Xanax has boxed warnings. These are the most serious warnings from the Food and Drug Administration (FDA). Boxed warnings alert doctors and patients about drug effects that may be dangerous.

Using benzodiazepines, even as prescribed, can lead to physical dependence and withdrawal if you stop taking the drug suddenly. Withdrawal can be life threatening.

Using benzodiazepines can also lead to misuse and addiction. Misuse of benzodiazepines increases your risk of overdose and death.

Only take these drugs as your doctor prescribes. Talk with your healthcare provider if you have any concerns about safely taking a benzodiazepine.

Panic attacks are sudden, intense surges of fear, panic, or anxiety. They are overwhelming, and they have physical as well as emotional symptoms.

If you have a panic attack, you might find you have difficulty breathing, you sweat profusely and tremble, and you may feel your heart pounding.

Some people will also experience chest pain and a feeling of detachment from reality or themselves during a panic attack, so they may think they’re having a heart attack. Others have reported feeling like they are having a stroke.

Causes

Panic attacks can happen for various reasons, and sometimes they happen for no apparent reason.

You’re more likely to experience them if you:

A panic attack often happens when you’re exposed to a trigger, but triggers vary widely between people. In some cases, there may be no clear trigger.

However, some people find that the following can trigger an attack:

  • social events
  • public speaking
  • conflict
  • situations that remind you of past or current stress in your life

Here, learn more about the causes and triggers of panic attacks.

Symptoms

The Diagnostic and Statistical Manual of Mental Health Disorders, Fifth Edition (DSM-5) defines a panic attack as “an abrupt surge of intense fear or discomfort.”

They tend to start without warning, and symptoms reach a peak within minutes.

If you have a panic attack, here are some of the symptoms you might experience:

Panic attacks can be scary and may hit you quickly. Here are 12 strategies you can use to try to stop or manage panic attacks. Some may help you in the moment, while others can help in the longer term.

1. Seek counseling

Cognitive-behavioral therapy (CBT) and other types of counseling can often help people who have panic attacks and who have panic disorders. CBT aims to help you change the way you see challenging or frightening situations and to help you find new ways to approach these challenges as they arise.

You can find CBT for individuals or groups, online or face-to-face, and the length of treatment can also vary. In exposure-based CBT, your therapist will expose you to something that can trigger a panic attack and help you work your way through it.

As well as changing behavior, there is some evidence that CBT might affect structures in your brain that are responsible for panic symptoms.

In 2018, some researchers found evidence that people who attended four weekly sessions of exposure-based CBT experienced changes in the neural pathways involved in panic symptoms. However, this was an early study, and more research is needed.

In 2018, 37 people in Korea attended a mindfulness-based program once a week for 4 weeks, to see if brief treatment would help reduce symptoms of panic disorder. One aspect of the treatment was to focus on their heart rate, as some people experience cardiovascular symptoms during a panic attack.

The findings suggested that the participants could better manage their symptoms using their own thought processes after the treatment. However, this was a small study, and there was no control group. More research is needed to find out how effective short-term therapy can be.

2. Take medications

Benzodiazepines, such as alprazolam (Xanax), can help treat the symptoms of panic when they occur.

However, they won’t help treat an underlying anxiety disorder and can quickly lead to dependence. For this reason, doctors only recommend them for short-term use during a crisis.

Because benzodiazepines are a prescription medication, you’ll likely need a panic disorder diagnosis to have the medication on hand.

In some cases, a doctor may prescribe anti-depressants for long-term use. Examples include:

  • selective serotonin reuptake inhibitors (SSRIs), such as escitalopram (Lexapro) or fluoxetine (Prozac)
  • serotonin-norepinephrine reuptake inhibitors (SNRIs), such as duloxetine (Cymbalta)
  • anti-anxiety drugs, for instance, azapirone (Buspirone)

Some anti-seizure medications, such as pregabalin or clonazepam, can also help treat anxiety.

