Overview of panic attack

A panic attack is defined as a discrete period of intense fear or discomfort. Symptoms of a panic attack may initially suggest an acute medical condition (eg heart attack, stroke, hyperthyroidism, a respiratory condition such as asthma) or a psychiatric disorder (eg social anxiety disorder, major depression, a psychotic disorder). Isolated panic attacks are common, occurring in around 15% of the population.

To diagnose a panic attack, 4 or more of the following symptoms need to have developed abruptly and reached a peak within 10 minutes:

  • palpitations, pounding heart or accelerated heart rate
  • sweating
  • trembling or shaking
  • sensations of shortness of breath or smothering
  • feeling of choking
  • chest pain or discomfort
  • nausea or abdominal distress
  • feeling dizzy, unsteady, light-headed or faint
  • derealisation (feelings of unreality) or depersonalisation (being detached from oneself)
  • fear of losing control or going crazy
  • fear of dying
  • paraesthesia (numbness or tingling sensations)
  • chills or hot flushes.

Exclude conditions that may cause similar symptoms (eg asthma). Physical symptoms of pregnancy (eg tachycardia, sweating, dizziness, shortness of breath) can mimic or precipitate a panic attack.

A panic attack can occur in the absence of a psychiatric disorder, or it can be a symptom of an anxiety disorder or other psychiatric disorder. For information on diagnosing and differentiating anxiety disorders, see here.

Note: A single panic attack is not the same as panic disorder.

A single panic attack is not the same as panic disorder, which is characterised by recurrent panic attacks that are not associated with a situational trigger (ie occur spontaneously).

Use psychosocial interventions to manage a panic attack. If the panic attack is a symptom of an anxiety disorder or other psychiatric disorder, treat the underlying condition accordingly. Short-term pharmacotherapy may be appropriate if psychosocial interventions are ineffective or not preferred.

When evaluating treatment options for a young person, also consider:

  • there are few data on psychotropic use in young people because young people are poorly represented in clinical trials
  • if pharmacotherapy is used, it should ideally be started by a clinician with expertise in using psychotropics in young people.

For treatment considerations for females of childbearing potential, including advice on contraception, preconception planning and psychotropic use, see here.

For considerations in managing anxiety disorders such as panic attack in the perinatal period, see here or for considerations in partners, see here.