On this page
Dr. Chrysoula I. Liakou MD, PhD
- Treated online: Yes, usually, once heart and lung causes are excluded. Panic attacks are assessed by video; treatment is usually CBT and sometimes an SSRI, and benzodiazepines are never prescribed online.
- What it is: a sudden adrenaline surge with a racing heart, breathlessness, chest tightness, dizziness, trembling, sweating and fear of dying or losing control, peaking inside 10 minutes and passing within 20 to 30.
- How common: about 1 in 10 adults has a panic attack in any year; panic disorder, with repeated attacks and dread of the next, affects around 2 to 3% of people and usually starts between 20 and 35.
- Why it persists: avoiding the places where attacks happened, and watching the body for the next one, teach the brain the attacks were dangerous, so the territory of fear grows.
- Treatment: CBT for panic, typically 8 to 12 sessions, helps most people; an SSRI started low with early reviews takes 4 to 6 weeks to work and is used when attacks are frequent or CBT alone is not enough.
- Emergency: never self-diagnose a first or severe episode of chest pain, breathlessness or a racing irregular heartbeat as a panic attack: call 112 and let the heart be checked; thoughts of harming yourself are a 112 call too.
A first or severe episode of chest pain, breathlessness or a pounding irregular heartbeat is not an online appointment. Call 112 or get emergency care so a heart problem can be ruled out first; panic can only be diagnosed safely after that. If your attacks follow a pattern that has already been checked, this page and an online consultation are for you.
Can an online doctor treat panic attacks?
Yes, once physical causes have been excluded. A video consultation can often provide enough information to assess panic attacks and panic disorder: the doctor maps the attacks and the avoidance growing around them, explains the panic cycle, refers you for CBT and, after full assessment, can prescribe an SSRI where appropriate.[1] A first severe episode with chest pain needs emergency assessment instead.
How an online consultation helps with panic attacks
- An explanation that shrinks the fear: Half the terror of panic is not knowing what it is. The doctor walks you through the adrenaline surge symptom by symptom, so the next wave meets a mind that knows what it is looking at.
- The physical causes taken seriously: Thyroid problems, heart rhythm issues, asthma, caffeine and some medicines can all mimic panic. The doctor checks the history properly and arranges local tests when the story warrants them.
- Treatment that targets the cycle: CBT for panic disorder is a first-line, well-evidenced treatment,[1] and the doctor refers you into it rather than leaving you with breathing tips and good wishes.
- Honesty about medication: What SSRIs can do for recurring attacks, why they start at low doses, and why benzodiazepines are not prescribed online, explained before anything is decided.
What does a panic attack feel like?
A panic attack is a sudden surge of intense fear that peaks within minutes, with strong physical symptoms driven by adrenaline. It typically brings a pounding heart, breathlessness, chest tightness, dizziness, trembling, sweating, tingling hands, nausea and a powerful sense of doom or unreality.[2] Attacks pass on their own, usually within 20–30 minutes.
- Racing or pounding heart, sometimes with skipped beats
- Breathlessness, a choking feeling or chest tightness
- Dizziness, light-headedness or feeling faint
- Trembling, sweating, hot flushes or chills
- Tingling or numbness in hands, feet or face
- Nausea or a churning stomach
- Feeling detached from yourself or that the world is unreal
- A conviction that you are dying, suffocating or losing control
That last symptom deserves respect: people mid-attack genuinely believe something catastrophic is happening, which is why so many first attacks end in an emergency department. That visit is not an overreaction. Chest pain and breathlessness should be treated as cardiac until proven otherwise, every time it is new or different.
Why do panic attacks keep coming back?
Panic attacks repeat because of a self-feeding cycle: a trigger or a stray body sensation sets off an adrenaline surge; the surge causes frightening symptoms; the mind reads the symptoms as catastrophe, which releases more adrenaline; and afterwards, fear of the next attack keeps the body scanning and primed. Avoiding places where attacks happened teaches the brain they were dangerous, so the territory of fear grows.[1]
Seen up close, the loop has three layers. During an attack, catastrophic interpretation turns a racing heart into “heart attack” and dizziness into “stroke”, which is rocket fuel for adrenaline. Between attacks, anticipatory anxiety keeps you monitoring your pulse, carrying water, sitting near exits; the vigilance itself generates the very sensations you are scanning for. And over months, avoidance and safety behaviours quietly redraw your map: motorways, supermarkets, lifts, being far from a hospital. When the avoidance spreads across many situations, the pattern is called agoraphobia, and it responds to the same treatment. This cycle is precisely what CBT for panic disorder dismantles, layer by layer, which is why treatment works so much better than willpower.[1]
How do I stop a panic attack right now?