Which drugs can treat anxiety disorder?

3. Use deep breathing

While hyperventilating is a symptom of panic attacks that can increase fear, deep breathing can reduce symptoms of panic during an attack.

In one study, published in 2017, 40 people joined either a therapy group that involved deep or diaphragmatic breathing or a control group. After 20 intensive training sessions, those who practiced deep breathing saw improvements in their attention levels and emotional well-being.

Blood tests also showed lower cortisol levels in this group, suggesting lower levels of stress. The participants did not have panic disorder, but the strategies could help people who have panic attacks.

Another group of scientists found that slow breathing could have similar effects. They suggested it could also improve feelings of relaxation, comfort, and alertness and reduce symptoms of arousal anxiety, depression, anger, and confusion.

If you’re able to control your breathing, you’re less likely to experience the hyperventilating that can make other symptoms — and the panic attack itself — worse.

Focus on taking deep breaths in and out through your mouth, feeling the air slowly fill your chest and belly and then slowly leave them again. Breathe in for a count of four, hold for a second, and then breathe out for a count of four:

What is diaphragmatic breathing and how do you do it?

4. Recognize that you’re having a panic attack

By recognizing that you’re having a panic attack instead of a heart attack, you can remind yourself that this is temporary, it will pass, and that you’re OK.

Take away the fear that you may be dying or that impending doom is looming, both symptoms of panic attacks. This can allow you to focus on other techniques to reduce your symptoms.

It is not always possible to avoid triggers for a panic attack, but if you know what triggers it, this can help you understand that it is a panic attack and not something else.

5. Close your eyes

Some panic attacks come from triggers that overwhelm you. If you’re in a fast-paced environment with a lot of stimuli, this can feed your panic attack.

To reduce the stimuli, close your eyes during your panic attack. This can block out any extra stimuli and make it easier to focus on your breathing.

6. Practice mindfulness

Mindfulness can help ground you in the reality of what’s around you. Since panic attacks can cause a feeling of detachment or separation from reality, this can combat your panic attack as it’s approaching or actually happening.

Mindfulness involves:

  • focusing your attention on the present
  • recognizing the emotional state you’re in
  • meditating to reduce stress and help you relax

Focus on the physical sensations you are familiar with, like digging your feet into the ground or feeling the texture of your jeans on your hands. These specific sensations ground you firmly in reality and give you something objective to focus on.

Experts say that mindfulness strategies, such as meditation, can help manage anxiety symptoms, although it’s not clear they can treat an underlying anxiety disorder.

American Family Physician recommended mindfulness as a strategy for dealing with panic and anxiety in 2015, saying it can be as helpful for reducing stress as CBT and other behavioral therapies.

Some research has suggested that mindfulness-based cognitive therapy could help people with anxiety disorders who are receiving medical treatment but haven’t found drug treatment helpful.

7. Find a focus object

Some people find it helpful to find something to focus all their attention on during a panic attack. Pick one object in clear sight and consciously note everything about it possible.

For example, you may notice how the hand on the clock jerks when it ticks, and that it’s slightly lopsided. Describe the patterns, color, shapes, and size of the object to yourself. Focus all your energy on this object, and your panic symptoms may subside.

8. Use muscle relaxation techniques

Muscle tension is a symptom of anxiety, and muscle relaxation techniques can help reduce tension and promote relaxation during an attack. Progressive muscle relaxation aims to release tension in one group of muscles at a time to relax the whole body.

Much like deep breathing, muscle relaxation techniques can help stop your panic attack in its tracks by controlling your body’s response as much as possible.

If you attend muscle relaxation therapy, your therapist might take you through the following steps:

  • First, you may learn how to tense the muscles before releasing the tension.
  • Then, you will learn how to relax the muscles without tensing them first.
  • You may also learn how to relax specific sets of muscles, for example, in the shoulders, for practical use in everyday situations.
  • Finally, you may learn how to practice rapid relaxation, when you can identify any areas of tension and release it as needed.

