What to Do for a Panic Attack

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This survival-medicine website provides general information, not individual advice. Most scenarios assume the victim cannot get expert medical help. Please see the disclaimer.

Panic Attacks: What to Do for Your Worst Nightmare

Artist Brad Siskin’s representation of a panic attack.

by James Hubbard, MD, MPH

Anyone preparing for a disaster needs to know what to do for a panic attack. We’re all susceptible during extreme stress. No matter how stoic or brave you are, it could happen, and for that period of time, you’re totally disabled. You can’t think straight or physically do much of anything.

Those of you who have experienced a panic attack (anxiety attack) know what I mean. If you haven’t, try to think of a time when you were most afraid, maybe it was just for a second, but you thought you were going to die. Now, imagine having that feeling for ten, fifteen minutes or more.

We’re not really sure what all goes into having a panic attack, but we think it has to do with your body going into its flight-or-fight mode, sometimes for no specific reason. And it seems some people’s bodies have lower trigger point than others.

Adrenaline and other hormones are released and increase your energy levels and heart rate. Your muscles tense, you sweat, you breathe fast, your thinking gets fuzzy. Now that’s great if you need to every iota of your energy focused on running away from or fighting a charging tiger, but for the average folks nowadays, it just wreaks havoc on your body.

Medical Treatment for Panic Attacks

If you’re having panic attacks now, there is good medical treatment available in addition to the paper-bag technique. A sedative like Xanax or Valium will provide immediate, short-term relief. Certain types of antidepressants can prevent attacks in the long-term.

Always try to rule out lung and heart problems by getting an oxygen level, EKG, chest X-ray, etc.

Your muscles may cramp, your chest ache; your feet, hands, and around your mouth may tingle, and you are just scared out of your wits. Many times, the fear is overwhelming. It’s often called a feeling of “impending doom.” You feel like you’re going to die and there’s nothing you can do about it. As a treating doctor, it’s often a difficult task to convince a person otherwise.

And if you’ve had one panic attack, you often live in fear you might have another because you never want to have that feeling again.

How Do You Know If It’s a Panic Attack?

Unless you’ve had one before and know the symptoms, you’re going to have to rule out other problems. This is important because the treatments are different, and one of the ways to relieve a panic attack (breathing into a paper bag) can make lung or heart problems worse.

You often can’t make the diagnosis with certainty without the proper diagnostic tests done in a medical clinic. One thing I’m going to start suggesting to add to your emergency kit is a pulse oximeter. You just slip it on the finger, and it measures the oxygen level in your blood. With a panic attack, your blood is getting plenty of oxygen, so if your oxygen level is, say, 94 or below, something else is going on. (Don’t use a paper bag.)

To see how much oxygen you’re getting, you can clip a pulse oximeter to your finger. (No needles, no blood.) If it reads about 94 or below, you’re not just dealing with a panic attack. There’s a heart or lung problem afoot. DON’T use that paper bag. (The picture is just an example, not a product recommendation.)

Here are some other tips to try to make an educated decision if there is no expert help available.

Think heart problems (heart attack, perhaps a sudden worsening of congestive heart failure) if:

    • The person is over forty-five years old.
    • The person has risk factors, like obesity, smoking, high blood pressure, high cholesterol, or a known history or family history of heart disease.
    • The heart rate is 150 or over (SVT).
    • The blood pressure is low.
Why That Paper Bag?

With a panic attack, you’re not breathing fast because you need more oxygen. You’re doing it because your fight-or-flight hormones have gone haywire.

With each breath, you blow out carbon dioxide. Usually that works out just right. But when you’re breathing too quickly, it messes up your body’s chemicals and the acid/base balance. That’s why your muscles cramp and sometimes spasm. That’s why your fingers and toes tingle, why you get dizzy. All those symptoms tend to make you more anxious and want to breathe more.

When you breathe into a bag, the carbon dioxide collects, and you breathe it back in. This can relieve your symptoms.

