Quick answer
Panic disorder means repeated, unexpected panic attacks, plus ongoing worry about the next one or changes in how you live to avoid them. Panic attacks can feel like a heart attack, but on their own they aren't life-threatening. Chest pain should still always be checked medically. Panic disorder is treatable, usually with therapy, medication, or both.
Key takeaways
- One panic attack isn't panic disorder. Panic disorder means repeated, unexpected attacks and at least a month of worry about more, or changes to avoid them.
- Panic attacks aren't life-threatening on their own, but chest pain needs medical attention, especially the first time.
- Sertraline, paroxetine, fluoxetine and venlafaxine ER are FDA-approved for panic disorder.
- CBT, including practice with the body sensations of panic, is a well-studied therapy for panic disorder.
What panic disorder looks like
A panic attack is a sudden wave of intense fear or discomfort, or a sense of losing control, even when there's no clear danger. It can happen at any time, even during sleep. An attack can last from a few minutes to an hour or sometimes longer. The physical symptoms can feel like a heart attack, which is why many people first go to an emergency room.
One panic attack isn't panic disorder. Panic disorder means repeated, unexpected attacks, along with ongoing worry about the next one or changes in how you live to avoid them. It often begins in the late teens or early adulthood.
Common signs, in plain language
- A pounding or racing heart
- Sweating, chills or trembling
- Trouble breathing, weakness or dizziness
- Tingly or numb hands, chest pain, stomach pain or nausea
- A sense of doom, or of being out of control
- Worrying about the next attack, or avoiding places where attacks have happened
These signs are a general guide, not a checklist for diagnosis.
Researchers think panic attacks work like false alarms: the body's survival response fires too often or too strongly. Then a pounding heart gets read as danger, and the fear feeds the next wave. Over time, some people develop agoraphobia: Intense fear of places or situations where escape or help might be hard to get if panic symptoms started.. For more, read What panic attacks actually are, and are not.
How it's evaluated
Panic symptoms overlap with real medical problems, so other causes need to be checked first. If your symptoms haven't been checked medically, it's worth seeing your primary care provider, who may do a physical exam and blood tests. A careful psychiatric evaluation then looks at:
- How often attacks happen, what they feel like, and what happens in between
- Worry about future attacks, and anything you've started avoiding
- Conditions that often come with panic disorder, such as depression, other anxiety disorders, PTSD, OCD or bipolar disorder, and health conditions such as thyroid, heart or breathing problems
- Caffeine, alcohol, other substances and medications, which can play a part
This is part of a comprehensive psychiatric evaluation. Your first evaluation is up to 90 minutes in length. Some people need more time, some less, and we take the time you need. Follow-up visits are typically 20 to 30 minutes, and extended follow-ups are available.
How we help
Panic disorder is treatable, and most people get better with the right treatment. The goal is fewer attacks, less fear of them, and getting back to the places and plans you've been avoiding.
Medication, when appropriate. Antidepressants, mainly SSRIs and SNRIs, are taken every day to prevent attacks or make them less severe. Four are FDA-approved for panic disorder. They may take several weeks to start working, and starting with a low dose helps keep side effects mild. We explain each option and what to expect. Please don't stop a medication on your own; some can cause withdrawal symptoms or a return of symptoms if stopped suddenly.
Practical work in your visits. We help you understand the panic cycle and practice reacting differently to the body's sensations. We also look at caffeine, sleep and exercise, which can affect panic.
Therapy. CBT is a well-studied therapy for panic disorder, and using medication and therapy together often works best. It often includes interoceptive exposure: Practicing, in a safe and planned way, the body sensations that come with panic, such as a fast heartbeat, so they become less frightening.. We don't offer standalone weekly therapy, but we're happy to help you find a therapist and, with your permission, we'll coordinate with them.
Regular follow-ups. We check how you're doing and adjust carefully over time.
Is it this or that?
Panic attack, or heart problem?
| Panic attack | Possible heart problem | |
|---|---|---|
| How it can feel | Pounding or racing heart, chest pain, trouble breathing, dizziness, sweating, trembling or tingling hands. | Chest pain that may feel like tightness, heavy pressure, squeezing or crushing, and may spread to the arm, shoulder, jaw or back. |
| Is it dangerous? | Frightening, but panic attacks themselves aren't life-threatening. | Can be serious, and sometimes life-threatening. |
| Can you tell them apart yourself? | Not reliably. A panic attack can be mistaken for a heart attack. | Not reliably. Only a medical check can rule a heart problem in or out. |
| What to do | If a provider has already checked you and these are your usual panic symptoms, use the plan you made together. | Call 911 for sudden crushing, squeezing or tight chest pain or pressure, or pain spreading to your jaw, left arm or between your shoulder blades. |
Panic attack
- How it can feel
- Pounding or racing heart, chest pain, trouble breathing, dizziness, sweating, trembling or tingling hands.
