When depression is severe, everything feels harder. Getting out of bed, making decisions, finding the energy to get through the day — all of it takes more than it should. And when panic attacks enter the picture alongside severe depression, the experience can feel overwhelming in a way that is genuinely difficult to describe.
Panic attacks during depression are more common than many people realize. The combination of the two can feel particularly disorienting — depression weighs you down while panic sends the nervous system into sudden, acute overdrive. Understanding what is happening in those moments, and having a clear set of actionable steps to work through them, can make a meaningful difference in how you navigate this experience while you work toward longer-term support and recovery.
This article is designed to give you exactly that: practical, honest steps for getting through a panic attack, written specifically for people who are managing the added weight of severe depression.
If you are in crisis or experiencing thoughts of suicide, please call or text 988 to reach the Suicide and Crisis Lifeline, available 24/7. You can also text HOME to 741741 to reach the Crisis Text Line.
What Is Actually Happening During a Panic Attack
Before the steps, a brief explanation — because understanding what a panic attack actually is can itself reduce some of its power over you.
A panic attack is a sudden surge of intense fear or discomfort that activates the body’s fight-or-flight response in the absence of real, immediate danger. The amygdala — the brain’s threat-detection center — fires an alarm, flooding the body with adrenaline and cortisol. Heart rate spikes. Breathing becomes rapid and shallow. Muscles tense. The body is doing exactly what it was designed to do in a moment of genuine threat — except there is no threat. The alarm has been triggered by internal experience rather than external danger.
This is why panic attacks feel so frightening and so physical. The symptoms — racing heart, chest tightness, shortness of breath, dizziness, tingling, a sense of unreality, fear of losing control or dying — are real physiological events. They are not imagined, and they are not a sign that something is medically wrong. They are the body’s survival system in overdrive.
When you are in the midst of severe depression, the nervous system is already dysregulated — already operating under significant strain. This can lower the threshold for panic, making attacks more likely and, in some cases, more intense. Understanding this connection doesn’t make panic attacks disappear, but it does make them more explainable — and explainable is less frightening than inexplicable.
Step 1: Remind Yourself What Is Happening
The very first thing to do when a panic attack begins is to name it. Not as a way of dismissing what you’re feeling, but as a way of orienting yourself to what is actually happening.
Say to yourself — aloud if possible, silently if not: This is a panic attack. It is not dangerous. It will pass.
This matters more than it might seem. One of the primary drivers of panic attack intensity is the fear of the panic itself — the catastrophic interpretation of physical symptoms (I’m having a heart attack, I’m going to pass out, I’m losing my mind) that escalates the alarm response and intensifies symptoms. Naming what is happening — anchoring yourself in the factual reality that this is a panic attack, not a medical emergency — interrupts that escalation.
A panic attack, however frightening, has a biological ceiling. It cannot sustain indefinitely. The nervous system cannot maintain that level of activation for more than a matter of minutes before it begins to self-regulate. Knowing this — and reminding yourself of it in the moment — gives you something solid to hold onto.
Step 2: Work With Your Breath
During a panic attack, breathing becomes rapid and shallow — which paradoxically worsens the physical symptoms by reducing carbon dioxide levels in the blood and contributing to dizziness, tingling, and a sense of unreality. Slowing and deepening the breath is one of the most direct and effective interventions available in the moment.
The most evidence-supported breathing technique for acute panic is extended exhale breathing. Breathe in slowly through your nose for a count of four. Then exhale slowly through your mouth for a count of six to eight — longer than the inhale. Repeat this cycle.
The extended exhale is key. A longer exhale than inhale activates the parasympathetic nervous system — the body’s “rest and digest” counterpart to the fight-or-flight response — and directly communicates to the nervous system that it is safe to begin calming down. It is not a trick or a distraction. It is a physiological intervention that works with the body’s own regulatory system.
If counting feels difficult in the moment, simply focus on making the exhale feel longer and slower than the inhale. That alone is enough to begin shifting the physiological state.
Step 3: Ground Yourself in the Present Moment
Panic pulls attention inward and forward — into frightening physical sensations and catastrophic thoughts about what those sensations mean. Grounding techniques work by pulling attention outward and into the present moment — into the immediate sensory environment, which is safe, even when the internal experience feels anything but.
The 5-4-3-2-1 technique is one of the most widely used and effective grounding practices for acute panic:
- 5 things you can see — look around and name them specifically
- 4 things you can physically feel — the weight of your body in a chair, the texture of a surface, the temperature of the air
- 3 things you can hear — near sounds and distant ones
- 2 things you can smell
- 1 thing you can taste
Work through each category slowly and deliberately. The goal is not to distract yourself from the panic but to engage the sensory, present-moment experience of the nervous system — which is incompatible with the threat-response state that panic generates. Many people find that by the time they reach the end of the exercise, the acute intensity of the attack has already begun to subside.
