Panic disorder and panic attacks

What are panic disorder and panic attacks?

A panic attack is a sudden rush of intense fear or discomfort that peaks within minutes. It can bring a pounding heart, breathlessness, chest tightness, dizziness, sweating, shaking, tingling and a frightening sense that something terrible is about to happen. The feelings are very real, but a panic attack itself is not dangerous and does pass.

Panic disorder is when these attacks keep happening, seem to come out of the blue, and you start to worry a lot about having more — sometimes avoiding places or situations where an attack might happen. That avoidance can grow into agoraphobia, where leaving home or being in crowds feels too risky.

Because the symptoms can feel like a heart or breathing problem, a first severe panic attack often leads people to A&E, and it is reasonable for a doctor to check that nothing physical is going on. Once panic disorder is recognised, it is very treatable.

The main treatments are talking therapy (especially CBT) and medication (usually an SSRI). Self-help based on CBT is often the first step. Treatment helps most people have fewer, less intense attacks and worry about them less — though it usually means managing panic well rather than a promise it will never happen again.

Types, options & approaches

There may be different ways to do this. The right approach depends on the clinical question and your circumstances.

Talking therapy vs medication for panic disorder

Both are effective and your preference matters. Benzodiazepines (like diazepam) are not recommended for ongoing panic disorder because of dependence and poorer long-term outcomes. Your clinician should explain the options.

Preparing for your treatment

• Before an appointment, note when your attacks happen, what they feel like, how long they last, and what you do during and afterwards.
• Write down any situations you have started to avoid because of panic.
• Note caffeine, alcohol, cannabis and stimulant use, which can all trigger or worsen panic.
• Bring a list of medicines and supplements, and any treatments you have already tried.
• If your first attacks involved chest pain or breathlessness, expect that a doctor may check your heart and physical health to be safe.
• In England, if you are 18 or over you can often refer yourself to NHS Talking Therapies without seeing a GP first; in Scotland, Wales and Northern Ireland referral is usually through your GP or a local service, so ask how to access psychological therapies where you live.
• If you have ever had thoughts of harming yourself, tell the clinician so they can keep you safe.

What happens

Treatment usually starts with an assessment — a conversation about your attacks, your physical symptoms, what you avoid, your history, and your use of caffeine, alcohol and drugs. Because panic can mimic heart or breathing problems, a clinician may arrange basic checks to rule out a physical cause, especially after a first severe attack.

NHS care often follows a stepped approach: lower-intensity help such as guided self-help first, then CBT or medication, and on to specialist services if needed. You should get a clear explanation of the panic cycle and a say in which treatment to try.

If you start CBT, sessions will help you understand panic, test frightening beliefs, drop unhelpful 'safety behaviours', and gradually face avoided situations. If you start medication, you will be told what to expect — including that anxiety can briefly feel worse before it improves — and you will be reviewed to check progress.

Is this treatment right for me?

A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.

Before you decide

Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.

The biggest practical issues are that medication can briefly worsen anxiety before it helps, and that benzodiazepines, while they may calm a single attack, are not a good ongoing treatment because of dependence and rebound. Ask your clinician how long to give a treatment, what side effects to expect, and how to stop medication safely. If anxiety, agitation or thoughts of self-harm get worse after starting treatment, contact them promptly.

Published figures to discuss

There are no surgical-style complication rates for panic treatment. How well treatment works, and how quickly, varies from person to person and depends on severity, avoidance, other conditions and which treatment is used. Because reliable, comparable figures for individual outcomes are limited and easily misread, this guide describes benefits and risks in words rather than quoting precise percentages. Two well-established points: relapse is common after stopping medication, which is why it is usually continued for at least a year if it helps; and benzodiazepines carry a real risk of dependence and rebound anxiety, which is why they are not recommended for ongoing treatment.

These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.

What happens afterwards

There is no physical recovery from treatment for panic disorder. What matters is the weeks that follow: understanding the panic cycle, gradually facing what you have avoided, and giving any medication a fair trial — improvement usually builds step by step.