- Is it dangerous?
- Frightening, but panic attacks themselves aren't life-threatening.
- Can you tell them apart yourself?
- Not reliably. A panic attack can be mistaken for a heart attack.
- What to do
- If a provider has already checked you and these are your usual panic symptoms, use the plan you made together.
Possible heart problem
- How it can feel
- Chest pain that may feel like tightness, heavy pressure, squeezing or crushing, and may spread to the arm, shoulder, jaw or back.
- Is it dangerous?
- Can be serious, and sometimes life-threatening.
- Can you tell them apart yourself?
- Not reliably. Only a medical check can rule a heart problem in or out.
- What to do
- Call 911 for sudden crushing, squeezing or tight chest pain or pressure, or pain spreading to your jaw, left arm or between your shoulder blades.
Chest pain needs medical attention. If you have chest pain and aren't sure what's causing it, call 911 or go to the nearest emergency room. Don't assume it's panic, especially the first time. This comparison is general information, not a diagnosis. Sources: MedlinePlus: Chest pain · MedlinePlus: Panic disorder · NIMH: Panic disorder
Medication quick facts
Medications FDA-approved for panic disorder
These are the medications FDA-approved for panic disorder. FDA approval reflects which uses a manufacturer chose to study and submit, not the only medications that help. Providers often use other medications off-label when research supports them. Your provider will talk with you about what fits you.
Browse by name. Your provider will talk with you about which options fit you.
Sertraline (Zoloft)
An SSRI antidepressant
- FDA-approved for
- Panic disorder, plus social anxiety disorder, OCD, PTSD, PMDD and depression.
- Watch for
- Nausea, diarrhea, sweating and sexual side effects.
- Antidepressant warning
- In short-term studies, antidepressants increased suicidal thoughts and behaviors in people up to age 24. Anyone taking one should be watched closely for worsening, especially during the first few months and at times of dosage changes. Don't stop suddenly; talk with your provider first.
Source: FDA label (DailyMed): Zoloft (sertraline) · MedlinePlus: Sertraline
General information, not medical advice; talk with your provider.
Paroxetine (Paxil, Paxil CR)
An SSRI antidepressant
- FDA-approved for
- Panic disorder in adults, in both the regular and extended-release (CR) forms.
- Pregnancy
- Early pregnancy use is linked to a small increase in heart-related birth defects. If you might become pregnant, ask about other options.
- Antidepressant warning
- In short-term studies, antidepressants increased suicidal thoughts and behaviors in people up to age 24. Anyone taking one should be watched closely for worsening, especially during the first few months and at times of dosage changes. Don't stop suddenly; talk with your provider first.
Source: FDA label (DailyMed): Paxil (paroxetine) · FDA label (DailyMed): Paxil CR (paroxetine extended-release) · MedlinePlus: Paroxetine
General information, not medical advice; talk with your provider.
Fluoxetine (Prozac)
An SSRI antidepressant
- FDA-approved for
- Panic disorder, with or without agoraphobia, plus OCD, depression and bulimia.
- Good to know
- Nervousness and trouble sleeping are possible side effects. It stays in the body a long time after the last dose.
- Antidepressant warning
- In short-term studies, antidepressants increased suicidal thoughts and behaviors in people up to age 24. Anyone taking one should be watched closely for worsening, especially during the first few months and at times of dosage changes. Don't stop suddenly; talk with your provider first.
Source: FDA label (DailyMed): Prozac (fluoxetine) · MedlinePlus: Fluoxetine
General information, not medical advice; talk with your provider.
Venlafaxine extended-release (Effexor XR)
An SNRI antidepressant
- FDA-approved for
- Panic disorder in adults, plus GAD, social anxiety disorder and depression.
- Watch for
- It can raise blood pressure, so your provider will check it. Nausea and sweating are common.
- Antidepressant warning
- In short-term studies, antidepressants increased suicidal thoughts and behaviors in people up to age 24. Anyone taking one should be watched closely for worsening, especially during the first few months and at times of dosage changes. Don't stop suddenly; talk with your provider first.
Source: FDA label (DailyMed): Effexor XR (venlafaxine extended-release) · MedlinePlus: Venlafaxine
General information, not medical advice; talk with your provider.
Benzodiazepines: clonazepam (Klonopin) and alprazolam (Xanax, Xanax XR) are also FDA-approved for panic disorder. These are controlled medications with an FDA boxed warning about misuse, addiction, dependence and withdrawal. They can be helpful in some situations but are generally meant for short-term use. Controlled medications are considered only case by case (see our FAQ).
Brand names are listed for recognition only. For more anxiety medications, see our anxiety disorders page.
Also commonly used (off-label)
Not FDA-approved for this condition
These are a few of several options. “Off-label” means a medication approved for something else is used because research supports it for this condition. Your provider will talk with you about what fits you.