Step 4: Resist the Urge to Escape or Fight
During a panic attack, two instincts tend to dominate: the urge to escape the situation you’re in, and the urge to fight the panic — to make it stop, to push it away, to do something to end it immediately.
Both of these responses, while completely understandable, tend to maintain and intensify panic rather than reduce it. Escape reinforces the belief that the situation or sensation was genuinely dangerous — teaching the nervous system that fleeing was the right response. Fighting the panic generates more tension and fear, adding fuel to an already activated system.
The more effective — and more counterintuitive — approach is to allow the panic attack to be present without trying to force it to end. This is not passive resignation. It is an active choice to stop adding fear to fear. When you stop struggling against the panic and instead breathe through it, ground yourself, and allow the physiological wave to crest and pass, the attack typically resolves more quickly than when you fight it.
This is easier said than done, particularly when depression is present and emotional resources are already depleted. It is a skill that develops with practice and, ideally, with the guidance of a therapist trained in anxiety and panic treatment.
Step 5: Have a Post-Panic Anchor
When a panic attack passes, the body and mind are often left in an exhausted, depleted state — particularly when severe depression is already part of the picture. Having a simple, pre-decided anchor for what you will do after a panic attack can provide a sense of structure and forward motion in a moment when both feel elusive.
Your post-panic anchor might be something as simple as:
- Making a warm drink and sitting somewhere comfortable
- Sending a text to one trusted person to let them know what happened
- Lying down with a blanket and allowing your body to rest
- Stepping outside briefly for fresh air and natural light
- Writing a few sentences in a journal about what the experience was like
The specific activity matters less than the fact that it is pre-decided, low-effort, and oriented toward gentle self-care rather than immediately pushing through or returning to whatever was happening before the attack. Your nervous system has just been through something significant. Giving it a moment to recover is not avoidance — it is appropriate self-care.
Step 6: Track Your Panic Attacks
If panic attacks are a recurring part of your experience alongside depression, keeping a simple log can be genuinely useful — both for your own understanding and for any clinical work you’re doing with a therapist.
A panic attack log doesn’t need to be elaborate. After each attack, note:
- The date and time
- Where you were and what you were doing
- Any identifiable trigger or what was on your mind beforehand
- The physical symptoms you experienced
- How long the attack lasted
- What helped, if anything
Over time, this record often reveals patterns — times of day, situations, emotional states, or physical conditions (hunger, poor sleep, caffeine) that tend to precede attacks. That information is valuable: it informs treatment, helps you anticipate and prepare for higher-risk moments, and gives you a sense of agency and understanding in an experience that can otherwise feel completely unpredictable.
When Panic Attacks and Depression Require Professional Support
The steps above are designed to help you get through individual panic attacks — to give you something concrete and effective to reach for in a difficult moment. But they are not a substitute for professional treatment, and it’s important to say that clearly.
When panic attacks are occurring alongside severe depression, professional support is not just helpful — it is important. The combination of these two experiences significantly impacts quality of life, and both respond well to evidence-based treatment when that treatment is targeted and appropriate.
CBT (Cognitive Behavioral Therapy) is the gold standard treatment for panic disorder and has strong evidence for depression as well. It addresses both the thought patterns that drive panic and the avoidance that maintains it, while also targeting the cognitive distortions at the heart of depression.
DBT (Dialectical Behavior Therapy) is particularly relevant when severe depression involves significant emotional dysregulation, suicidal ideation, or a history of trauma. DBT builds concrete skills for distress tolerance and emotional regulation that directly apply to managing panic in the context of depression.
Medication — particularly SSRIs and SNRIs — can be an important component of treatment for both depression and panic disorder. A psychiatrist can help determine whether medication is appropriate and monitor its effects over time.
If your panic attacks and depression are significantly impacting your daily functioning, a higher level of care — such as an Intensive Outpatient Program (IOP) or Partial Hospitalization Program (PHP) — may provide the frequency and intensity of support that weekly therapy alone cannot.
You Don’t Have to Navigate This Alone
Managing panic attacks in the midst of severe depression is genuinely hard. The fact that you’re looking for ways to cope — that you’re reaching for tools and information even when everything feels heavy — says something important about your resilience.
You deserve support that matches the weight of what you’re carrying. At Arya Therapy Center of New Jersey, we work with adults navigating depression, panic, anxiety, and co-occurring conditions across multiple levels of care. Our clinicians are trained in evidence-based approaches and committed to providing care that is genuinely tailored to your experience. Reach out to us online or call (609) 245-6480 — we’re here to help.
If you are in crisis or experiencing thoughts of suicide, please call or text 988 or text HOME to 741741. Help is available right now, 24 hours a day.