If you have had a panic attack, you know how terrifying it can be. Many of my patients describe their first panic attack as feeling like they were dying — heart racing, chest tight, certain something was catastrophically wrong. Many ended up in an emergency room, only to be told their heart was fine.
That experience is real. What is happening in the body during a panic attack is physiologically intense. And it is also treatable.
What Is a Panic Attack?
A panic attack is a sudden surge of intense fear or discomfort that peaks within minutes and involves at least four of the following symptoms:
- Pounding or racing heartbeat (palpitations)
- Sweating
- Trembling or shaking
- Shortness of breath or feeling smothered
- Chest pain or discomfort
- Nausea or abdominal distress
- Dizziness, lightheadedness, or faintness
- Chills or hot flashes
- Numbness or tingling
- Feelings of unreality (derealization) or being detached from yourself (depersonalization)
- Fear of losing control or "going crazy"
- Fear of dying
What Causes Panic Attacks?
Panic attacks occur when the brain's alarm system — the amygdala — fires inappropriately. It is essentially a false alarm: your body launches a full fight-or-flight response in the absence of real danger.
Why this happens varies. For some people, there is a clear trigger — a crowded place, a medical procedure, a stressful life event. For others, attacks seem to come out of nowhere, which is particularly disorienting.
Risk factors include a family history of anxiety, high stress, certain medical conditions (thyroid disorders, cardiac arrhythmias), stimulant use, and caffeine.
Panic Attacks vs. Panic Disorder
Not everyone who has a panic attack develops panic disorder. Panic disorder is diagnosed when panic attacks recur unexpectedly and the person develops persistent concern about future attacks and/or changes their behavior to avoid situations where attacks might occur.
That behavioral avoidance — staying home, avoiding exercise, avoiding crowds, checking your pulse constantly — is often where panic disorder has its greatest impact on quality of life.
Treatment: What Actually Works
Panic disorder responds very well to treatment. The good news is that most people see meaningful improvement.
Cognitive Behavioral Therapy (CBT)
CBT is the most effective psychological treatment for panic disorder. It addresses the catastrophic thinking patterns that fuel panic, teaches breathing and grounding techniques, and uses graduated exposure to feared situations to reduce avoidance. A course of CBT for panic disorder typically produces lasting results.
Medication
SSRIs (such as sertraline, escitalopram, or fluoxetine) and SNRIs are first-line medications for panic disorder. They work by reducing the overall reactivity of the alarm system over time. They are not habit-forming and are taken daily — not just when attacks occur.
Benzodiazepines (such as clonazepam or lorazepam) are sometimes used short-term for acute panic but are generally not recommended as a long-term solution due to tolerance and dependence risks.
Immediate Techniques During a Panic Attack
- Slow your breathing — breathe in for 4 counts, hold for 4, out for 6
- Name five things you can see to ground yourself in the present
- Remind yourself: "This is a panic attack. It will peak and pass. I am not dying."
- Do not flee the situation if possible — leaving reinforces avoidance
Getting Help for Panic Disorder in Texas
If panic attacks are affecting your daily life, I encourage you to seek an evaluation. Heartland Psychiatry and Wellness provides telehealth psychiatric care across Texas. You can meet with me from your home — no commute, no waiting room — and we will build a treatment plan that addresses both the attacks and the anxiety around them.