Some docs don’t think much of this CO2 theory. They think breathing in a bag works because you’re concentrating on doing that one thing. It takes your mind off your other symptoms, and you start relaxing. Whatever. If it works, it works.

Tips it could be the lungs (blood clot or spontaneous collapsed lung):

    • The person is wheezing.
    • The lips or area around them turn bluish.
    • The pulse oximeter shows an oxygen saturation below 95.
What to Do for a Panic Attack
  1. Try, try, try your best to calm down.
  2. Slow your breathing. Concentrate on slow, deep breaths.
  3. Breathe into a bag. Find a bag (I think a paper one works better), seal the opening around your mouth, and breathe. This replenishes your carbon dioxide balance. Don’t do this for more than a minute or two without taking some fresh-air breaths to make sure you’re getting enough oxygen. HOWEVER, if the diagnosis is wrong and you’re having lung or heart problems, carbon dioxide is not your issue. You need as much oxygen as fresh air can deliver. In those cases, breathing in a bag could make your condition worse. So how do you know? I’d follow my tips above.
  4. Or, better yet, learn breathing and relaxation techniques. Psychologists and respiratory therapist are good at teaching these. Use your stomach muscles to help you take in a deep breath, hold it for a few seconds, and blow it out with your mouth closed or through pursed lips. There are some techniques that require a certain instrument to help you train—best done by pulmonary therapists. Integrative-medicine doctor Andrew Weil describes some simpler ones here.

>> Got a wound but no doctor? Don’t panic! Pull up your handy The Survival Doctor’s Guide—ready when you are. <<

How to Prevent Panic Attacks
  1. If you can, go to a doctor to rule out medical causes such as thyroid disease, lung disease, and heart disease.
  2. There’s some evidence that supplemental zinc and magnesium can help.
  3. Treat underlying anxiety. More on that in the next post.


Painting and its photo by Brad Siskin, via Flickr.

Full disclosure: The picture of the pulse oximeter includes an affiliate link to Amazon.com. If you buy anything through that link, someone who works on this site—not myself—gets a commission. As noted, the link is not meant as an endorsement, just an informational example.

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  • Ivette

    After two in a row car accident I being getting panic attacks. I can’t no longer drive my car because i often get the panic while driving. I found my self reducing the speed or stopping.I am scare to go in a plane what should i do.. i don’t want medication….

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Check with a therapist about relaxation and breathing techniques.

      • Ivette

        Thanks, James Hubbard, MD,MPH

  • Becky

    A couple days ago, I slipped but caught myself before I fell. However, I was 35 weeks pregnant and my abdomen was cramping and hurting so I went to Labor and delivery just to be on the safe side. Turns out everything was fine. When I returned home as I was walking up my sidewalk I rolled my ankle and fell roughly on the pavement. I was bruised and bleeding and my ankle pain was horrendous. My husband helped me inside to the couch and I suddenly started shaking and shivering uncontrollably. I couldn’t talk and my husband didn’t know what to do so he called 911. Once the EMTs got there and started caring for me the shaking subsided. Could this have been a panic attack? I know I was really upset that I had just come back from the hospital and before I even got in the door I injured myself again.

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Becky, yes it could been a panic attack. I can’t say, for sure, that’s what happened to you, but it’s certainly a possibility.

      • Becky

        Is there anyway to know for sure? Should I mention it to my PCP during my next visit?

        • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

          Yes, definitely mention it. Panic attacks are really diagnosed by symptoms, response to treatment, and trying to rule out at least the most common problems that might cause the same symptoms.

