DoseStreaks
Health library
Mental health

Panic attacks – what is happening, and how to ride one out

A panic attack feels like dying and is not dangerous. Understanding the mechanism is most of the treatment, because the fear of the next one is what keeps them coming.

What is actually happening

A panic attack is the body's alarm system firing at full strength with no threat present. Adrenaline floods the system: the heart races, breathing speeds up, the chest tightens, hands tingle, the world feels unreal, and there is an overwhelming sense of impending death or losing control.

It peaks within about ten minutes and passes. It is intensely unpleasant and it is not dangerous — it will not stop your heart, suffocate you or make you lose your mind. Knowing that is not a platitude; it is the single most effective thing, because the fear of the sensations is what escalates them.

Getting through one

  1. Name it: 'this is a panic attack, it peaks and passes'. Saying it aloud helps more than thinking it.
  2. Slow the OUT-breath specifically. Breathe in for about four, out for about six or seven. The long exhale is what calms the nervous system.
  3. Stop fighting the sensations. Trying to make them stop adds fear; letting them be there without resisting shortens the attack.
  4. Ground yourself in the room: five things you can see, four you can touch, three you can hear.
  5. Stay where you are if you safely can. Fleeing teaches the brain the place was dangerous, which is how avoidance builds.
  6. Afterwards, expect to feel drained. That is the adrenaline clearing, not damage.

Stopping the cycle

Panic disorder is not really about the attacks — it is about the fear of having one, and the shrinking of life that follows as places and situations get avoided. That is what treatment targets, and it works well.

  • Cognitive behavioural therapy is first-line and has strong evidence, specifically the part that involves gradually facing avoided situations.
  • Regular exercise measurably reduces panic frequency.
  • Cut caffeine — it is a direct trigger and many people with panic are drinking a lot of it.
  • Reduce alcohol. It calms in the evening and rebounds into anxiety the next day.
  • Sleep, which is both a trigger when short and a casualty of the disorder.
  • Antidepressant medication is effective for panic disorder and is usually preferred over sedatives for long-term use.

Used for panic disorder, prescribed and reviewed:

  • Escitalopram — Cipralex, Lexamil, Adco-Escitalopram, Ecytara

    Major depressive disorder; generalised anxiety disorder; social anxiety disorder; panic disorder

  • Sertraline — Zoloft, Serdep, Adco-Sertraline, Lustral

    Major depressive disorder; OCD; PTSD; social anxiety disorder; panic disorder

  • Fluoxetine — Prozac, Lorien, Adco-Fluoxetine, Nuzak

    Major depressive disorder; anxiety disorders; PTSD; OCD; bulimia nervosa

  • Venlafaxine — Efexor, Efexor XR, Venlor XR, Sandoz Venlafaxine

    Major depressive disorder; generalised anxiety disorder; social anxiety disorder; neuropathic pain

Making sure it is panic

Common questions

Can a panic attack cause a heart attack?
No. A panic attack is an adrenaline surge in a healthy heart and does not damage it. The symptoms overlap enough that a first episode should be checked, but recurrent, recognisable panic attacks are not harming your heart.
Should I breathe into a paper bag?
No — that advice is outdated and can be dangerous if the cause is not hyperventilation, for example an asthma attack or a heart problem. Slowing the out-breath achieves the same thing safely.
Why do they happen when nothing is wrong?
They often arrive at rest, or even from sleep, precisely because there is no external threat to explain the sensations — so the brain concludes the danger must be internal. That is a false alarm, not a sign something is being missed.

Sources

Last reviewed 4 August 2026.