Anxiety and panic attacks

Explains anxiety and panic attacks, including possible causes and how you can access treatment and support. Includes tips for helping yourself, and guidance for friends and family.

Coronavirus (Covid-19) is impacting all our lives, and we know that the usual advice might not quite apply. Some ideas for looking after yourself may feel unrealistic right now. And some treatment and support options will be harder to access, or may be unavailable for a while. But we hope that you can still find information here that helps you understand what you're going through, and find a path forward.

You can also find lots of resources in our coronavirus information hub. And our page of coronavirus useful contacts can direct you to more support.

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What treatments are available?

There are various evidence-based treatments that have been found to help with anxiety problems and panic disorder. This page covers:

Self-help resources

A self-help resource might be the first treatment option your doctor offers you. This is because it's available quite quickly, and there's a chance it could help you to feel better without needing to try other options.

Self-help could be delivered through:

Workbooks. For example, your GP might recommend particular titles from a scheme called Reading Well Books on Prescription. This scheme is supported by most local libraries, so you can go and check the books out for free – you don't actually need a prescription from a doctor. (Find out more on the Reading Well website).
A computer-based CBT programme for treating anxiety and panic attacks. There are several app-based CBT courses recommended on the NHS apps library, which you can search to find an app that may work for you.
You might be offered a resource to work through your own, or on a course with other people who experience similar difficulties.

"I was diagnosed with generalised anxiety disorder, depression and OCD traits. I had cognitive behavioural therapy for almost a year, which was very helpful."

Talking treatments

If self-help resources aren't likely to help with the anxiety problems you're experiencing, or you've already tried them and they haven't helped, your doctor should offer you a talking treatment. There are two types of talking treatment recommended for anxiety and panic:

Cognitive behavioural therapy (CBT) – this focuses on how your thoughts, beliefs and attitudes affect your feelings and behaviour, and teaches you coping skills for dealing with different problems.
Applied relaxation therapy – this involves learning how to relax your muscles in situations where you normally experience anxiety.

(See our pages on talking treatments and CBT for more information on these and other kinds of therapy.)

How CBT helped me beat the bully in my head

"I’m no longer over-analysing every small thing that happens..."

Read Sarah's story

Medication

Your doctor might offer to prescribe you medication to help manage some symptoms. Some people find it helpful to try talking treatments and medication at the same time, but medication shouldn't be the only thing you're offered.

Here are some medications you might be offered.

Antidepressants

Usually this will be a type called a selective serotonin reuptake inhibitor (SSRI), but these drugs can sometimes cause side effects such as sleeping problems or feeling more anxious than you did before. If SSRIs don't work or aren't suitable you may be offered a different kind called a tricyclic antidepressant. (See our pages on antidepressants for more information.)

Pregabalin

In some cases, such as if you have a diagnosis of generalised anxiety disorder (GAD), your doctor may decide to prescribe you a drug called pregabalin. This is an antiseizure drug which is normally used to treat epilepsy (a neurological disorder that can cause seizures), but is also licensed to treat anxiety. (See our pages on anti-anxiety medication and pregabalin more more information.)

Beta-blockers

Beta-blockers are sometimes used to treat the physical symptoms of anxiety, such as a rapid heartbeat, palpitations and tremors (shaking). However, they are not psychiatric drugs so they don’t reduce any of the psychological symptoms. They may be helpful in certain situations, such as if you have to face a phobia (see our page on treatment for phobias for more information).

Benzodiazepine tranquillisers

If you experience very severe anxiety that is having a significant impact on your day-to-day life, you may be offered a benzodiazepine tranquilliser. But these drugs can cause unpleasant side effects and can become addictive, so your doctor should only prescribe them at a low dose for a short time, to help you through a crisis period. (See our page about benzodiazapines for more information.)

Before deciding to take any drug, it's important to make sure you have all the facts you need to make an informed choice. See our pages on things to consider before taking medication and your right to refuse medication for more information. Our pages on coming off medication give guidance on how to come off medication safely.

"I take medication and this helps, but I have also had online [cognitive behavioural therapy] which was invaluable and [cognitive analytic] therapy as an outpatient at a psychiatric hospital. Talking cures are fantastic tools."

How do I access treatment?

To get treatment on the NHS, the first step is normally to visit your doctor (also known as your GP). They will do an assessment, which might include asking you to fill in a questionnaire about how often you feel worried, anxious and nervous. They should then explain your treatment options to you, and you can decide together what might suit you best. (See our pages on seeking help for a mental health problem for more information on how to prepare for an appointment and having your say in treatment.)

Unfortunately NHS waiting lists for talking treatments can be very long. If you're finding it hard to access talking treatments you could consider:

Charities and specialist organisations. See useful contacts for a list of organisations that may offer therapy or be able to put you in touch with local services. Mind's Infoline could also help you find services near you.
Private therapy. Finding a private therapist is another option some people choose to explore, but it's not suitable for everyone because it can be expensive. (See our page on private treatment for more information.)

What if my anxiety stops me from seeking help?

It can be especially hard to access treatment if making or attending an appointment with your doctor involves doing something that causes anxiety for you. For example, you might not feel able to talk on the phone or leave the house.

Here are some things you could try:

Ask your doctor if they offer home visits or telephone assessments. If not, they might be able to book you an appointment at a time when the surgery tends to be quiet.
Some GP practices will allow someone else to ring up and book appointments for you (with your consent). It could also help to have someone come with you to the appointment for support.
Depending on what's available in your area, you may be able to refer yourself for talking treatment at a local Improving Access to Psychological Therapies (IAPT) service. Some IAPT services are delivered over the phone. You can search for IAPT services on the NHS Choices website.

You can read the National Institute for Health and Care Excellence (NICE) best-practice guidelines for treating anxiety disorders in full on the NICE website.

"If you don’t know what is wrong with you, how do you know how to fix it? For me, actually being diagnosed with anxiety and panic disorder came as a relief! It meant that I wasn’t imagining the awful symptoms I’d been experiencing."

What if I don't feel better?

Your doctor should offer you regular appointments to check how you're doing, and see how well any treatment is working for you. Different things work for different people, so if a particular medication or talking treatment doesn't work for you, your doctor should offer an alternative.

If you've tried a range of treatments and none of them have helped, your doctor might refer you to a community mental health team (CMHT). This is is made up of a number of different healthcare professionals, such as psychiatrists and clinical psychologists. Your CMHT can assess you separately and offer you a personalised treatment plan.

This is particularly recommended if:

your symptoms are making it very difficult to carry out everyday activities
you have a serious physical health problem or another mental health problem
you're having thoughts of self-harm or suicide.

It's important to remember that recovery is a journey, and it won't always be straightforward. You might find it more helpful to focus on learning more about yourself and developing ways to cope, rather than trying to get rid of every symptom of your anxiety problem. (See our pages on self-harm and coping with suicidal thoughts and recovery for more information on these topics.)