To start relaxing your muscles at home, consciously relax one muscle at a time, starting with something simple like the fingers in your hand, and move your way up through your body.

Muscle relaxation techniques will be most effective when you’ve practiced them beforehand.

9. Picture your happy place

Guided imagery techniques can help reduce stress and anxiety. Research suggests that both spending time in nature and visualizing nature can help treat and manage anxiety.

What’s the most relaxing place in the world that you can think of? A sunny beach with gently rolling waves? A cabin in the mountains?

Picture yourself there and try to focus on the details as much as possible. Imagine digging your toes into the warm sand, or smelling the sharp scent of pine trees.

This place should be quiet, calm, and relaxing — no streets of New York or Hong Kong, no matter how much you love the cities in real life.

Here, learn about five visualization techniques that can help you meditate.

10. Engage in light exercise

Research shows that regular exercise can not only keep the body healthy but boost mental well-being, too.

Experts have found that exercising at 60 to 90 percent of your maximum heart rate for 20 minutes three times per week can help reduce anxiety.

If you are not used to exercising, talk with your doctor before starting. There is some evidence that starting aerobic exercise anew can trigger additional anxiety in people with an anxiety disorder. Building up gradually can help your body adjust and avoid breathing problems. Aerobic exercise includes activities such as running on a treadmill.

If you feel stressed or you’re hyperventilating or struggling to breathe, stop and take a rest or choose a more moderate option, such as walking, swimming, or yoga.

11. Keep lavender on hand

Lavender is a traditional remedy that many people use to reduce stress and help them relax.

Research suggests it has a calming effect but doesn’t lead to dependence or cause withdrawal symptoms. Using products that contain diluted lavender oil may help reduce or manage symptoms of anxiety.

However, the Food and Drug Administration (FDA) does not regulate essential oils, and strengths and ingredients vary widely.

If you use lavender essential oil, make sure you:

  • get your oil from a reputable source, such as a pharmacy
  • follow the instructions for use
  • avoid applying concentrated oil directly to the skin
  • avoid using lavender with benzodiazepines because the combination can cause intense drowsiness

Which essential oil is right for you?

12. Repeat a mantra internally

Repeating a mantra internally can be relaxing and reassuring, and it can give you something to grasp onto during a panic attack.

Whether it’s simply “This too shall pass,” or a mantra that speaks to you personally, repeat it on loop in your head until you feel the panic attack start to subside.

It is not always possible to prevent a panic attack, but the following tips may help:

  • do breathing exercises every day
  • get regular exercise
  • follow a diet that is low in added sugar and eat regularly to avoid glucose spikes
  • avoid caffeine, smoking, and alcohol, as they may make anxiety worse
  • seek counseling and other professional help
  • ask your doctor about local support groups

Avoiding specific triggers may help prevent a panic attack, but this may not always be possible or appropriate. Some experts encourage people to “ride out” the attack and continue doing things, if possible.

However, if a situation is likely to cause severe distress, consider waiting until you’ve worked with a professional to develop skills and strategies to help you cope.

If you have concerns about panic attacks, consider talking with a doctor, especially if:

  • You have one or more panic attacks and continue to worry about panic attacks for a month or longer.
  • You find yourself changing your behavior after an attack.
  • Your concerns or feelings of fear or anxiety are affecting your work, studies, or daily life.

Many people experience panic attacks, in which they suddenly feel anxious and not in control of a situation, possibly without knowing why.

You may feel breathless or as if you are having a heart attack, and it can be very frightening.

Panic attacks can occur unexpectedly and have a significant impact on your daily life, but there are ways to manage them. Treatment is also available for panic and anxiety disorders, which may be an underlying condition.

If you have concerns about panic attacks, speak with your doctor. They can help you work out a suitable strategy to manage symptoms and reduce the impact. This may involve medications, such as antidepressants, alongside counseling.

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