Panic Attack Treatment: What Helps and When to Get Care

Panic attacks are treatable. The approaches with the strongest evidence are cognitive behavioral therapy (CBT), especially a technique called interoceptive exposure, and daily antidepressant medications such as SSRIs or SNRIs, used alone or together (AAFP (opens in a new tab)). Before any of that, new chest pain or a racing heart deserves a medical check, because panic and heart problems can feel alike.

If you have had one frightening attack, or they keep coming back, this guide explains what is happening, what to do in the moment, and how treatment works over time.

What is the difference between a panic attack and panic disorder?

A panic attack is an abrupt surge of intense fear or discomfort that peaks within minutes and brings at least four physical or mental symptoms, such as a pounding heart, sweating, trembling, shortness of breath or a fear of dying. Panic disorder is diagnosed when attacks are recurrent and unexpected, and at least one is followed by a month or more of persistent worry about more attacks or a real change in behavior to avoid them (AAFP (opens in a new tab)). So one attack, on its own, does not mean you have panic disorder.

The National Institute of Mental Health lists the physical symptoms people describe most: a pounding or racing heart, sweating, chills, trembling, difficulty breathing, weakness or dizziness, tingly or numb hands, chest pain, and stomach pain or nausea. People with panic disorder often worry about when the next attack will come and start avoiding places where attacks have happened (NIMH (opens in a new tab)). About 2.7% of U.S. adults have panic disorder in a given year (NIMH (opens in a new tab)).

How long do panic attacks last? NIMH says an attack can last from a few minutes to an hour, or sometimes longer (NIMH (opens in a new tab)). MedlinePlus notes that an attack usually peaks within 10 to 20 minutes, although some symptoms can linger for an hour or more (MedlinePlus (opens in a new tab)).

Is it a panic attack or a heart attack?

You cannot reliably tell the difference on your own, especially the first time. Chest pain is one of the listed symptoms of a panic attack (NIMH (opens in a new tab)), and MedlinePlus notes that people often mistake a panic attack for a heart attack (MedlinePlus (opens in a new tab)). Panic attacks themselves are not life-threatening, but a heart attack is (NIMH (opens in a new tab)).

Once a clinician has examined you and you have a diagnosis of panic attacks, it becomes easier to recognize your usual pattern. Anything new or different, such as pain that feels unlike your usual attacks, still deserves medical attention.

Video · 23:18 · Cleveland ClinicHeart Attack vs. Panic Attack: How to Tell The Difference | Jacqueline Tamis-Holland, MD

What should you do during a panic attack?

These steps are for someone whose attacks have already been checked by a clinician. They will not stop every attack, but they can make one easier to ride out.

1. 01

   Step 1: Rule out an emergency first

   If this is the first time, or the chest pain feels different from your usual attacks, call 911. MedlinePlus says a first episode of hyperventilation (fast, deep breathing) may need emergency care (MedlinePlus (opens in a new tab)).

2. 02

   Step 2: Slow your breathing out

   Breathe out slowly through pursed lips, and breathe from your belly rather than your chest. A calm person speaking in a soft, relaxed voice can help too (MedlinePlus (opens in a new tab)).

3. 03

   Step 3: Name it and let it peak

   Remind yourself that this is a panic attack, that it usually peaks within minutes (AAFP (opens in a new tab)), and that panic attacks themselves are not life-threatening (NIMH (opens in a new tab)).

4. 04

   Step 4: Stay where you are if you can

   Avoiding places where attacks happened is one of the signs of panic disorder, and exposure-based therapy works by helping people face what they have been avoiding (NIMH (opens in a new tab)). If you are safe, letting the wave pass where you are helps more than escaping.

5. 05

   Step 5: Skip the drink and the extra coffee

   MedlinePlus suggests avoiding alcohol and reducing or avoiding caffeine, certain cold medicines and stimulants (MedlinePlus (opens in a new tab)).

6. 06

   Step 6: Write it down afterward

   Note the time, where you were, what you had eaten or taken (coffee, energy drinks, decongestants) and how long it lasted. A short log helps you and your clinician see patterns.

What physical causes should be ruled out?

Several medical problems and substances can cause panic-like symptoms or make attacks worse. A review in American Family Physician lists hyperthyroidism, heart rhythm problems (arrhythmias) and other heart and lung conditions; medications such as albuterol inhalers, levothyroxine and decongestants; and substances including caffeine, alcohol, cocaine, amphetamines and cannabis (AAFP (opens in a new tab)). MedlinePlus says a workup may include a physical exam, blood tests for thyroid problems and tests of heart health (MedlinePlus (opens in a new tab)).

