Ozempic (semaglutide) is a GLP-1 receptor agonist licensed in the UK for treating type 2 diabetes mellitus in adults. Whilst panic attacks and anxiety are not officially recognised side effects in regulatory guidance from the MHRA or EMA, some patients report experiencing anxiety-related symptoms whilst taking this medication. Understanding the potential connections, recognising panic attack symptoms, and knowing when to seek medical advice are essential for anyone prescribed Ozempic. This article examines the evidence, explores possible mechanisms, and provides practical guidance for managing panic attacks if they occur during Ozempic treatment.

What Is Ozempic and How Does It Work?

Ozempic (semaglutide) is a prescription medicine licensed in the UK for the treatment of type 2 diabetes mellitus in adults. It belongs to a class of drugs known as glucagon-like peptide-1 (GLP-1) receptor agonists. Ozempic is administered as a once-weekly subcutaneous injection and is available in pre-filled pens.

Treatment typically begins with 0.25 mg once weekly for 4 weeks as an initiation dose only (not for glycaemic control). The dose is then increased to 0.5 mg once weekly. If additional glycaemic control is needed after at least 4 weeks, the dose may be increased to 1 mg once weekly and potentially to 2 mg once weekly if required and tolerated.

The medication works by mimicking the action of GLP-1, a naturally occurring hormone in the body that plays several important roles in glucose regulation. When blood sugar levels rise after eating, Ozempic stimulates the pancreas to release insulin, which helps move glucose from the bloodstream into cells. Simultaneously, it suppresses the release of glucagon, a hormone that raises blood sugar levels. This dual action helps maintain more stable blood glucose levels throughout the day.

Beyond its effects on blood sugar, Ozempic also slows gastric emptying, meaning food moves more slowly from the stomach into the small intestine. This contributes to increased feelings of fullness and reduced appetite, which can lead to weight loss—a beneficial effect for many people with type 2 diabetes who are overweight. The medication also acts on areas of the brain involved in appetite regulation.

Ozempic is typically prescribed when diet and exercise alone have not achieved adequate blood sugar control, and it may be used alongside other diabetes medications such as metformin. When used with insulin or sulfonylureas, there is an increased risk of hypoglycaemia (low blood sugar), and dose reductions of these medications may be needed. Combining Ozempic with DPP-4 inhibitors is generally not recommended in UK practice.

Important safety considerations include monitoring for signs of acute pancreatitis (severe, persistent abdominal pain, sometimes with vomiting) which requires urgent medical assessment, and potential worsening of diabetic retinopathy, particularly in patients with pre-existing retinopathy experiencing rapid improvement in blood glucose control.

Ozempic is not indicated for type 1 diabetes and must not be used to treat diabetic ketoacidosis. The MHRA (Medicines and Healthcare products Regulatory Agency) has approved Ozempic specifically for diabetes management, and NICE (National Institute for Health and Care Excellence) provides guidance on its use within NHS treatment pathways. It is important to note that whilst Ozempic has gained attention for weight loss, its primary licensed indication in the UK remains the treatment of type 2 diabetes.

Recognising Panic Attack Symptoms While Taking Ozempic

A panic attack is a sudden episode of intense fear or discomfort that reaches a peak within minutes. Understanding the symptoms is crucial for anyone taking Ozempic, as recognising these episodes early allows for appropriate management and medical review.

Common physical symptoms of panic attacks include:

• Cardiovascular symptoms: Rapid or pounding heartbeat (palpitations), chest pain or tightness, and feelings of the heart racing

• Respiratory symptoms: Shortness of breath, hyperventilation, or sensations of choking or being unable to breathe properly

• Neurological symptoms: Dizziness, light-headedness, feeling faint, or experiencing tingling sensations (paraesthesia) in the hands, feet, or face

• Gastrointestinal symptoms: Nausea, abdominal discomfort, or upset stomach

• Temperature dysregulation: Sweating, hot flushes, or chills

Psychological symptoms often accompany the physical manifestations:

• Intense fear of losing control or "going mad"

• Fear of dying or having a heart attack

• Feelings of unreality (derealisation) or detachment from oneself (depersonalisation)

• Overwhelming sense of dread or impending doom

Panic attacks typically last between 5 and 20 minutes, though the after-effects may persist longer. It is important to distinguish panic attacks from other medical conditions, particularly if you have diabetes. Hypoglycaemia (low blood sugar) can produce similar symptoms including sweating, trembling, rapid heartbeat, and anxiety. If you experience these symptoms whilst taking Ozempic, check your blood glucose levels if possible, as this can help differentiate between a panic attack and a diabetes-related episode requiring immediate glucose intake.

If you cannot check your glucose level and are unsure whether your symptoms represent a panic attack or hypoglycaemia, it is safest to treat as hypoglycaemia first. Take a fast-acting carbohydrate (such as glucose tablets, fruit juice, or sugary drinks) followed by a longer-acting carbohydrate (such as a sandwich or biscuits) according to your individual diabetes management plan.

