat, feeling faint, sweating, nausea, chest pain, shortness of breath, trembling, hot flushes, chills, shaky limbs, a choking sensation, dizziness, numbness or pins and needles, a dry mouth and a churning stomach. NHS inform adds palpitations, ringing in the ears, a need to go to the toilet, shivering and shaking.

Alongside these are the frightening thoughts: a feeling of dread or a fear of dying, feeling that you are losing control, and feeling not connected to your body. The NHS also lists breathing very quickly and tingling in the fingers or lips.

Most of these symptoms can occur in other conditions or problems, so an episode may not always be a panic attack. The NHS gives the example that a racing heartbeat can be caused by very low blood pressure.

Both the NHS and NHS inform say most panic attacks last between 5 and 20 minutes. Some have been reported to last up to an hour. NHS inform suggests that in these cases one attack has probably followed straight after another, or high levels of anxiety have kept going after the first.

How often attacks happen varies a lot. The NHS says some people with panic disorder have them once or twice a month, while others have them several times a week.

The NHS and NHS inform give very similar advice. The central idea is not to fight the attack, because NHS inform says fighting a panic attack can often make it worse. Instead, accept that the attack is not life threatening and let it pass.

• Stay where you are, if you can.

• Breathe slowly and deeply.

• Remind yourself that the attack will pass and that it is not life threatening.

• Focus on positive, peaceful and relaxing images (NHS).

Sometimes the symptoms of a panic attack are so intense that they feel like a heart attack or like dying. NHS inform says people with panic disorder sometimes learn to recognise this sensation. If you have never had one before, or the pain is not like anything you have had, do not try to decide for yourself.

The NHS chest pain page says not to self-diagnose, and advises calling 999 for sudden chest pain or discomfort that does not go away. It says that in most cases chest pain is not caused by a heart problem, and that an often sharp, continuous pain triggered by worries or a stressful situation, with a faster heartbeat, sweating and dizziness, may be anxiety, depression or a panic attack.

Call 999 if you have chest pain that feels tight or like squeezing, pain that spreads to the arms, neck or jaw, severe difficulty breathing, or if someone has passed out and is not responding normally. The NHS says not to drive yourself to A&E.

The NHS says to call NHS 111 if you are suddenly more short of breath than usual, or have chest pain with sickness or a heart that is racing, going too slowly, skipping a beat or fluttering.

If panic is affecting your daily life, you are not looking after yourself or you are finding it hard to manage responsibilities, NHS inform advises contacting your GP practice, and it points to urgent mental health help for a crisis. NICE advises that someone who attends A&E with a panic attack should have the minimum investigations needed to exclude acute physical problems and then be referred back to primary care with written information about support.

Sometimes there is an obvious trigger and sometimes there is none. NHS inform says that for panic disorder the exact cause is not fully understood, but it is thought to be a combination of physical and psychological factors, including traumatic life experiences such as bereavement, having a close family member with panic disorder, an imbalance of neurotransmitters in the brain, over-breathing and catastrophic thinking.

The NHS adds that if you start to avoid places because you fear they will trigger another attack, you can end up living in fear of fear, which adds to the sense of panic and can cause more attacks.

One panic attack does not mean you have a disorder. NHS inform says that everyone who has panic disorder will experience panic attacks, but not everyone who has panic attacks has panic disorder. The diagnosis is made when attacks are recurring and unexpected and are followed by at least one month of continuous worry about having further attacks.

NICE guidance makes the same distinction and notes that appropriate treatment of a panic attack may limit the development of panic disorder. For the full diagnostic and treatment pathway, see the separate panic disorder guide.

For repeated attacks, the NHS says treatment aims to reduce how many attacks you have and ease the symptoms, and that talking therapies and medicine are the main treatments. A CBT-based talking therapy teaches you ways of changing your behaviour so that you stay calm during an attack.

To help prevent further attacks, the NHS suggests reading a CBT-based self-help book for anxiety, trying activities such as yoga and pilates, learning breathing exercises, taking regular exercise, and avoiding sugary food and drinks, caffeine and alcohol and stopping smoking, as these can make attacks worse. Its wider anxiety advice includes talking about your feelings, eating regular meals, and slowly building up time in situations you have been avoiding.

NICE says benzodiazepines are associated with a less good long-term outcome and should not be prescribed for panic disorder, and that antidepressants should be the only drug treatment used in the longer term.

The NHS says that if a child has the signs and symptoms of panic disorder they should see a GP. After taking a detailed medical history, the GP carries out a thorough physical examination to rule out physical causes, and may refer the child to a specialist for assessment and treatment, who may recommend a course of CBT.

More widely, the NHS says that for children whose anxiety affects school, home and social life, it is a good idea to seek professional help if it is not getting better or self-help is not working. The GP may refer to children and young people's mental health services (CYPMHS), and a child may be offered counselling or CBT, with medicines only usually prescribed by specialists if anxiety is severe.

On the NHS you can see a GP, or in England refer yourself directly to a local NHS talking therapies service without a GP referral. You need to be registered with a GP and aged 18 or over (16 or over in some areas); under 18s have a separate route through children and young people's services.

Some people pay for therapy privately instead. The NHS advises making sure a private therapist is registered with a professional organisation accredited by the Professional Standards Authority. NICE says CBT should be delivered by suitably trained and supervised practitioners in a total of 7 to 14 hours, usually weekly sessions completed within 4 months, so that is a useful benchmark when comparing offers.