- Escitalopram (Lexapro). An SSRI that, in a large review of panic trials, was among those with high remission and few side effects. Source: Chawla et al., BMJ 2022 (network meta-analysis) · Stahl et al., 2003 (randomized trial)
- Citalopram (Celexa). An SSRI that eased panic and agoraphobia symptoms in trials, though study quality was low. Source: Cochrane review, Guaiana et al., 2023
- Imipramine or clomipramine. Older tricyclic antidepressants a UK clinical guideline (NICE) lists when an SSRI isn't suitable or hasn't helped. Source: NICE guideline CG113
Antidepressant warning: In short-term studies, antidepressants increased suicidal thoughts and behaviors in people up to age 24. Anyone taking one should be watched closely for worsening, especially during the first few months and at times of dosage changes. Don't stop suddenly; talk with your provider first.
General information, not medical advice; talk with your provider.
What to expect
What to expect
1Start your intake packet
Fill out our secure intake packet. Once it's submitted, we'll verify your insurance and call you to schedule your appointment.
2A careful evaluation
A longer video visit about your attacks, what happens between them, your health and history, and your goals.
3Understanding the picture
We explain whether this looks like panic disorder, something else, or more than one thing, and why.
4Your plan
If medication could help, we go through the options, side effects and timing, and decide together. If CBT or another therapy would help, we can help you find it.
5Regular follow-ups
Regular visits to see how often attacks happen now, check side effects and adjust carefully.
Bring this to your visit
Questions to ask your provider
Tick the ones you want to ask, then copy your list. Nothing is saved or sent.
Before your first visit
Information your provider will want to know
Tick what you have ready, then copy the list to fill in your notes. Nothing is saved or sent.
Frequently asked questions
Can a panic attack hurt me?
Panic attacks themselves aren't life-threatening, and the physical symptoms usually pass with time. But chest pain needs medical attention. If you're not sure what's happening, call 911 or go to the nearest emergency room.
I've had one panic attack. Do I have panic disorder?
Not necessarily. A single panic attack isn't a mental disorder. Panic disorder means repeated, unexpected attacks with ongoing worry about more, or changes in how you live to avoid them.
How long does medication take to help?
SSRIs and SNRIs may take several weeks to start working. They're taken every day to prevent attacks, not just when one starts.
Do I need therapy too?
Often it helps. CBT is a well-studied therapy for panic disorder, and medication and therapy together often work best. We don't offer standalone weekly therapy, but we're happy to help you find a therapist and, with your permission, we'll coordinate with them.
Can you treat panic disorder by video?
Yes. Most visits are by secure video, anywhere in New Jersey. Our office is in Mount Laurel, NJ, and in-person visits there are limited and by appointment only; ask our office.
Is a psychiatric nurse practitioner the same as a psychiatrist?
Both diagnose psychiatric conditions and prescribe psychiatric medication. Ours are board-certified psychiatric nurse practitioners (PMHNP-BC), focused on careful evaluation and medication management.
Check your understanding
Three quick questions
1What should you do about chest pain you're not sure about?
Chest pain needs medical attention. Don't assume it's panic, especially the first time.
2Does a single panic attack mean you have panic disorder?
One attack isn't panic disorder. It's the repeated, unexpected attacks and the worry about more that define it.
3How are SSRIs taken for panic disorder?
They're taken daily to prevent attacks or make them less severe, and may take several weeks to work.
Myth or fact? Panic disorder
Choose an answer for each to see the explanation. Nothing is saved.
1A panic attack can feel like a heart attack.
Fact. Racing heart, chest pain and trouble breathing are common. That's why chest pain should always be checked medically.
2Avoiding places where you've panicked keeps panic away.
Myth. Avoidance can shrink your life over time. Treatment helps you get back to what you've been avoiding.
3Panic disorder is treatable.
Fact. Most people get better with the right treatment, usually therapy, medication, or both.
The science: how we checked this
Sources
- NIMH: Panic disorder
- MedlinePlus: Panic disorder
- MedlinePlus: Chest pain
- FDA label (DailyMed): Zoloft (sertraline)
- FDA label (DailyMed): Paxil (paroxetine)
- FDA label (DailyMed): Paxil CR (paroxetine extended-release)
- FDA label (DailyMed): Prozac (fluoxetine)
- FDA label (DailyMed): Effexor XR (venlafaxine extended-release)
- MedlinePlus: Sertraline
- MedlinePlus: Paroxetine
- MedlinePlus: Fluoxetine
- MedlinePlus: Venlafaxine
How we checked this
- Written in our own words from NIMH, MedlinePlus and the FDA labels on DailyMed, checked October 25, 2026.
- Signs are described in plain language and aren't a diagnostic checklist.