  • Dorothy

    It’s so wonderful to find this site and read the support and good information on “panic” attacks. Mine have come on suddenly about 18 months ago. I can be asleep or sitting enjoying a romantic movie when suddenly my pulse goes crazy and BP climbing like mad! I start shaking and heart starts jerking around like it is having convulsions. I keep thinking not good for my heart!!!
    I’m told it has a lot to do with anxiety and stress. I’ve spent 5 years recovering from an accident. But stress has other causes, not just physical, mental and emotion.
    I have figured out some stress triggers are foods (gluten intolerant, dairy, nightshades, goitrogens, onions, coconut/dates, eggs/chicken, soy and a few others). I’ve learned I can only have small meals and not too much of any food at any one time. I am also very sensitive to EMF’s and my BP spikes when I am around any Wi-Fi equipment and chest pain begins. I have to limit my computer time.
    I am now on a very careful and simple diet (alas, no treats!) which seems to really help. I feel best when I don’t eat at all, but that’s not a good idea!
    I feel nervy/jumpy and “at risk” with the feeling of impending disaster hanging over me. When I feel that way I challenge myself to stop destructive thoughts, and it helps to do some inspiring activity to change my thoughts. Chatting with friends is the most helpful.
    There has to be an answer for this. I figure everything is connected. So my Celiac Disease means I probably have leaky gut and impaired nutrutional uptake. That imacts liver, hormones, brain, thoughts, actions … chain reaction. Then everything feeds back into everything else like a spiral.
    I look fine but feel like I am shaking inside. Hard to relax – magnesium helps as does herbals. Used to be really bad, but now milder but still distressing. After years of exhausting tiredness (CFS in the past) I still wonder if there could be heavy metal toxicity or viruses of some sort linked to all this. (I travelled extensively in the past).
    I wanted to be tested again for hypothyroidism as this was diagnosed some years ago (Reverse T3 test) but the doctor did TSH and said nothing is wrong. He didn’t know what Reverse T3 was, so I felt disillusioned. Maybe I need a different doctor?
    My gut instinct says adrenals and thyroid are involved. Is my gut feeling possibly correct?

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      It’s always an option to get a second opinion, but you should keep in mind that by far the most likely problem causing your symptoms is underlying anxiety. And you should concentrate on methods to get that under control.

  • Lois Timms

    hi im 49 yrs old & I had a panic attack a last month October 2013 I just let mine run its course bc I don’t know really what to do bc I was very scared I was at my sisters house in rome ga I guess that it was when I hear some one talk about me I get kind of upset & it stays in my mind of what I heard about me & my son but mine lasted about half the night I was scared to go to sleep it was hard for me I guess its where I have been around drama to much people want to talk about me and put me down a lot I have tried to srug it off but it was hard to do so I was trying to calm myself down by breathing slowly in my nose & out my mouth I was still shaking & nerveous & I was rocking myself sitting on my bed but I didn’t really know what to do I have had this since I was a very young girl at the age of 10 yrs old it still is difficult on me but if it happens again what shall I do to help myself ,,,,, oh I also heard that if you have this problem that you maybe able to get some finance help from the social security for s s I , is this true or does any one knows sometimes I get nerveous to easy

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      You could see your regular doctor or, in most towns, there are psychological and counseling services at a low price. It’s usually called Behavioral Health or Mental Health services. They might can give you advice and counseling that would help a great deal in preventing these attack. If you don’t know about them, your regular doctor or your local hospital could help you locate them.

      • Lois Timms

        hi james I am a little better about my panic attacks its a lot of stress and it gets me really nervous so now sometimes my blood pressure goes a little low that it scares me so I had been drinking water and doing a lot of walking sometimes I get tired of walking and my ankle hurts so if you can look me up on facebook and send me a friend request plz I would like to keep intouch

  • Manda

    I had terrible panic attacks in my early twenties- to the point that I couldn’t leave my house on my own. I had to have an escort of some form. I was terrified that if I started having an attack in public, whoever found me wouldn’t understand what was going on and I’d end up in the ER (again).

