Panic disorder symptoms and treatment

A panic attack is a sudden wave of intense fear that peaks within minutes, often with a pounding heart, shortness of breath and a feeling that something terrible is happening. Panic attacks are frightening but not dangerous. Panic disorder is when the attacks keep coming out of the blue and you start to worry about the next one, or change your life to avoid them. It's very treatable.

What does a panic attack feel like?

During a panic attack, you might feel:

• A pounding or racing heart
• Sweating, trembling or shaking
• Shortness of breath, or a feeling of choking
• Chest pain or tightness
• Nausea or stomach discomfort
• Dizziness or lightheadedness
• Chills or hot flashes
• Numbness or tingling
• A sense of unreality, or of being detached from yourself
• Fear of losing control, going crazy or dying

Attacks usually peak within about 10 minutes and fade after that, though you may feel drained for hours.

If you have chest pain, especially for the first time, get checked right away. Panic attacks can feel like a heart attack, and only a medical exam can tell the difference.

When are panic attacks panic disorder?

Many people have a panic attack at some point, often during a stressful time. Panic disorder means the attacks happen repeatedly and unexpectedly, and for at least a month afterward you either worry a lot about having more, or change what you do to avoid them, like skipping the gym, highways or crowded places.

Over time, some people start avoiding so many places that their world gets smaller. This is called agoraphobia, and it's treatable too.

If you're not sure, the free panic attack self-check uses the panic questions from the Patient Health Questionnaire (PHQ), which clinicians use to screen for panic disorder. It takes about two minutes. Panic often comes with ongoing worry, so the anxiety self-check can also be useful.

Not sure whether what you had was a panic attack or an anxiety attack? Our post on panic attack vs anxiety attack explains the difference.

How common is panic disorder?

About 2.7% of US adults have panic disorder in a given year, and about 4.7% will have it at some point in their lives, according to the National Institute of Mental Health (NIMH). It often starts in the late teens or early adulthood and is more common in women.

What causes panic disorder?

Panic disorder tends to run in families. Major stress, big life changes and a tendency to be very aware of body sensations can also play a part. Caffeine, nicotine, some medications and stopping alcohol or certain drugs can trigger attacks.

Some medical conditions can cause similar symptoms, including heart rhythm problems, thyroid problems and asthma. That's why a doctor may want to check your physical health first.

How is panic disorder diagnosed?

A clinician diagnoses panic disorder by asking about your attacks: what they feel like, how often they happen, whether they come out of the blue, and how they've changed your life. Your doctor may do a physical exam, an ECG or blood tests to rule out heart or thyroid problems.

How is panic disorder treated?

Cognitive behavioral therapy (CBT) is one of the most effective treatments. You learn how panic works, how to stop fearing the physical sensations, and how to gradually return to places you've been avoiding. Many people see big improvements within a few months.

Medication. SSRIs and SNRIs, two families of antidepressants, are common first choices. They take a few weeks to work and are taken daily to prevent attacks. Benzodiazepines can stop attacks quickly but can be habit-forming, so they're generally meant for short-term use.

What helps during an attack. Slow breathing, reminding yourself that the attack will pass and can't hurt you, and letting the sensations rise and fall without fighting them can make attacks shorter and less scary.

Who should I see for panic attacks?

If you haven't had a checkup since the attacks started, see your primary care doctor first to rule out a physical cause. They can also prescribe common medications. For therapy, look for a therapist who offers CBT for panic disorder and ask about it when you call. A psychiatrist or psychiatric nurse practitioner can help if medication is needed or if first treatments haven't helped.

Our guides to psychiatrist vs therapist and how to find a therapist who fits can help you choose.

Does insurance cover panic disorder treatment?

Usually, yes. Most health plans cover therapy and medication visits for panic disorder, and federal parity rules mean most plans can't make mental health care harder to use than comparable medical care. See how much does therapy cost for typical prices.