Ride it out rather than fight it: an attack peaks within minutes and always passes. Lengthen your out-breath, in through the nose for four counts, out slowly for six, because the long exhale is what dials the alarm down.[4] Drop your shoulders, plant your feet, and name five things you can see and four you can touch. Stay where you are if it is safe to do so; fleeing tells your brain the place was the danger. Remind yourself, in words, that this is adrenaline and it cannot harm you. These techniques manage the wave; treatment stops the sea from producing them.
Is it panic, or something else?
Good panic care starts by refusing to assume. An overactive thyroid can produce racing heart, sweating and anxiety; heart rhythm disturbances can feel identical to panic; asthma can drive breathless episodes; low blood sugar, heavy caffeine or energy-drink use, decongestants, some asthma inhalers and stimulant medicines can all trigger surges; and withdrawal from alcohol or sedatives is a classic mimic. The doctor takes the history that separates these, and arranges local blood tests or a heart trace when the story points that way, before panic disorder is named. Attacks that wake you from sleep, common and frightening, still follow the same rules. And because broken sleep lowers the panic threshold, stubborn insomnia is treated as part of the problem, not background noise; the insomnia page explains that side properly. Panic that travels with months of general worry may be part of a wider anxiety disorder, which shifts the emphasis of treatment slightly, not the destination.
Which panic treatment might the doctor recommend?
Treatment follows the pattern and what has already been ruled out. This is the decision framework the doctors use, aligned with European and UK guidance:[1]
Swipe sideways to compare →
| Presentation | Likely first step | Suitable for online care? | When referral or in-person care is needed |
|---|---|---|---|
| A first or severe attack with chest pain, breathlessness or irregular heartbeat | Emergency assessment to exclude heart and lung causes | No, not yet | Call 112 or attend emergency care first; online care follows once causes are excluded |
| Occasional attacks with a clear trigger, little avoidance, physical causes checked | Explanation of the panic cycle, self-help techniques, booked review | Usually yes | If attacks recur or avoidance starts to spread |
| Recurring attacks with dread between them and growing avoidance (panic disorder) | CBT referral; an SSRI after full assessment when appropriate | Usually yes | Little response after adequate treatment courses: psychiatry review |
| Attacks alongside heavy alcohol, sedative or stimulant use | Supervised, in-person assessment | No | Withdrawal can be dangerous and needs local, supervised care |
| Panic with thoughts of harming yourself | Crisis support today | No: crisis support comes first | Call 112 in an emergency, or find your national crisis helpline at findahelpline.com |
Not sure which row fits your attacks? A doctor can tell you in one consultation.
See available times →What the doctor checks in an online panic consultation
Describing an attack to someone who understands them is often a relief in itself. Behind the conversation, the assessment is structured. The doctor will typically check:
- The attacks themselves: how they start, how fast they peak, which symptoms dominate, how long they last, and whether any have been checked in an emergency department or clinic.
- What has been ruled out: previous heart traces, blood tests or examinations, so nothing is assumed and nothing useful is repeated blindly.
- The space between attacks: dread, body-scanning, safety behaviours and what you have quietly stopped doing, because avoidance is where panic disorder does its real damage.
- Chemical contributors: caffeine and energy drinks, alcohol and its rebound, nicotine, decongestants, stimulants and any new medicines.
- Physical mimics: thyroid symptoms, palpitation patterns, asthma history and low blood sugar clues, with local tests arranged when the story warrants them.
- Sleep and mood: night attacks, broken sleep and low mood, which shape the plan rather than sitting outside it.
- Safety: asked plainly, because repeated attacks grind people down further than they usually admit.
One limit is stated just as plainly: no doctor, online or in person, should diagnose a first episode of chest pain as panic over video. Emergency assessment comes first; everything else follows.
