A first panic attack often starts without warning during an ordinary activity such as shopping or walking down the street.

• You may become confused and think you are "going crazy." You may feel like something terrible is going to happen.
• You may feel a strong need to leave the area and go to a place that feels safe, such as your car or home.
• You may also have physical symptoms such as shortness of breath, a pounding heart, or chest pain. It is common to think that you are having a heart attack and to seek treatment in a hospital emergency room.

The intensity of these symptoms usually peaks within 10 minutes.

For many people, the first panic attack may occur a stressful time. It may happen during a life-threatening illness or accident, the loss of a relationship, or separation from family. A woman may have her first panic attack after she gives birth.

It is also possible for a first panic attack to be caused by a drug reaction or a reaction to nicotine or caffeine. But after the situation that caused the first panic attack is resolved, attacks may continue.

Panic disorder

Common traits in panic disorder include:

• Feeling exhausted from lack of sleep.
• Using drugs or alcohol (to numb your fears or give you a false sense of courage to face feared situations).
• Having depression.
• Having irrational fears (phobias).
• Having other anxiety disorders, such as post-traumatic stress disorder.
• Having trouble relating to other people in social settings because of intense feelings of anxiety.

Recurrent panic attacks can be mild to severe. They may continue for years, especially if you also have agoraphobia (avoiding places where you fear another attack will occur). You may have long periods of time without panic attacks. And you may have other periods of time when attacks occur often.

You may need longer or different treatment if you have both panic disorder and agoraphobia. You may also have other conditions linked with panic disorder and panic attacks, such as drug or alcohol problems, depression, or other mental health disorders. You will need treatment for these conditions.

Panic disorder may last a lifetime, but its symptoms can be controlled with treatment. Most people who have panic disorder get better with treatment. They are able to get back to a normal lifestyle. But relapse can occur, especially if treatment is stopped too soon.