Panic disorder

Expert reviewer, Dr Liz Russell, Consultant Psychiatrist
Content editor review by Victoria Goldman, December 2023
Next review due December 2026

Panic disorder is a type of anxiety disorder. You have regular sudden panic attacks and may feel anxious about having more panic attacks. Talking therapies and medicines are usually used to treat panic disorder.

About panic disorder

Many people feel anxious from time to time. Sometimes, a particularly stressful event may trigger a panic attack. A panic attack is a sudden feeling of intense anxiety or fear that causes physical symptoms. Panic attacks are common. They affect around 1 in 10 people.

Most people who have a panic attack recover quickly and don’t have another panic attack. But if you have panic disorder, you get regular and unexpected panic attacks without a clear cause or trigger. You may also be constantly anxious about having more panic attacks, and worry about whether this could affect your health. You may worry that you’ll lose control. You may avoid any situations that could trigger a panic attack.

If you have panic disorder, you may also have:

a fear or avoidance of public places, this is called agoraphobia
social anxiety, this is when your panic attacks are triggered by social events and interacting with other people

Panic disorder tends to start in teenagers and young adults. It affects around 3 in 100 women and 1 in 100 men.

If you need help now

This page is designed to provide general health information. If you need help now, please use the following services.

Samaritans. 116 123 (UK and ROI) - This helpline is free for you to call and talk to someone.
NHS Services has a list of where to get urgent help for mental health.
Mind website. Click the ‘Get help now’ button on the page. This is a tool that is designed to help you understand what’s happening to you and how you can help yourself.

If you think you might harm yourself or are worried someone else might come to immediate harm, call the emergency services on 999 or go to your local accident and emergency department.

Causes of panic disorder

It isn’t clear why some people have panic disorder and others don’t. But certain things may make you more likely to have it. These include:

a close family history – if your parent, brother, sister, or child has panic disorder
very stressful life events
having other types of anxiety
chemical changes in your body that affect how your brain and nervous system react to danger
stopping certain medicines suddenly –for example, medicines for insomnia
taking illegal drugs such as cocaine or ecstasy
drinking a lot of alcohol – alcohol may make you feel calmer at first, but it can trigger increased anxiety and panic attacks in the following days

Symptoms of panic disorder

If you have panic disorder, you have regular panic attacks. A panic attack can be frightening and worrying. It can build up quickly and unexpectedly for no known reason. The symptoms usually peak within around 10 minutes and last for 10 to 30 minutes. They rarely last for more than an hour.

Everyone experiences a panic attack differently. Panic attack symptoms include:

a racing heartbeat (palpitations)
sweating
trembling or shaking
feeling like you can’t breathe or you’re being suffocated
breathing very quickly
feeling like you’re choking
chest pain or discomfort
feeling sick
tummy pain
feeling dizzy, unsteady, light-headed or faint
numbing or tingling sensations
feeling hot or cold
wanting to escape to a safe place
a feeling of dread or fear of dying

Some people with panic disorder have panic attacks several times a day. Others have a few attacks a month or a few attacks a year.

If you have panic disorder, you have a constant fear that you’ll have another panic attack. This may trigger more panic attacks. You may start to avoid going to places or doing things that have triggered a panic attack before.

A panic attack can be very uncomfortable and upsetting. Sometimes the symptoms can be so intense that you think you’re having a heart attack or asthma attack. During a panic attack, your blood pressure and breathing rate may increase for a short while, but everything is otherwise normal. Panic attacks aren’t dangerous and won’t cause you any physical harm. Many panic attack symptoms can be a sign of other medical conditions such as heart disease. So if you’re worried about your symptoms, speak to your GP.

Diagnosis of panic disorder

Many people are diagnosed with panic disorder after seeing their GP about vague symptoms such as chest pain, dizziness, or sleep problems.

Your doctor will ask about your symptoms and medical history. They’ll also examine you and ask:

about any medicines you’re taking or have recently stopped taking – for example, benzodiazepines or opiates
if you drink alcohol or have recently stopped drinking a lot of alcohol
if you have a lot of caffeine – for example, in tea or coffee
if you smoke or use nicotine-containing products such as e-cigarettes (vapes)
if any particular situations or events trigger your symptoms

It’s important to talk about how you’re feeling and to tell your GP if anything makes you feel anxious.

Panic disorder can’t be diagnosed with any tests or scans. But it’s usually diagnosed by ruling out physical causes first. Your GP may want to do some blood tests to check for medical conditions that may cause anxiety-like symptoms – for example, thyroid problems or low blood sugar.

Your GP may diagnose panic disorder if they can’t find a physical reason for your symptoms. But you’ll only be diagnosed with the condition if the following also apply:

your panic attacks are recurrent and unexpected
you have at least four symptoms of a panic attack – for example, a pounding heart, shaking, nausea, and finding it hard to breathe
your panic attacks didn’t happen because of alcohol or substance misuse, medical conditions or other mental health problems

Self-help for panic disorder

If your panic disorder symptoms are mild, you may be able to treat them with self-help measures. You might not need to take any medicines for panic disorder unless your symptoms get worse.

Learn to recognise and deal with a panic attack to keep your symptoms under control. Learn to recognise your panic attack triggers too.

Controlled breathing may help while you’re having a panic attack. During an attack, it can be calming to breathe out for longer than you breathe in. Breathe in for four seconds, hold for two seconds, breathe out for six seconds, then repeat this 10 times.

Talk to your family and friends about how you’re feeling and how panic disorder affects you. Speak to them about how they can help you treat it.