Treatment options for panic attacks
What you can do yourself
Between attacks is where self-help earns its keep. Practise slow breathing with a longer out-breath for a few minutes twice daily while calm, so the skill exists when the wave hits; a skill first rehearsed mid-attack rarely holds. Cut caffeine and energy drinks honestly, including the afternoon ones, and notice that alcohol calms tonight and repays you with a jumpier tomorrow. Keep your sleep regular, and keep moving: regular exercise measurably lowers baseline anxiety, and it also teaches your body that a raised heart rate can mean something safe. Most importantly, resist the quiet edits, the abandoned trolleys, the avoided motorways, the standing near exits, because each one teaches your brain the fear was justified. Go back to the places attacks happened, gently and repeatedly, ideally as part of structured therapy.[1] What does not help: breathing into paper bags on the advice of films, scanning your pulse, and reassurance-googling at 2 a.m., which feeds the loop it promises to soothe.
Prescription treatment
CBT built for panic disorder is a first-line treatment: it retrains the catastrophic interpretations, deliberately recreates feared sensations in safe conditions until they lose their meaning, and dismantles avoidance step by step.[1] The doctor refers you and keeps oversight. A prescription is never issued without a consultation; when medication is right, usually for frequent attacks or heavy anticipatory anxiety, an SSRI such as sertraline or escitalopram is the standard choice.[1] Honesty about how that goes: people with panic are unusually sensitive to the first-week activation effects, so doctors start at low doses and climb slowly; benefit builds over four to six weeks; and an early review is booked so wobbles are managed rather than endured. SSRIs are not addictive, and stopping is planned and gradual.[5] Benzodiazepines such as diazepam or alprazolam deserve a direct sentence: they are dependence-forming controlled medicines, guidance advises against them for panic disorder,[1] and they are not prescribed through online consultations, ever. Anyone promising otherwise is not offering care.
When panic is treated online, and when you need in-person care
Treated online: panic attacks and panic disorder once heart and lung causes are excluded; the agoraphobic avoidance that grows around attacks; SSRI starts at panic-appropriate doses with early booked reviews; medication reviews and planned, gradual stopping; and CBT referrals with a doctor keeping oversight of the whole plan.
In-person care: a first or severe episode of chest pain, breathlessness or irregular pounding heartbeat goes to 112 or emergency care before any panic diagnosis; attacks tangled with heavy alcohol, sedative or stimulant use need supervised, in-person care, because withdrawal can be dangerous; attacks with fainting, attacks during exertion, or a family history of sudden cardiac death get cardiology assessment; treatment-resistant or complex cases go to psychiatry; and requests for benzodiazepines are declined with an explanation and a safer plan, because controlled medicines are not prescribed online. If the attacks are one strand of wider stress overload, the stress page maps that territory.
When to get in-person care
Call 112 immediately for chest pain or breathlessness that is new, severe or different from your usual attacks; for pain spreading to the arm, neck, jaw or back; for symptoms with fainting, or during exercise; or for an irregular racing heartbeat that does not settle. Let emergency doctors rule out the heart; panic is diagnosed only after that, never instead of it.
If you are having thoughts of harming yourself, call 112 in an emergency. You can also find your national crisis helpline at findahelpline.com. You do not have to wait for an appointment.
How Mobi Doctor works
- Book a time that suits you: open daily 7am–11pm CET. You can see a doctor over video, usually within 15 minutes. No subscription, exact price up front.
- Speak to a licensed doctor about panic attacks: a private video call: you describe what you feel, the doctor asks what matters, and you agree the right plan together.
- Leave with your plan: everything agreed before you hang up: your plan, and a prescription to use at a pharmacy near you where medication is clinically right for you. If your doctor decides you need to be seen in person, you get a full refund.
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Not sure it’s a panic attack? Tick every symptom you have to see each condition page that mentions it. It finds the right page, not a diagnosis: a doctor gives you that on a video call. If you have an emergency sign listed on this page, call 112 instead.
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Not sure this is the right page? Look up any symptom in the full symptom checker, or book and describe it to a doctor.
Frequently asked questions about panic attacks
What is a panic attack?
A panic attack is a sudden surge of intense fear or discomfort that peaks inside 10 minutes: a racing or pounding heart, breathlessness, chest tightness, dizziness, trembling, sweating, tingling, nausea and a sense of unreality or of dying or losing control. It is adrenaline doing its job at the wrong moment, it is not dangerous to a healthy heart, and it usually passes within 20 to 30 minutes.
What does a panic attack feel like?
A panic attack feels like an emergency arriving from nowhere: the heart hammers, breathing feels impossible, the chest tightens, the room tilts, hands tingle or shake, and a conviction takes hold that you are about to die, faint, lose control or go mad. The peak passes quickly, leaving you shaky and exhausted, often with dread of the next panic attack for hours or days.
