What Are the Symptoms of a Panic Attack? What to Do During an Attack?

The symptoms of a panic attack manifest as an intense, sudden feeling of fear, accompanied by overwhelming physical reactions like a racing heart, shortness of breath, sweating, and trembling. Even though there is no real danger present, this powerful false alarm from your body can make you feel as though you are having a heart attack or completely losing control. Knowing the right breathing techniques and taking steps to calm your body during an episode can make it much easier to get through this challenging experience.

At a Glance:

• Attacks usually start suddenly and reach their peak intensity within 10 to 20 minutes.
• Although the physical symptoms are deeply unsettling, a panic attack does not pose a direct threat to your life.
• Unlike a heart attack, chest pain during a panic attack typically occurs while resting rather than during physical exertion.
• It is a highly manageable condition with cognitive behavioral therapy and, when necessary, medical support.
• Shifting your focus to the outside world and taking slow, deep breaths during an attack helps alleviate the symptoms.

What Is a Panic Attack?

A panic attack occurs when the body's natural "fight or flight" response is suddenly and intensely triggered without any concrete threat. To survive a moment of danger, the human body releases adrenaline, accelerates the heart rate, and pumps more blood to the muscles. In a person experiencing a panic attack, the amygdala—the part of the brain that processes emotions—sounds a false alarm, initiating this chain of physical reactions. The person feels as if they are in grave danger.

This condition, which is quite common in society, typically begins in young adults in their 20s and 30s. It is seen approximately twice as often in women as in men. While many people may experience a single attack in their lifetime, if these attacks constantly recur and the person begins to live in fear of having another one, it is diagnosed as panic disorder. For individuals living in a bustling, fast-paced metropolis like Istanbul, the accumulation of daily stress can significantly increase the frequency of such anxiety-related issues.

Causes and Risk Factors

While there is no single definitive cause of panic attacks, they are known to arise from a complex combination of genetic, biological, and environmental factors. People with a family history of panic disorder or anxiety have a higher likelihood of experiencing this condition due to genetic predisposition. Imbalances in brain chemistry, particularly differences in how neurotransmitters like serotonin and noradrenaline function, can also pave the way for attacks.

Environmental factors and major life events are among the biggest triggers. Significant sources of stress, such as the loss of a loved one, a divorce, sudden unemployment, or moving to a new city, can make the nervous system hypersensitive. Past physical or emotional traumas may also surface years later as a panic attack. Furthermore, excessive caffeine consumption, smoking, irregular sleep patterns, and certain stimulants can overly excite the nervous system, noticeably increasing the risk of an attack.

What Are the Symptoms of a Panic Attack?

A panic attack usually begins suddenly without any warning—whether you are resting, working, or even sleeping. The symptoms peak within minutes, creating an intense sense of terror. According to the diagnostic criteria of the American Psychiatric Association, for an episode to be considered a panic attack, at least four of the following physical and psychological symptoms must occur simultaneously:

• Severe palpitations or an accelerated heart rate
• Sweating, trembling, or a feeling of shaking
• Shortness of breath or a feeling of smothering/choking
• Chest pain or tightness in the chest
• Nausea or abdominal discomfort
• Dizziness, lightheadedness, or feeling faint
• Chills, shivering, or hot flashes
• Numbness or tingling sensations in various parts of the body (especially the hands and lips)
• A feeling of detachment from reality (derealization) or being detached from oneself (depersonalization)
• Fear of losing control or "going crazy"
• Fear of dying

These symptoms are so powerful that, in the moment, the person truly believes they are experiencing a physical collapse. Once the attack passes, it leaves behind a profound sense of fatigue and exhaustion.

Heart Attack or Panic Attack? How to Tell the Difference

Because they share common symptoms like chest pain and palpitations, patients' biggest fear is that they are having a heart attack. However, there are distinct differences between the two. In a heart attack, the chest pain is usually described as a pressing, crushing, or heavy sensation, and this pain radiates to the left arm, jaw, back, or stomach. It typically begins during physical exertion, such as climbing stairs or lifting something heavy, and does not go away immediately with rest.

In a panic attack, the chest pain is more likely to be sharp, stabbing, and localized. It usually occurs suddenly while the person is resting. An attack generally peaks within 10-20 minutes and gradually subsides, whereas heart attack symptoms tend to worsen over time. If you would like to learn more about irregular heart rhythms, you can review our article titled What Causes Heart Palpitations (Arrhythmia)? When Is It Dangerous? However, if you are experiencing severe chest pain for the first time, you should seek immediate medical help rather than trying to make the distinction yourself.

Diagnosis: How Is It Diagnosed at the Hospital?

When a person experiencing panic attack symptoms visits the hospital, the physicians' first priority is to rule out any physical illnesses that could be causing these symptoms. In the emergency room or cardiology clinic, a detailed physical examination is performed first. An Electrocardiogram (ECG) is taken to check heart health, and if necessary, cardiac enzymes like troponin are analyzed in the blood.

Another step in the physical evaluation involves blood tests. An overactive thyroid gland (hyperthyroidism), vitamin deficiencies, or blood sugar imbalances can mimic the exact same symptoms. If no physical issue is found after tests like TSH (thyroid-stimulating hormone) and a complete blood count, the patient is referred to a psychiatrist. The psychiatrist will evaluate the frequency and duration of the symptoms, as well as their impact on daily life, to make a diagnosis of panic disorder.

