Panic attack: symptoms, what helps and when to get help

The NHS describes a rush of intense mental and physical symptoms that can come on very quickly and often for no apparent reason. The symptoms it 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, dry mouth, a feeling of dread or fear of dying, a churning stomach, tingling in the fingers and feeling disconnected from the body.

The NHS anxiety page adds a feeling of losing control, and breathing very quickly, and repeats that an attack usually lasts 5 to 20 minutes. The NHS recommends slow, deep breathing, and calming breathing exercises, as practical first steps.

The first attack is the one that most needs care. The NHS says that most panic symptoms can occur in other conditions. The table lists the main alternatives and the features that make them more likely.

The NHS advice for chest pain is to call 999 for sudden pain or discomfort in the chest that does not go away, pain spreading to the arms, neck, jaw, stomach or back, or chest pain with sweating, sickness, light-headedness or breathlessness. If you have never had a panic attack before, or the symptoms feel different from usual attacks, that advice takes priority over assuming it is panic.

For breathlessness the NHS says to call 999 for severe difficulty breathing where you are gasping or cannot get words out, a tight or heavy chest, pain spreading to the arms, back, neck and jaw, blue, grey or very pale lips or skin, or sudden confusion. NHS atrial fibrillation advice says to call 999 if you have a fast or irregular heartbeat with chest pain, shortness of breath, sweating, sickness, fainting, a severe headache, weakness or numbness on one side, blurred vision or loss of sight, or confusion or difficulty speaking.

The NHS also asks anyone in a mental health crisis, or supporting someone who is, to seek urgent help, and Samaritans can be contacted on 116 123 at any time.

• Chest pain or pressure that does not ease, or spreads to arm, jaw or back.

• Severe breathlessness, gasping, blue or grey lips.

• Fainting, weakness on one side, slurred speech or confusion.

• A first-ever attack with symptoms unlike anything before.

• Thoughts of self-harm or suicide.

• Attacks happening many times a week or leading you to avoid daily life.

The NHS says a GP will ask you to describe your symptoms, how often you get them and how long you have had them, and may carry out a physical examination to rule out other conditions. Panic disorder is diagnosed when attacks are regular and unexpected and followed by at least a month of continuous worry or concern about further attacks.

Questions also cover caffeine, alcohol, drugs, medicines, stress, bereavement or trauma, and family history. The NHS says panic disorder is thought to be linked to a combination of things, including a traumatic or very stressful life experience such as bereavement, having a close family member with panic disorder, and imbalance of chemical messengers in the brain.

Where the heartbeat is a concern, CKS describes a 12-lead ECG ideally during an episode, blood tests for causes such as thyroid disease or anaemia, and further monitoring depending on findings.

The NHS suggests: stay where you are if possible, breathe slowly and deeply, remind yourself that the attack will pass, focus on positive, peaceful and relaxing images and remember it is not life threatening. Its anxiety page advises calming breathing exercises or meditation and not avoiding situations that make you anxious, but building up time in them gradually.

The NHS advises not to try to do everything at once, to set small achievable targets and to avoid using alcohol, cigarettes, gambling or drugs to relieve anxiety, because they can contribute to poor mental health. It adds that avoiding sugary food and drinks, caffeine and alcohol, and stopping smoking, may help prevent further attacks.

The NHS says talking therapies and medicine are the main treatments. Cognitive behavioural therapy teaches ways to keep calm during an attack and to change patterns of behaviour; you can refer yourself to a talking therapies service in England, or be referred by a GP. Where appropriate, a doctor may prescribe a selective serotonin reuptake inhibitor (SSRI) or, if that is unsuitable, a tricyclic antidepressant, or in some cases an anti-epilepsy medicine such as pregabalin or, when anxiety is severe, clonazepam.

The NHS says antidepressants can take 2 to 4 weeks to start working and up to 8 weeks to work fully, and that you should keep taking them even if you feel they are not working and only stop on a GP's advice. If symptoms do not improve after CBT, medicine and support groups, a GP may refer to a psychiatrist or clinical psychologist.

The NHS says untreated panic disorder can escalate and raises the risk of agoraphobia, other phobias and alcohol or drug problems, and that it can affect the ability to drive, in which case the DVLA must be informed about a condition that could affect driving.

A GP for a first attack or when attacks are recurring; an NHS talking therapies service, which adults can contact directly; support organisations such as Anxiety UK, Mind, No Panic and Triumph Over Phobia, all of which the NHS lists; and a mental health specialist if treatment in primary care has not helped. Children with signs of panic disorder should see a GP, who will examine them to rule out physical causes and may refer for specialist assessment.