Psychiatric Care for Panic Attacks

A panic attack is a sudden surge of intense fear with physical symptoms such as a racing heart, chest tightness, shortness of breath, dizziness or a sense of doom. In panic disorder, attacks recur and people begin to fear the next one, often avoiding places or situations where attacks happened. The symptoms are real, distressing and treatable.

How our physicians help

Our physicians first make sure the symptoms are not due to a medical cause, then explain what is happening in the body during an attack. Care can include cognitive behavioral therapy for panic, and medication when appropriate, monitored by the same physician. For young people, we involve parents in the plan.

How panic disorder shows up in adults

• A wave of fear that can hit out of nowhere, peaks within minutes, and leaves you shaky and drained.
• Sweating, trembling, chills, tingling hands, or a feeling that you or the room is not real.
• An emergency room visit, sure it was your heart, then normal test results.
• Checking your pulse often, or always knowing where the nearest exit is.
• Skipping the gym, coffee, highways or trains for fear of setting off another attack.

Panic in children and teens

Without words for a panic attack, a young person may seem to have a stomach bug or a behavior problem.

• Sudden trips to the school nurse with a pounding heart, nausea or trouble breathing.
• Calling home to be picked up, then seeming fine an hour later.
• New refusal of the bus, gym class, assemblies or field trips.
• Wanting a parent close by at all times after an attack.

How panic disorder is diagnosed

One panic attack does not mean panic disorder. The diagnosis fits when attacks keep coming without warning and, for a month or more, you worry about the next one or change your life to avoid it. Attacks can also happen within other conditions, such as a phobia or PTSD, so we ask what came right before each one. We also ask about agoraphobia, a fear of places where getting out or getting help might be hard, such as buses, bridges or crowds.

Panic can mimic physical illness, so we review what has already been tested. Thyroid disease, heart rhythm problems, asthma, caffeine, stimulants, cannabis, and withdrawal from alcohol or sedatives can all cause similar symptoms.

Treatment options for panic

Cognitive behavioral therapy (CBT) for panic targets the fear of your own body's signals. You learn how a normal flutter can spiral when the mind reads it as danger. With a therapist's guidance, you then practice bringing on harmless sensations, such as a fast heartbeat from exercise, so your brain stops treating them as a threat. You also return to avoided places step by step and give up safety habits, like needing an aisle seat. Feeling the sensations on purpose is hard at first.

SSRIs and SNRIs, antidepressants that also lower the tendency toward panic, are the usual medicines for preventing attacks. They build up over several weeks, and the early days can bring jitters that feel a lot like panic. Benzodiazepines act fast, but sedation and dependence are risks, and they may get in the way of learning that the sensations are safe. Coming off them takes a plan made with your physician. For young people, therapy usually comes first. If an antidepressant is considered, parents hear its risks, including a warning about new or worse suicidal thoughts, and we follow up closely.

When to get help, and how to support someone

Reach out if attacks keep coming, if they are shaping your plans, or if you have stopped driving, exercising or going places alone.

If you are with someone during an attack, stay calm and stay close. Speak slowly and remind them it has passed before. Later, encourage small steps back to the places they avoid, and try not to take over the things they fear.

Repeated attacks can be exhausting and lonely, and many people do improve with care. If panic has left you feeling hopeless or you are thinking about suicide, call or text 988 (the Suicide & Crisis Lifeline) or call 911. We are not an emergency service.

Find your doctor for panic disorder →