Treatment: Home Care and Medical Methods

Panic attack treatment is a multifaceted process aimed at restoring the person's quality of life. The foundation of treatment consists of psychotherapy and, when necessary, medication. Cognitive Behavioral Therapy (CBT) has the highest success rate in this field. During therapy, the individual learns not to catastrophize bodily sensations, to face their fears, and to replace the negative thoughts that arise during an attack with rational ones.

For medication, antidepressants from the SSRI (Selective Serotonin Reuptake Inhibitors) group are generally preferred. These medications regulate the brain's chemical balance, reducing the frequency and severity of attacks. It usually takes 2 to 4 weeks for the medication to show its effects, so it is important to be patient and stick to the dosage recommended by your doctor. The treatment process can take months depending on the patient's condition, but full recovery is possible with regular follow-ups.

What to Do During an Anxiety Attack?

There are practical methods you can use at home or outside to regain control during an attack. The first step is breathing exercises that calm the body. Inhale deeply through your nose for 4 seconds, hold your breath for 7 seconds, and exhale slowly through your mouth for 8 seconds. This method slows the heart rate.

To shift your focus away from physical symptoms, you can use the "5-4-3-2-1 Grounding Technique." Mentally list 5 things you can see around you, 4 surfaces you can touch, 3 sounds you can hear, 2 things you can smell, and 1 thing you can taste. Additionally, splashing your face with cold water triggers a biological response called the mammalian dive reflex, which helps your nervous system calm down rapidly.

Complications and Risk Groups

If left untreated, panic disorder can lead to complications that severely restrict a person's life. The most common complication is agoraphobia. The individual begins to avoid places where they believe they wouldn't be able to get help or escape if they had an attack (such as crowded squares, public transportation, or elevators). Over time, this avoidance behavior can result in the person being unable to even leave their home.

Living with the constant fear that "another attack is coming" (anticipatory anxiety) paves the way for chronic stress and sleep disorders. Disruption of sleep patterns further negatively affects mental health. For detailed information on this cycle, you can check out our article Biological Clock and Depression: The Impact of Sleep Patterns. Furthermore, some patients may turn to alcohol or unprescribed medication in an attempt to suppress their anxiety, which brings along the risk of addiction.

When to See a Doctor?

If the attacks you are experiencing are becoming more frequent, preventing you from doing your daily tasks, or if you constantly carry the fear of the next attack, you should consult a psychiatrist without delay. Early intervention is a critical step in preventing the development of phobias and depression.

However, in some situations, it is necessary to go directly to the emergency room or call 112. If you are experiencing severe chest pain for the first time in your life, if the pain radiates to your left arm or jaw, or if shortness of breath is accompanied by cold sweats and a feeling of fainting, you should not interpret the situation as a panic attack; you must seek emergency medical help immediately. A suspected heart attack must always be treated as the top priority.

The Panic Attack Process at BHT CLINIC

At BHT CLINIC İstanbul Tema Hastanesi, we offer a multidisciplinary approach to the diagnosis and treatment of panic attacks and anxiety disorders. When you present to our 24/7 emergency department with severe physical symptoms, our specialist physicians will quickly perform detailed cardiological and internal examinations. Once it is determined that there is no physical risk, your care plan is safely mapped out.

For your long-term treatment, our specialist doctors in the Psychiatry department will step in. With personalized therapy plans and modern medical approaches, we help you bring the attacks under control and regain your quality of life. Bringing any previous test results and a list of medications you are currently taking when you visit our hospital will speed up the evaluation process.

Frequently Asked Questions

Can a panic attack happen in your sleep?

Yes, nocturnal panic attacks can occur. The person suddenly wakes up with shortness of breath, palpitations, and an intense feeling of fear. This usually happens a few hours after falling asleep and shares similar characteristics with daytime attacks.

Do panic attacks go away on their own?

A single panic attack episode usually ends on its own within 10 to 30 minutes. However, the underlying panic disorder that causes the attacks to recur does not tend to heal completely on its own without professional psychological or medical support.

Can a panic attack kill you?

No, no matter how severe and frightening the physical symptoms of a panic attack may be, it does not directly lead to death or a heart attack. This reaction from the body is entirely due to a false alarm from the nervous system and does not damage your organs.

Does drinking coffee trigger an attack?

Yes, consuming high amounts of caffeine can trigger panic attacks because it stimulates the nervous system and increases the heart rate. It is recommended that individuals prone to anxiety limit their consumption of tea, coffee, and energy drinks.

Does eating sweets help during an attack?

Eating sweets during an attack does not directly stop a panic attack. However, because a sudden drop in blood sugar (hypoglycemia) can create symptoms similar to a panic attack, eating something might provide relief if the issue is blood sugar-related. For a genuine panic attack, breathing exercises are much more effective.

To protect your mental health and receive a personalized treatment plan, you can schedule a consultation with our specialist physicians via our BHT CLINIC Appointment page.

This article is for informational purposes only; please consult your physician for diagnosis and treatment.