The risk of suicide during panic attacks

What is a panic attack?

A panic attack is a sudden, short-lived period of intense fear that typically lasts five minutes to half an hour. Panic attacks are unpredictable and disproportionate to how a person experiencing a panic attack finds themselves.

Physical symptoms of panic attacks include a racing heartbeat, dizziness, shaking, chest pain, breathing difficulties, and a feeling of choking. Other symptoms include feeling trapped, a disconnect with reality, and a fear of losing control, 'going crazy,' or dying.

Panic attacks may be a symptom of an anxiety disorder, such as panic disorder which affects about 6 million adults in the U.S. Women are twice as likely to develop panic disorder ^[1].

Research shows a strong link between anxiety disorders and suicide attempts.

The connection between panic attacks and suicide

While not all panic attacks lead to suicidal thoughts, the acute physical and psychological symptoms can make you feel like you are trapped or going to die. These feelings may increase your fear of having panic attacks in the future and make suicide seem like the only viable way to find relief.

The intensity and frequency of panic attacks can affect the likelihood of suicide attempts. Some people might consider suicide because of the power of the thoughts they experience during the panic attack.

• In these instances, individuals can feel acutely overwhelmed by their psychological symptoms during the panic attack. These individuals may experience thoughts regarding past negative experiences in their life. They may also experience an intense sensation of being trapped within their experience, resulting in the belief that they cannot escape the attack.

• Other individuals might consider suicide because they have built up an intense fear of the broader symptoms of a panic attack, such as feeling like they're going to die. This intense fear of experiencing symptoms can lead to feelings of hopelessness that their condition will ever improve.

Panic attack risk factors

There are a variety of factors that increase the risk of suicide in individuals who suffer from panic attacks. These include:

• Having an anxiety disorder - Anxiety disorders, especially panic disorder, are independently associated with suicide attempts. And among individuals who have attempted suicide, over 70% have an anxiety disorder ^[2].
• A previous suicide attempt - Studies show that somebody who has attempted suicide previously is 30-40 times more likely to die by suicide compared to somebody who hasn't made an attempt ^[3][4].
• A previous panic attack, especially those with a fear of dying ^[5].
• Being female, divorced, or widowed ^[6].
• Alcohol and other substance abuse.
• Experience of a major depressive episode.

Treatment/How to get help

Learning how to de-escalate your panic attack is the most immediate step you can take to minimize the risk of suicide or suicidal ideation during a panic attack. Ways to regulate yourself and decrease the physical and mental symptoms include:

• Taking deep breaths - Try breathing slowly through your nose and out through your mouth. Some people find it effective to close their eyes and count steadily from 1-5 on each breath in and out.
• Putting your face in ice-cold water - For some people, this technique works by refocusing the neurotransmitters in their brain away from the symptoms of a panic attack and onto the pain-like response to the ice-cold water. Ice water can also slow down the heart rate, which is often increased during a panic attack.
• Practicing mindfulness - Try to remind yourself that the symptoms you're feeling are caused by anxiety and that panic attacks will always pass. Remember that while panic attacks are scary, they are not, in themselves, life-threatening.
• Improving your general health - Regular physical exercise, healthy eating, and avoiding caffeine, alcohol, and other recreational drugs can all improve well-being and the underlying feelings that lead to panic attacks.

Below are some options when treating the underlying causes of your panic attacks and to help address any suicidal thoughts during and between panic attacks:

• Talking to your doctor - Talking to your doctor is a positive first step toward understanding why you are experiencing panic attacks and suicidal thoughts and what professional help you can receive. They might suggest a combination of the following:
  • Taking medication to reduce anxiety, as certain types of antidepressants or anti-epilepsy medicine can help to treat anxiety symptoms ^[7].
  • Receiving talking therapy, including cognitive behavioral therapy (CBT).
• Exploring suicidal prevention sources and support groups.

If you experience suicidal thoughts, you can call 911, or contact the National Suicide Prevention Hotline at 1-800-273-8255 or text HOME to the Crisis Text Line at 741741.