MENTAL HEALTH
Panic Attacks: When Symptoms Feel Sudden and Overwhelming
Why panic symptoms are real and deserve proper assessment, and how support can help.
Panic attacks can feel alarming because the symptoms are overwhelmingly physical. Patients may experience sudden palpitations, chest tightness, breathlessness, dizziness, shaking, nausea, tingling, sweating, a sense of unreality, or a feeling of impending collapse or death. Episodes typically peak within minutes and pass within 20–30 minutes, but the aftermath — exhaustion, confusion, and fear of recurrence — can persist for much longer. Many patients who have experienced a panic attack begin to avoid situations where symptoms might happen again, which can gradually narrow their daily life.
Panic symptoms are real, physically measurable, and deserve proper assessment — not dismissal.
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What happens during a panic attack
A panic attack is essentially the body’s fight-or-flight response activating at an inappropriate time. Adrenaline surges, heart rate increases, breathing quickens, muscles tense, and blood flow shifts towards the limbs. This produces the palpitations, chest tightness, breathlessness, dizziness and tingling that patients describe. The symptoms are not imagined — they are the same physiological responses that would occur during a genuine physical threat. The difference is that no external danger exists, which makes the experience confusing and frightening.
Many patients present at A&E or their GP convinced they are having a heart attack, a stroke, or a collapse. Once cardiac and other medical causes have been ruled out, the realisation that the episode was a panic attack can itself be distressing — particularly if the patient worries it will happen again.
Medical assessment
When medical causes should be ruled out
Not every episode of palpitations, chest tightness or breathlessness is a panic attack. A GP assessment is appropriate the first time these symptoms occur, particularly if they are accompanied by chest pain on exertion, sustained fast or irregular heartbeat, fainting, or a family history of cardiac conditions. Blood tests — including thyroid function, which can cause palpitations and anxiety when overactive — may also be worth checking. Ruling out a medical cause provides reassurance and allows the focus to shift to psychological support.
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How panic attacks are treated
Effective treatment usually involves understanding the physiology of panic (which reduces fear of the symptoms), identifying triggers and patterns, learning to respond differently when the early warning signs appear, and gradually re-engaging with situations that have been avoided. Counselling and structured psychological support — particularly CBT-based approaches — have good evidence for reducing the frequency and intensity of panic attacks. For some patients, medication may also be discussed alongside therapy, particularly if panic is frequent, disabling, or accompanied by broader anxiety or depression.
Getting help
When to seek help
A single panic attack, while frightening, does not always require ongoing treatment. But if attacks are recurring, if avoidance behaviour is developing, if daily functioning is being affected, or if the fear of having another attack is itself becoming a source of constant anxiety, professional support is worthwhile. At Basuto, counselling and GP assessment are available through the same practice, which means physical symptoms can be investigated and psychological support can be arranged without fragmentation.
Common questions
What do panic attacks typically feel like, and how are they different from a medical emergency?
Panic attacks can feel like a medical emergency — chest tightness, shortness of breath, racing heart, lightheadedness, sense of unreality, fear of losing control. They are intensely distressing but not dangerous in themselves, and usually peak within minutes and settle within half an hour. However, because the symptoms overlap with cardiac and respiratory emergencies, a first episode or a change in pattern is worth reviewing medically.
When should a panic-attack-like episode be assessed medically to rule out physical causes?
A first significant episode, episodes that feel different from previous ones, episodes with prolonged chest pain, fainting, or persistent symptoms beyond the typical panic pattern, or any concern about cardiac or respiratory disease should be reviewed medically. If symptoms feel severe or include new chest pain, breathing difficulty, or collapse, call 999 or go to A&E.
What support helps with recurrent panic attacks?
Support may include structured psychological therapy (for example, CBT), lifestyle review (sleep, caffeine, alcohol), medical review of any contributing physical factors, and in some cases medication discussed with a GP. Counselling at Basuto can be combined with GP input when recurring panic attacks are affecting daily life. If you are in immediate distress or at risk, Samaritans are on 116 123 free, 24/7, and NHS 111 can help with urgent mental health support.
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