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Take the following steps: Immediate management during an episode: Move to a quiet, safe space if possible Practice controlled breathing: breathe in slowly through your nose for 4 counts, hold for 4, exhale through your mouth for 6 counts Use grounding techniques: focus on physical sensations (feet on floor, objects you can see, sounds you can hear) Remind yourself that panic attacks, whilst distressing, are not dangerous and will pass If symptoms include chest pain, severe breathlessness, or you're unsure whether it's a panic attack, seek immediate medical attention by calling 999 or NHS 111 for urgent but non-emergency advice If experiencing thoughts of self-harm or suicide, seek urgent help via your local crisis team, A&E, or call 999 Follow-up actions: Contact your GP or prescribing clinician within 1-2 days to discuss your symptoms

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After significant weight loss, metabolic adaptation occursthe body's energy expenditure decreases beyond what would be predicted by the loss of body mass alone

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