What causes panic attacks?
Panic attacks are triggered when the brain's alarm fires without a real threat and the body's response (a faster heart, quicker breathing) is read as proof of danger, which escalates the alarm. Stress, exhaustion, caffeine, alcohol withdrawal, some medicines, an overactive thyroid and a family tendency all lower the threshold; the attacks then persist because avoidance and watching the body for the next one keep the alarm primed.
How do I know it was a panic attack and not a heart attack?
You cannot reliably tell the first time, and you should not try: new or severe chest pain needs emergency assessment, every time. Once the heart has been checked, the pattern becomes informative: a panic attack peaks fast, eases inside half an hour, comes with tingling, a sense of unreality and fear of dying, and often follows a stressful period; cardiac pain tends to build with exertion and persist.
Can panic attacks damage my heart?
A panic attack does not damage a healthy heart; the surge is adrenaline doing what adrenaline does, unpleasantly but safely. The real cost of untreated panic attacks is the shrinking life around them. Anyone with known heart disease should still have new or changed chest symptoms checked rather than assuming panic.
How do I stop a panic attack when it starts?
To ride out a panic attack, slow your breathing with a longer out-breath (in for four counts, out for six), stay where you are rather than fleeing, which teaches the brain the place was dangerous, remind yourself that the surge peaks and passes inside half an hour and cannot harm you, and focus on something outside your body such as five things you can see. Leaving, bracing and breathing fast all prolong panic attacks.
Why do I get panic attacks at night?
Night-time panic attacks wake you mid-surge, heart pounding, gasping, frightened, and they are common in panic disorder. They are not dangerous, though they feel worse for arriving without warning. Late caffeine and alcohol make them likelier, and so do exhaustion and untreated daytime panic. The same treatment, CBT with or without an SSRI, settles night attacks too.
Can an online doctor prescribe medication for panic attacks in Europe?
Yes, where clinically appropriate, an online doctor can prescribe medication for panic attacks in Europe. After a full video assessment, the doctor may prescribe an SSRI, started at a low dose with early reviews, once physical causes are excluded. Benzodiazepines are controlled, dependence-forming medicines and are not prescribed online.
How long do panic attacks last, and will they go away?
A single panic attack peaks inside 10 minutes and usually passes within 20 to 30, though the shaky aftermath can last hours. Without treatment, panic disorder tends to wax and wane for years. With CBT, most people see fewer and milder panic attacks within 6 to 8 weeks, and many become attack-free; an SSRI takes 4 to 6 weeks to reach its effect.
Will I have panic attacks for the rest of my life?
Very unlikely: with treatment, panic attacks rarely continue for life. Panic disorder responds well to CBT, with or without an SSRI, and many people become attack-free or reduce attacks to rare, manageable blips. The earlier the avoidance is unwound, the quicker the recovery, which is why treatment is worth starting after the first few attacks rather than years in.
How can I prevent panic attacks coming back?
Keep going into the places where panic attacks happened, so the brain keeps relearning they are safe; cut caffeine, alcohol and exhaustion, which lower the threshold; practise slow breathing daily rather than only in a crisis; treat stress and poor sleep early; and if you take an SSRI, stop it only gradually with your doctor. A single attack during a stressful month is normal and is not a relapse.
Are panic attacks different in pregnancy or with a heart condition?
Panic attacks are common in pregnancy and after birth and are treated rather than waited out, with CBT first and any medication chosen with pregnancy or breastfeeding in mind. In someone with a known heart condition, new or changed chest symptoms are checked every time rather than assumed to be panic, and treatment of the panic attacks is coordinated with their cardiac care.
- Generalised anxiety disorder and panic disorder in adults: management (CG113), NICE, National Institute for Health and Care Excellence, 2011 (updated 2020).
- Anxiety disorders: fact sheet, WHO, World Health Organization, 2023.
- Guidance and resources on anxiety and panic disorders, European Psychiatric Association, accessed August 2026.
- Panic attacks: signs, causes, diagnosis and treatments, HSE, Health Service Executive (Ireland), reviewed 2025.
- Sertraline, HSE, Health Service Executive (Ireland), accessed August 2026.
- Panic disorder, NHS, National Health Service (UK), accessed October 2026.
This page is for information only and is not a substitute for a medical consultation. Guideline links are provided for transparency; treatment decisions are made with your doctor.
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