Panic Attacks: What They Are, Why They Happen, and How to Fight Back
By: Brian Hoeflinger, MD
April 1, 2026 | #82
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Disclaimer: Opinions are my own. Not medical advice.
Medical Trivia of the Week
The heart generates enough electrical energy in a lifetime to approximately power which of the following? (the correct answer is at the end of this email)
- A) A laptop for a year
- B) A cross-country train
- C) A small city for a day
- D) An electric car for 100 miles
What is a Panic Attack?
A panic attack is something you will never forget, and here's why.
Imagine you are hiking in Yosemite on a smooth granite plateau 3,000 feet above the valley below. The scenery is beautiful and life couldn't be better. It had rained recently, and the warm, moist air carries a sense of serenity. You feel like you are part of nature.
As you take it all in, you suddenly feel yourself slip on the wet stone and start sliding downward. You try to stop yourself, but the angle steepens and your speed increases. Below is an expansive ledge with a 3,000-foot vertical drop straight to the valley floor. There is no railing to grab as you slide faster down the wet, slippery stone. You cannot stop yourself, and no one is there to help.
Your heart immediately starts to race. Your body tenses and trembles. You hyperventilate. You are clawing with your hands but cannot stop. This can't be happening is all you can think. The situation is out of your control as you slide faster and closer toward the ledge. You feel the impending doom of falling 3,000 feet to your death, and there is no way to stop it. The fear is uncontrollable. You are in a full-blown panic because you think you are going to die at any second.
Pause and take a deep breath.
Now imagine that instead of sliding toward the edge of a cliff, you have that exact same physical and emotional reaction in a completely safe environment, like a classroom, a restaurant, a friend's party, a pet store, an airplane, a cruise ship, or even your own bedroom at home.
That is what a panic attack is.
It is a sudden episode of uncontrollable fear and a sense of impending doom when there is no real threat or danger. You literally feel like you are going to die if you don't escape the situation you are in. It is one of the worst feelings a person can experience, and I know that firsthand because I had uncontrollable panic attacks for nearly 20 years.
How Common Are Panic Attacks?
Panic attacks are fairly common. Up to 10 percent of the U.S. population experiences one each year, and up to 30 percent of people will have at least one in their lifetime.
Women are twice as likely to experience a panic attack compared to men, and the most common age of onset is during late puberty and early adulthood, though they can occur at any age.
What Actually Happens During a Panic Attack?
The hallmark of a panic attack is that it comes on suddenly, out of nowhere. It typically lasts 5 to 20 minutes on average, then stops as quickly as it came on. You are left exhausted and drained but relieved. It is a state of both physical and mental overdrive, driven by what is known as the "fight or flight" response.
The "fight or flight" response is our body's natural survival mechanism, driven by the sympathetic nervous system. Here is what actually happens in your brain:
An area of the brain called the amygdala is primarily responsible for processing emotions, especially fear and anxiety. During a panic attack, the amygdala mistakenly interprets a situation as dangerous or life-threatening. Once activated, the amygdala signals the hypothalamus, which acts like a command center and activates the sympathetic nervous system. The sympathetic nervous system then triggers the release of hormones like adrenaline, which cause the physical symptoms people experience: racing heart, rapid shallow breathing, chest tightness, sweating, trembling, and more.
We don't know exactly why the amygdala misinterprets a safe situation as a threat, but there are a few leading theories. The most widely accepted is called the False Alarm Theory, in which normal physical changes like a temporary increase in heart rate or breathing are misread by the amygdala as signs of imminent danger, triggering the fight or flight response. Another theory suggests that the prefrontal cortex, the part of the brain responsible for logical thinking, fails to override the exaggerated fear signal from the amygdala as it should. In the end, though, we still don't fully understand why certain people experience panic attacks.
When It Becomes More Than Just Panic Attacks
Even worse than a panic attack is what I dealt with for nearly 20 years: a panic disorder.
A panic disorder means having repeated panic attacks and then living in constant fear of the next one. It consumed my every thought. I immediately began avoiding any place or situation I believed might trigger another attack. Approximately 2 to 3 percent of the U.S. population is affected by panic disorder.
For me, it meant leading a very hidden, fearful life throughout my entire teenage years and well into my late 20s. It changed everything about me. With panic disorder, you don't just survive one attack and move on. You reshape your entire life around trying to avoid the next one.
What Can You Do About It?
So how do you get better once panic attacks start? Unfortunately, there is no guaranteed cure, but there are effective treatment options worth exploring.
Immediate techniques to stop a panic attack include:
- Deep breathing: Inhale deeply through your nose and exhale slowly through your mouth to calm the nervous system.
- The 5-4-3-2-1 Grounding Method: Identify 5 things you can see, 4 you can hear, 3 you can touch, 2 you can smell, and 1 you can taste.
- Temperature shock: Splash your face with cold water or hold an ice cube to help interrupt the panic response.
- Ride it out: Acknowledge the panic without fighting it, knowing it will pass on its own in 5 to 20 minutes. This one is easier said than done, but it works.
Long-term management strategies:
- Cognitive Behavioral Therapy (CBT): This is the gold-standard treatment. CBT helps you identify and challenge irrational thoughts, reduce the fear of physical symptoms, and stop the avoidance behaviors that reinforce the cycle.
- Regular aerobic exercise.
- Reduce or avoid stimulants like alcohol, caffeine, and nicotine.
- Seek professional help. Medications like beta-blockers, prescribed by your doctor, can help blunt the physical effects of the fight or flight response.
My Story
My panic attacks started in the mid-1970s, at a time when the condition was not well recognized. I was only 13 years old and had no idea what was happening to me. I was scared, embarrassed, and completely alone. I never spoke about it and never sought help. I dealt with it on my own.
It took nearly 20 years to finally reach a point where I could function normally. Each attack knocked me down, but I got back up and kept going. I was not going to let this destroy my life completely. With each failure came a small success, and those small successes built confidence over time until, one day, I was free of my panic disorder.
It was a slow, gradual process, but it is absolutely possible to beat panic attacks. You cannot give up. Keep fighting, find what works for you, and know that being on the other side of this is well worth the effort.
Forward this email to a friend who has had a panic attack before.
Impactful Quote of the Week
"You don’t have to control your thoughts. You just have to stop letting them control you.”
- Dan Millman
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All my best,
Brian Hoeflinger
P.S. - if you enjoyed this newsletter, you may enjoy my book that details my life as a neurosurgeon and the loss of my oldest son, Brian (see below a synopsis) and/or my podcast where I explain topics in further detail.
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Learn More About My Book
Life and Death . . . Two words with such opposite meaning and which inflict such contradictory emotions and yet are so closely intertwined in our lives. As parents, we bring meaning and life into this world through our children. Our lives become defined as a result. We learn the joy, hardship, and responsibility of shaping an innocent life. But a day will come when that life will be taken. For some, death will come too soon. This is the story of my son, Brian Nicholas Hoeflinger, who died unexpectedly at age 18.
https://doctorhoeflinger.com/products/the-night-he-died-the-harsh-reality-of-teenage-drinking
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Medical Trivia Answer:
The correct answer is B) A cross-country train
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