    For me, simply coming to understand that the attack itself wouldn’t kill me (I wasn’t dying.) was a huge breakthrough. I learned to ride out my attacks. Over time I also learned other coping techniques such as reciting favorite Bible verses (at one point, I wrote them on my arm.), deep-breathing, and meditative prayer. I also took up yoga, which helped to ease my stress levels in a way that no other form of exercise has even come close to. Over the past decade, I’ve been able to reduce my panic attacks (sans medication) to the point that they really aren’t even a blip on my radar, anymore. They still happen, but they’re very rare and I’m able to squash them nearly as quickly as they pop up.

    I’m not an anti-drug freak. For many people, they do great things. Unfortunately, I wasn’t one of them. The medications just left me in this awful, zombified state. I’m always grateful that I’ve been able to control my anxiety and still keep my emotions intact.

    • Marie

      Manda, I am right there with you. My panic attacks were brought on suddenly from my body attempting to pass a gallstone 1/3 of the size of my gallbladder. To this day whenever I get nauseous or stomach pain, I have a panic attack. I had no clue what was going on, only that I couldn’t function. It took days to figure out the panic part and they put me on Xanax. I hated that drug. I would find myself staring at a wall and no clue when or how I got there or how long I’d been out of touch with reality. With 4 kids, one still at home, I knew I needed to find a better way to cope with the panic attacks. As of this time, my gallbladder issues still were unknown. They would be for a year of visits to the ER over and over. It took passing out in the triage and vomiting while passed out to be diagnosed by a PA. Anyway, I researched and researched better ways to deal with panic attacks. Drugs, meditation, you name it. I finally found someone who related that they talked themselves out of it. They believed for some, if not all, panic attacks are triggered by something else, not actual fear. For me that made sense because I never had them outside of being sick or feeling sick. So I started playing a game with my own brain. At this time I was still feeling sick all the time. Mostly because I was still eating wrong for someone with gallstones as well as gastroparesis which I was later diagnosed with as well. So I was nauseous, a lot! And because of that, I was having panic attacks, a lot! So I decided that when one started I would focus on it, and only it. I would breathe through them like I did when I was in labor. All the while I would tell myself over and over and over that I was okay. Nothing was going to happen. I was not going to die. My kids would still have their mother. Calm down. It’s okay. Again and again and again. They would last for hours in the beginning. Now, 6 years later, I forget I even had them. I might get the occasional attempt when sick but I can squash it within seconds. It took a long time to get them under control and a couple months to wean off Xanax. I am so glad I took the time to research and even more importantly, I got off that horrendous drug that turned me into a zombie.
      I know some are not strong enough to do this, but it’s always worth a try.

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Manda, thanks for sharing. It’s great you have found relief and what works best for you.

  • alexjonesradio1

    My husband and both have anxiety attacks, though his are more mild and have different triggers. Meditation and relaxation techniques help us both. It also helps so very very much that we’ve talked about it and each of us know the best ways to help each other when one of us experiences one. I had one a few months ago while riding a public bus and called him–just talking to him helped me through it since I was basically trapped for 5 minutes until the next stop. Brisk walking or even pacing can help. We’ve also learned that MSG consumption is a trigger. We’ve stopped eating everything that contains it (it’s in much more than we ever realized, including soups) and both of us have had a large decrease in the number of “out of the blue” ones that we experience. Once those were out of the way, it’s been much easier to figure out the “triggers” and work on those. The information in this post is extremely important to know so that you can help someone else through one, even if you don’t experience them yourself.

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Thanks for sharing. As you allude to, it’s important to find what works best for you.

  • August Arkham

    and when I say “great” Rob Black, I’m talking a great big scumbag that needs to be given life and executed.

  • August Arkham

    His “artwork” is about the same as his porn directing. Truly garbage. What a lowlife disgusting human being running on the mental capacity of a disturbed 8 year old. Of course leave it up to the great Rob Black to give the nutcase money to make “movies”.

  • August Arkham

    Brad Sisken (your “artist” image) is better known by the name August Arkham. A psychotic porn addict and failed “director” who made movies such as “1,001 Ways To Eat My Jizz”. He now draws terrible looking and often sick pictures in Crayola crayons and calls himself an artist.