​Panic Attacks: Explore Causes, Symptoms, and Treatment Options

Intense Fear of a Panic Attack

You can't stop it but its going to be okay.

What Is Panic Disorder?

Panic disorder involves sudden episodes of intense fear or apprehension. People often describe it as a sense of dread, loss of control, or even fear of dying. During an attack, some may feel disconnected—visually, physically, or mentally—from their surroundings. This disconnection is known as depersonalization (feeling detached from oneself) and derealization (feeling detached from reality).

These episodes can strike at any time—even during sleep—and may occur daily or infrequently. Regardless of frequency, they’re deeply distressing for those affected.

Panic episodes are explored in more detail throughout this guide—Panic Attacks: Exploring Causes, Symptoms, and Treatment Options—to help you understand what they are, why they happen, and what can help.

Impact on Daily Life

As you can imagine, panic disorder can severely disrupt daily functioning. The unpredictability and intensity of symptoms can lead to avoidance behaviors or heightened anxiety about future attacks.

What Causes Panic Attacks?

The root cause often lies in the amygdala, the brain’s fear center, which becomes overactivated. This tends to be more common in people with generalized anxiety disorder, depression, or those facing intense stress, whether real or perceived. Genetics can also play a role.

As outlined in Panic Attacks: Exploring Causes, Symptoms, and Treatment Options, panic-related symptoms can be alarming, especially when they mimic other serious conditions.

Common Physical Symptoms

During a panic attack, people may experience:

• Diaphoresis (sweating)

• Palpitations

• Tachycardia (heart rate ≥ 120 bpm)

• Tachypnea (fast breathing)

• Nausea

• Dizziness

• Numbness or tingling of fingers or toes

• Shortness of breath (cannot catch one's breath)

  
  

These symptoms often mimic those of other conditions like asthma, heart attacks, and pulmonary emboli (blood clots in the lungs), making panic attacks particularly frightening.

​How to Check Your Pulse During an Episode

These days, a person can check their pulse on an Apple Watch, or it can be checked by gently placing two fingers on the thumb side of the wrist, feeling for pulsations. The beats should be counted for 60 seconds (as seen in the photo below).  

Checking a Pulse

In younger individuals—especially teens to those in their early 30s—panic attacks can occur when anxiety and life’s pressures pile up. If someone with a history of anxiety starts experiencing the symptoms described above, it’s likely a panic attack. However, if these symptoms arise for the first time, it’s important not to assume. 

When to Seek Help and What to Do During a Panic Attack

For Those Who Have NEVER had a panic attack:

If someone experiences symptoms like chest pain, rapid heartbeat, or shortness of breath—and it’s their first time—they should not assume it’s just a panic attack. A medical evaluation is essential to rule out other serious conditions, including cardiac issues. When possible, underlying causes should be evaluated during the event itself. And if in doubt, call 911, especially if symptoms are intense or unfamiliar. Sometimes, a fast heart rate may stem from an undiagnosed cardiac arrhythmia.

For those with a history of panic attacks:

If hyperventilation occurs—especially with numbness or tingling in the hands or feet—sitting down and breathing into a paper bag for a minute or two may help regulate breathing and reduce symptoms.

Anyone experiencing panic attacks should consider talking to a counselor. Relaxation techniques, such as guided breathing or progressive muscle relaxation, can be beneficial. And in some cases, medication may be an important part of treatment (see below).

The reassuring news is this: a panic attack is not fatal. At worst, a person may faint and regain consciousness shortly afterward.

If in doubt, call 911

Panic Attacks: Exploring Causes, Symptoms, and Treatment Options

Treatments Approaches to Panic and Anxiety

There are a lot of possible approaches to improve anxiety and panic, which is good because not everyone will respond to one approach, and not everyone will like the same approach. In serious cases, medication along with therapy is the best way to go but again, not all people care for one or the other.

Most of the following approaches and treatments are similar to the approaches to generalized anxiety:

​General Approaches to Anxiety

• First of all, try to attack this early, especially if it is escalating

• Acknowledge your feelings

• Staying present in the moment

• Relaxation exercises, mentioned many times in the above discussion, play a big role in reducing feelings of stress and anxiety:  

           -Deep breathing exercises

           -Progressive muscle relaxation techniques

           -Mindfulness (which reportedly helps the fronto-limbic, including the amygdala)

        areas of the brain - as evidenced by MRIs)

-Guided imagery

• Meditation

• Yoga

• Read self-help books

• Social support - Engage with Family, friends, or groups (even online)

• A healthy diet

• Exercise may help develop greater neuroplastic patterns so that you can "re-form" neurotransmission responsible for your anxious thoughts