What to Do If You Experience Panic Attacks on Ozempic

If you experience what you believe to be a panic attack whilst taking Ozempic, there are several important steps to take both in the immediate moment and for longer-term management.

Immediate management during a panic attack:

1. Ensure physical safety: Sit or lie down in a safe place to prevent injury if you feel faint or dizzy.

2. Check blood glucose levels: If you have a glucose meter available, check your blood sugar to rule out hypoglycaemia, which can mimic panic symptoms. If your reading is below 4 mmol/L, follow your diabetes management plan for treating low blood sugar.

3. Focus on breathing: Try to slow and regulate your breathing. A helpful technique is to breathe in slowly through your nose for a count of four, hold for a count of four, then exhale slowly through your mouth for a count of six. This helps counteract hyperventilation.

4. Ground yourself: Use grounding techniques such as the "5-4-3-2-1" method—identify five things you can see, four you can touch, three you can hear, two you can smell, and one you can taste. This helps anchor you to the present moment.

When to seek medical attention:

• Immediately call 999 if you experience chest pain, severe difficulty breathing, or symptoms that feel different from previous panic attacks, as these could indicate a cardiac or other medical emergency.

• Seek urgent medical help if you develop severe, persistent abdominal pain (with or without vomiting), as this could indicate acute pancreatitis, a rare but serious side effect of Ozempic requiring immediate assessment.

• Contact NHS 111 for urgent advice if symptoms are concerning but not immediately life-threatening.

• Contact your GP within 24-48 hours if you experience your first panic attack, or if panic attacks become frequent or severe.

• Book a routine appointment to discuss your symptoms with your GP or diabetes specialist nurse, particularly if panic attacks are affecting your quality of life or medication adherence.

If you are unwell with vomiting or unable to keep fluids down, follow your diabetes sick-day rules to avoid dehydration and complications. This may include more frequent blood glucose monitoring and ensuring adequate fluid intake.

Your healthcare provider may wish to review your Ozempic dosage, assess for other contributing factors, and discuss whether additional support or treatment adjustments are needed. Do not stop taking Ozempic without medical advice, as abrupt discontinuation could affect your diabetes control.

Can Ozempic Cause Panic Attacks or Anxiety?

The relationship between Ozempic and panic attacks or anxiety is an area where there is no official established link in the current evidence base, though patient experiences and emerging research warrant careful consideration.

Current evidence and regulatory position:

Panic attacks and anxiety disorders are not listed as recognised adverse effects in the official Summary of Product Characteristics (SmPC) for Ozempic approved by the MHRA and EMA (European Medicines Agency). The most commonly reported side effects of Ozempic include gastrointestinal symptoms such as nausea, vomiting, diarrhoea, constipation, and abdominal pain, which occur in more than 10% of patients. These typically diminish over time as the body adjusts to the medication.

It is worth noting that UK and European medicines regulators (MHRA and EMA) continue to monitor reports of neuropsychiatric events with GLP-1 receptor agonists through their pharmacovigilance systems, but no causal association has been established at this time.

Some patients have reported experiencing anxiety or panic-like symptoms whilst taking GLP-1 receptor agonists. Several hypothetical mechanisms might potentially contribute to such experiences, though these remain speculative and not proven as causal links:

1. Gastrointestinal distress: The significant nausea and digestive discomfort that some people experience with Ozempic could potentially trigger anxiety or panic in susceptible individuals, particularly those with a history of anxiety disorders.

2. Hypoglycaemia: Although less common with Ozempic monotherapy, low blood sugar episodes can occur, especially when combined with other diabetes medications like insulin or sulfonylureas. Hypoglycaemia produces physical symptoms nearly identical to panic attacks.

3. Rapid physiological changes: Significant weight loss and metabolic changes may affect some individuals' psychological wellbeing, particularly if changes occur quickly, though the evidence for this is limited.

4. Pre-existing vulnerability: People with type 2 diabetes have higher rates of anxiety and depression compared to the general population, which may make them more susceptible to panic symptoms regardless of medication.

What patients should know:

If you experience new or worsening anxiety or panic attacks after starting Ozempic, it is essential to discuss this with your healthcare provider. They can assess whether the symptoms might be related to the medication, explore other contributing factors, and determine the most appropriate course of action. This might include dose adjustment, additional support for anxiety management, or consideration of alternative diabetes treatments if deemed necessary. Your mental health is as important as your physical health in diabetes management, and both should be addressed holistically.

Patients and healthcare professionals are encouraged to report any suspected adverse reactions to Ozempic or other medications through the MHRA Yellow Card Scheme (yellowcard.mhra.gov.uk), which helps regulators monitor medication safety.

Frequently Asked Questions