• Feeling more anxious for a week or two after starting medication before it settles
• Anxiety when you first face situations you have been avoiding — this usually eases with practice
• Occasional attacks even as things improve overall
• Good days and bad days rather than a steady straight-line recovery
• Wanting to avoid therapy tasks that feel frightening — doing them gradually is how panic loosens its grip

Aftercare

• Give each treatment a fair trial — therapy and medication both take weeks, not days.
• Practise the CBT tasks, including gradually facing situations you have avoided, rather than relying on safety behaviours.
• Take medication regularly as prescribed and do not stop suddenly — talk to your clinician first.
• Cut down on caffeine, alcohol and recreational stimulants, which can all trigger panic.
• Avoid relying on 'just in case' benzodiazepines, which can keep panic going in the long run.
• Keep review appointments so the plan can be adjusted if needed.
• Know who to contact if things get worse, and keep crisis numbers easy to find.

• A diary of attacks and any situations you avoid
• A list of current medicines and past treatments
• Questions written down for your clinician
• A plan for who to contact if you feel worse
• Crisis numbers saved: 999, Samaritans 116 123, the 111 mental health option (England, Scotland and Wales) or Lifeline 0808 808 8000 (Northern Ireland), SHOUT to 85258
• Realistic time set aside for therapy sessions and homework

⚠ Get urgent help if…

• Thoughts of suicide or self-harm, or feeling you cannot keep yourself safe — call 999 or go to A&E now
• An immediate crisis at any time of day or night — call Samaritans free on 116 123 or text SHOUT to 85258. For urgent mental health support, in England, Scotland or Wales call 111 and choose the mental health option; in Northern Ireland call Lifeline free on 0808 808 8000 or your GP out-of-hours service
• New or different chest pain, breathlessness or collapse that you are not sure is panic — get it checked urgently, as panic should not be assumed
• Anxiety or agitation that clearly worsens in the first weeks of a new medication
• A sudden lift into an unusually 'high', overactive or irritable mood, which should be reviewed
• Increasing avoidance to the point where you cannot leave home or carry on with daily life
• Drinking much more alcohol, or using drugs or 'just in case' tablets, to cope

Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.

General guidance — it doesn't replace the specific advice your psychiatrist gives you.

Results & realistic expectations

A good outcome usually means fewer and less severe attacks, much less worry about having them, and being able to do things you had avoided — rather than a promise that panic will never happen again. Many people improve substantially with CBT, medication, or both.

Treatment cannot guarantee panic will never return, particularly at stressful times, and it does not remove normal anxiety. What it can do is break the cycle that keeps panic going and give you tools to handle attacks if they occur. If one treatment does not work, that helps guide the next step rather than meaning nothing will.

Many people stay well once they have learned how to manage panic, but it can return at times of stress. If medication is helping, it is usually continued for at least a year before being slowly reduced, because stopping early raises the chance of relapse. CBT skills can be refreshed with a top-up course if symptoms return. Plans should be reviewed as your life and symptoms change.

Related tests, treatments or support

Panic disorder often comes with agoraphobia, generalised anxiety, low mood or alcohol use, and treatment may need to address these together. CBT and medication can be combined when one alone is not enough. Cutting caffeine and alcohol, improving sleep and tackling everyday stress all support formal treatment rather than replacing it.

Follow-up & long-term care

After starting treatment you should be reviewed to check how it is working and to catch problems early, particularly in the first weeks of medication. Therapy includes regular sessions with a planned ending. If you are on medication long term, you should have periodic reviews, and you should always know how to get back in touch sooner if panic worsens.

• Regular review of medication while you take it, and a slow, planned reduction when stopping
• Refresher CBT or self-help if attacks start to return
• Keeping up the habit of facing rather than avoiding feared situations
• Limiting caffeine, alcohol and 'just in case' tablets
• A simple plan for early warning signs and what to do if panic flares

Repeat, follow-on and what comes next

• It is common to need to switch SSRI, change the dose, or move between therapy and medication before finding what works.
• The diagnosis may be revisited if treatment does not help, in case another condition fits better.
• Panic can return after stopping treatment, and a further course of therapy or medication may be needed.
• Plans are expected to be reviewed and adjusted over time rather than set once.

Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.

What good aftercare looks like

• A named contact and a clear plan for what to do if panic or mood worsens
• Early review after starting medication to check side effects and safety
• A planned course of therapy with a clear ending and option to return
• Sensible advice on how long to stay on medication and how to reduce it slowly
• Written crisis information, including 999/A&E, Samaritans 116 123, the 111 mental health option (in England, Scotland and Wales) or Lifeline 0808 808 8000 (in Northern Ireland), and SHOUT to 85258

What affects the cost

Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:

• Whether you choose talking therapy, medication, or both
• The type and length of therapy (guided self-help, individual CBT, or longer specialist input)
• Who provides care — GP, accredited therapist, or consultant psychiatrist
• The number of sessions and how often you are seen
• Whether you need physical checks to rule out other causes, or a fuller psychiatric assessment
• Ongoing medication reviews where relevant
• Follow-up appointments and how long support continues

• The clinician's or therapist's fee and their accreditation or specialty
• How many sessions are included and the cost of further sessions
• What an initial assessment covers and costs
• Whether any physical checks or medication reviews are included
• What follow-up and between-session support are provided
• The cancellation policy
• What happens, and what it costs, if you need to be referred on or step up to specialist care

On the NHS? Treatment for panic disorder is widely available across the UK through the NHS and, in Northern Ireland, Health and Social Care (HSC). Talking therapies are accessed through the local psychological therapies service — in England this is often NHS Talking Therapies, which adults can usually self-refer to, while service names and referral routes differ in Scotland, Wales and Northern Ireland. Medication can be prescribed by your GP. Private care may be used for faster access or particular therapists.

You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.

Consent traps and marketing red flags

These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.

Choosing a specialist safely

• Check the psychiatrist is on the GMC Specialist Register for this area.
• Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
• You're entitled to time to consider and to have your questions answered before you agree — the psychiatrist who looks after you should explain it, not a salesperson.
• Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
• You're entitled to your total cost in writing — including any follow-up — before you decide.

How Vuemedics verifies every consultant →

Take this to your consultation. A good psychiatrist will welcome every one of these.

• Could a physical problem be causing my symptoms, and do you need to check anything?
• Would you suggest starting with CBT, medication, or both for my panic?
• What side effects should I expect, and how long before I should notice benefit?
• How should I handle an attack while I wait for treatment to work?
• How long would I stay on medication, and how would I come off it safely?
• What should I do, and who should I contact, if panic or my mood gets worse?
• Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
• Will you be the psychiatrist who carries out my treatment, and who looks after me afterwards?
• What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
• What does a realistic result look like — and what can this treatment not achieve?
• What are my options, including waiting, doing nothing for now, or choosing a different approach?
• Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
• What is the total cost in writing, including any follow-ups, and how much time do I have to decide?

Find a verified psychiatrist for panic disorder and panic attacks

Every consultant is GMC-checked and independently reviewed. Search by postcode and distance, or switch to a map. Ordered by rating, relevance and recency — never by who pays.

How we made this page

Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →

Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.

Sources & standards: NHS — Panic disorder NICE CG113 — Generalised anxiety disorder and panic disorder in adults: management NICE CG113 — Recommendations (panic disorder) Royal College of Psychiatrists — Anxiety, panic and phobias Mind — Anxiety and panic attacks NHS — Where to get urgent help for mental health nidirect — urgent and emergency care services (NI) nidirect — GP out-of-hours service (NI) NHS England — 111 mental health crisis support NHS inform (Scotland) — urgent mental health help NHS 111 Wales — mental health and wellbeing nidirect — mental health crisis help (Lifeline, NI) NHS — Find NHS Talking Therapies (England) NHS inform (Scotland) — psychological therapies NHS 111 Wales — counselling nidirect — mental health care professionals (NI)

Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.

Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.