• Journal - Write down your feelings and thoughts, as they happen or about things of the past

• Do things you enjoy

• Avoid alcohol and drugs (these are often a means of self-medication that are used by those who do not want to deal with therapy or other medications for mental health, but they eventually have harmful physical and neurological effects)

• Get enough sleep

• Get Counseling. Sometimes we get into a rut, and our brain keeps circulating the same anxious messages. Counseling helps you "retrain" your brain to learn other patterns and to see things from a different perspective (changes in neuroplasticity). Some of these approaches include:

            CBT - Cognitive behavioral therapy                                                                                  DBT - Dialectical Behavioral Therapy

            ERT - Emotion Regulatory Therapy

• EMDR - This is a really unusual treatment that often helps. It is reported to help to decrease activity in the amygdala (especially for trauma).

  
  

Over-the-Counter Medicines for the Treatment of Anxiety

There are few over-the-counter (commercial) treatments for anxiety, except possibly an antihistamine, which will help make a person possibly more relaxed and tired.

• Benadryl/diphenhydramine as directed over the counter

Considered Alternative and Herbal Approaches to Anxiety

(These may help on a long-term basis to decrease anxiety, but generally do not work immediately in a full-blown panic attack)

• L-Theanine

• ​Lemon balm

• ​Valerian

• Ashwagandha

• Magnesium

• Kava kava

• CBD or low dose medical marijuana

• Vitamins  B and D and Omega 3s

• Aromatherapy (especially lavender, chamomile, and others)

• 5-HTP

Prescriptive Treatments for Anxiety

• Barbiturates and benzodiazepines increase GABA (these work very well for episodic moments of great anxiety, for example, panic attacks, but both are potentially very addictive and should not be used on an ongoing basis)

• SSRIs - Selective serotonin reuptake inhibitors (common: Celexa/citalopram, Lexapro/escitalopram, Prozac/fluoxetine, Luvox/fluvoxamine, Paxil/paroxetine, Zoloft/sertraline, Trintellix/vortioxetine). These increase the availability of serotonin neurotransmitters for use in the brain. These work by enhancing cortical (thinking) processes (assists well with therapies) and possibly by decreasing excitation in the amygdala (emotion center). These often help decrease the incidence of panic attacks.

• SNRIs - Serotonin-norepinephrine reuptake inhibitors - (common: Effexor /venlafaxine, Cymbalta/duloxetine, and Pristiq/desvenlafaxine. These medications help decrease activity in the amygdala (therefore anxiety).

• Other Antianxiety Medications- Remeron/mirtazapine is used off-label for anxiety (not FDA approved for this problem). This medication increases the production of serotonin in the brain. Buspar/buspirone also increases serotonin (slows neurotransmission that causes anxiety) and decreases dopamine (an excitatory neurotransmitter in the amygdala).

Everyone has a different response to medications; People's brain structures and functions are similar, but when it comes down to it, everyone naturally has some differences in anatomy, in neurochemistry, and neurotransmission. Therefore, it is not surprising that people have some different responses to medications: What works for one may not work for another. These medications are like a shoe that fits: you have to try on a few different shoes before you find the one that fits.

There are many medications and many approaches that can help with anxiety. If your anxiety is making your life uncomfortable, if it is causing unhappiness or making it hard to function, talk to someone to see if there might be something you can do to help yourself out of that rut. Someone can help you.

If you are having problems with medications, please consider these things-

• Are you having side effects? Many can cause side effects, especially stomach symptoms in the beginning. Typically, these settle down. However, if your side effects are too bad, especially if you start feeling more anxiety or depression, talk to the person who prescribed them (ideally) or another healthcare provider.

• The medications don't seem to be helping? It typically takes these medications about two to three weeks to start working well. Don't give up and be sure not to skip any doses (you might end up on an emotional roller coaster ride!). If it continues to be ineffective, you may need an increased dose, an add-on medication, or a switch.

• Do you feel blunted? "I don't want to take these medicines. I don't don't seem to feel any emotion". This is a fairly common complaint about antianxiety (and antidepressant) medications. If this is occurring, and you think the loss of feelings is worse than your anxiety, you can have your prescriber change your medication to one that works in a different way, or you can try some therapy instead.

• I feel great, I think I will come off my medications. Not a good idea. Don't just drop off your medication - it's probably helping. Speak to your prescriber about decreasing it slowly so you don't end up in "shock" (too much of an anxiety rebound). I have met a lot of people who just drop off their medications, and they realize how bad they feel without them.

*Note: This information is for educational purposes only and isn’t a substitute for professional care. Always consult a healthcare provider if you’re unsure about your symptoms