Contact local and national support groups to see if they have face-to-face meetings or online support. You may find it helpful to speak to other people with panic disorder.

Having a healthy lifestyle may help to keep your panic attacks under control.

Keep physically active – exercise may help to improve your mood.
Avoid caffeine, cigarettes, alcohol, and cannabis – these may trigger panic attacks.
Make sure you’re getting plenty of sleep.
Eat a healthy diet.

Trying to relax more often can help to reduce your anxiety. Find hobbies, interests, and activities that you enjoy. You could also try relaxation therapies such as:

mindfulness
meditation
slow, steady breathing
hypnosis

Treatment of panic disorder

If your panic disorder is moderate or severe or self-help hasn’t reduced your symptoms, your GP may recommend some treatments. Some people can keep their panic attacks under control without any regular treatment. But this may be because they avoid situations or places that trigger their panic attacks.

Panic disorder treatment aims to:

reduce the frequency and intensity of your panic attacks
reduce your anxiety before certain events and situations
stop you avoiding places that usually trigger your panic attacks
improve your daily life related to having panic disorder

Panic disorder is usually treated with:

talking therapies
medicines
both medicines and talking therapies

Different treatments help different people, so it’s important to discuss your options with a healthcare professional. Everyone responds to panic disorder treatments differently. If your GP can’t treat your panic disorder, they may refer you to a mental health specialist such as a psychiatrist or clinical psychologist.

Talking therapies

You may find talking therapies or counselling help to control your panic disorder, especially if you have mild to moderate symptoms.

Cognitive behavioural therapy (CBT) is a type of talking therapy that’s used to treat panic disorder. It helps you understand how your thoughts and feelings can trigger a panic attack. This will help you work out what’s triggering your panic attacks and how to deal with attacks when they happen.

You’ll speak to a mental health professional who is specially trained in CBT for 1 or 2 hours a week. You may need 7 to 14 hours of CBT for up to 4 months. You can have CBT face to face, online, on your computer, or using an app. CBT for panic disorder may involve:

learning about your condition
self-monitoring how you’re feeling
relaxation therapies
exposing you to uncomfortable situations so you learn to get used to them

Talking therapies such as CBT can be used on their own or with medicines. While you’re having CBT, it’s important to see your GP regularly as well to discuss whether it’s working for you.

Medicines

If talking therapies don’t help your panic disorder, your GP may prescribe some medicines. Which medicine is right for you depends on lots of things, including your age and if you have other medical conditions. Discuss with your doctor:

the risks of taking the medicines
possible side-effects and how these may affect you
interactions with other medicines you’re taking
if other medicines have already helped your panic disorder

Your GP is likely to prescribe an antidepressant medicine. This will be either a selective serotonin reuptake inhibitor (SSRI) or a serotonin-noradrenaline reuptake inhibitor (SNRI) first. These medicines include:

paroxetine
sertraline
citalopram
escitalopram

Antidepressants can cause some side-effects, so discuss this with your pharmacist or GP. Your GP will prescribe a low dose at first to reduce the risk of side-effects. Then they’ll gradually increase the dose until you feel your panic disorder is under control. Your anxiety may get worse at first, before you start feeling better.

Your GP will review your medicines regularly. If the antidepressant seems to be working, you’ll usually keep taking it for at least six months. Your GP may then begin to reduce the dose of your medicine.

Follow your GP’s instructions on how to take your medicines – it’s important to take antidepressant medicines regularly. Stopping them suddenly can cause withdrawal symptoms. Withdrawal symptoms include dizziness, feeling sick, numbness and tingling, headache, and sweating. Your GP will need to reduce the dose gradually before you come off them completely.

If you stop taking antidepressants suddenly, your panic attacks may come back. This is called a relapse. You may need to take your medicines for at least a year to make sure you don’t have a relapse. If you’re worried about taking these medicines regularly for a long time, speak to your doctor.

Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist or GP for advice.

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Complications of panic disorder

Untreated panic disorder can lead to complications. So it’s important to get help for your symptoms as soon as possible to stop your condition getting worse. It’s also important to seek help if your panic disorder symptoms come back after you’ve been treated.

Panic disorder can affect your day-to-day life if it’s not treated properly. It can affect your work and relationships. It can also lead to depression and other mental health conditions. People with panic disorder are more likely to smoke and have alcohol or drug problems.

Having anxiety and panic attacks may affect your ability to drive. You should tell the Driver and Vehicle Licensing Agency (DVLA) if your anxiety may affect your ability to drive safely. Ask your doctor if you’re not sure if your anxiety will affect your driving.

You may have panic disorder if you have recurrent and unexpected panic attacks without a clear cause or trigger. You may be anxious about having more panic attacks. You may avoid situations or events that may trigger a panic attack.

For more information, see our section on symptoms of panic disorder .

Panic disorder can be triggered by lots of things. Possible triggers include very stressful life events, other types of anxiety, and suddenly stopping certain medicines – for example, medicines for insomnia.

For more information, see our section on causes of panic disorder.

Everyone experiences an anxiety or panic attack differently. But the symptoms can include a racing heartbeat, sweating, trembling, and feeling like you can’t breathe.

For more information, see our section on symptoms of panic disorder.

A panic attack can be very uncomfortable and upsetting. Sometimes, you may worry that you’re having a heart attack. But a panic attack isn’t dangerous and won’t cause you any physical harm.

For more information, see our section on symptoms of panic disorder.

Related information

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