This is why a good evaluation asks about every medication, supplement, energy drink and substance, not just your mood. The article on physical health problems that can mimic anxiety, depression or ADHD explains the wider picture.

How does cognitive behavioral therapy treat panic attacks?

NIMH describes CBT as a research-supported psychotherapy commonly used for panic disorder. It teaches people to respond differently to the body sensations of anxiety, and it often uses exposure therapy, which focuses on confronting the fears and beliefs tied to panic, sometimes alongside relaxation and breathing training (NIMH (opens in a new tab)). The American Psychiatric Association also describes CBT as a first-line treatment (APA (opens in a new tab)).

Interoceptive exposure is the part that sets panic treatment apart. With a therapist, you practice bringing on the body sensations you fear, such as a fast heartbeat or lightheadedness, in a safe and planned way, so your brain learns they are uncomfortable but not dangerous. An analysis of 72 trials with more than 4,000 participants found that CBT packages with interoceptive exposure and face-to-face sessions had better results (Pompoli et al. (opens in a new tab)), and the American Family Physician review calls it the most beneficial part of CBT for panic disorder (AAFP (opens in a new tab)).

Can panic disorder be treated with medication?

Yes. SSRIs and SNRIs are the first-line medications for panic disorder (AAFP (opens in a new tab)), and providers typically start there because they have fewer side effects than older options (NIMH (opens in a new tab)). They are taken every day, not only during attacks (MedlinePlus (opens in a new tab)), and usually take 4 to 8 weeks to work (NIMH (opens in a new tab)). Antidepressants such as sertraline carry an important warning about suicidal thoughts in children, teenagers and young adults (MedlinePlus (opens in a new tab)). The guide to types of anxiety medication covers the classes in more detail.

Benzodiazepines can reduce panic symptoms quickly, but tolerance and dependence can develop, so they are often prescribed for short periods (NIMH (opens in a new tab)). In 2020 the FDA required the boxed warning on all benzodiazepines to be updated to cover abuse, misuse, addiction, physical dependence and withdrawal reactions. Dependence can develop within days to weeks of steady use, even as prescribed, and stopping suddenly can cause withdrawal (FDA (opens in a new tab)). The American Family Physician review does not recommend them as a first-line or long-term treatment (AAFP (opens in a new tab)).

Sources for the table: NIMH on beta-blockers and benzodiazepines (NIMH (opens in a new tab)), NIMH on medication cautions (NIMH (opens in a new tab)), the FDA on alcohol and opioids with benzodiazepines (FDA (opens in a new tab)), and the American Family Physician review on beta-blockers (AAFP (opens in a new tab)).

Do therapy and medication work better together?

Often, yes. The American Family Physician review says combining psychotherapy with medication is likely more effective than either alone for anxiety disorders, including panic disorder. When medication helps, it is usually continued for at least 6 to 12 months after improvement, because stopping before a year is linked to relapse in up to half of people treated with an SSRI or SNRI (AAFP (opens in a new tab)).

Some people start with therapy, some with medication, and many use both. The guide to medication management vs. therapy explains what each does and how to decide where to start.

How Better Place Now helps with panic attacks

Care for anxiety at Better Place Now starts with a full 60-minute first visit with Dr. Justin Schwarting, DNP, PMHNP-BC, a board-certified psychiatric-mental health nurse practitioner. That hour makes room for sleep, labs, health, stress, substances and every current medication and supplement, so physical causes can be ruled in or out. Lab work is ordered when it could change the plan.

• Options explained plainly. Each option comes with its purpose and tradeoffs, starting with the smallest change likely to help. Medication is one option, never a default.
• Therapy alongside medication. Therapy is offered as part of care. If you want panic-focused CBT with exposure work specifically, ask us whether it is the right fit or whether a referral makes more sense.
• Careful follow-up. Follow-ups are 30 minutes, every two to four weeks at first, and changes are made one at a time.
• Video statewide. Visits are by video anywhere in Arizona, or in person in the Phoenix area by arrangement. You must be physically located in Arizona at the time of a video visit.

Most patients use insurance, and self-pay is $220 for the 60-minute evaluation and $120 for a 30-minute follow-up. The anxiety and depression care page has plans and details. When you are ready, you can request an appointment. The team replies within one business day, and no health details are needed to book.