Saxenda (liraglutide 3.0 mg) is a GLP-1 receptor agonist licensed in the UK for weight management in adults with obesity or overweight with related health conditions. Whilst Saxenda is effective for weight loss when used alongside diet and exercise, some patients report experiencing anxiety or panic-like symptoms during treatment. Although panic attacks are not listed as common adverse reactions in the Summary of Product Characteristics and no established causal link exists, understanding the relationship between Saxenda and mental health symptoms is important for safe prescribing and patient wellbeing. This article examines the evidence, symptom recognition, and management strategies for patients experiencing panic attacks whilst taking Saxenda.

What Is Saxenda and How Does It Work?

Saxenda (liraglutide 3.0 mg) is a prescription medicine licensed in the UK for weight management in adults with obesity (BMI ≥30 kg/m²) or overweight (BMI ≥27 kg/m²) with weight-related health conditions such as type 2 diabetes, hypertension, dyslipidaemia, obstructive sleep apnoea or prediabetes. It is administered as a once-daily subcutaneous injection and is intended to be used alongside a reduced-calorie diet and increased physical activity.

Saxenda belongs to a class of medications called glucagon-like peptide-1 (GLP-1) receptor agonists. It works by mimicking the action of GLP-1, a naturally occurring hormone that regulates appetite and food intake. The medication acts on specific receptors in the brain—particularly in areas that control appetite—to increase feelings of fullness and reduce hunger. This mechanism helps patients consume fewer calories, leading to gradual weight loss over time. Additionally, Saxenda slows gastric emptying, which prolongs the sensation of satiety after meals.

The medication is typically initiated at a low dose (0.6 mg daily) and gradually increased over five weeks to the maintenance dose of 3.0 mg daily. This titration schedule helps minimise common gastrointestinal side effects such as nausea, vomiting, and diarrhoea. According to the Summary of Product Characteristics (SmPC) and reflected in NICE guidance (TA664), Saxenda should only be continued beyond 12 weeks on the 3.0 mg daily dose if patients have lost at least 5% of their initial body weight.

On the NHS, Saxenda is only available through specialist weight management services, subject to specific NICE criteria (TA664), and treatment is typically limited to a maximum of 2 years. Local NHS commissioning arrangements may apply.

Whilst Saxenda has been shown in clinical trials to be effective for weight management, patients and healthcare professionals should remain vigilant about potential adverse effects, including those affecting mental health and emotional wellbeing.

Recognising Anxiety Symptoms While Taking Saxenda

Anxiety and panic-related symptoms are not listed as common adverse reactions in Saxenda's Summary of Product Characteristics (SmPC), and there is no official established causal link between liraglutide and panic attacks. The European Medicines Agency's Pharmacovigilance Risk Assessment Committee (PRAC) concluded in 2024 that there is no established causal association between GLP-1 receptor agonists and suicidal ideation, though monitoring continues. Some patients have reported experiencing increased anxiety, nervousness, or panic-like symptoms whilst taking the medication. Understanding whether these symptoms are directly related to Saxenda, coincidental, or secondary to other factors requires careful clinical assessment.

Panic attacks are characterised by sudden episodes of intense fear or discomfort that reach a peak within minutes. Typical symptoms include:

• Rapid or pounding heartbeat (palpitations)

• Sweating and trembling

• Shortness of breath or feeling of choking

• Chest pain or discomfort

• Nausea or abdominal distress

• Dizziness, light-headedness, or feeling faint

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

• Fear of losing control or "going mad"

• Fear of dying

• Numbness or tingling sensations

It is important to distinguish between panic attacks and some of Saxenda's known side effects. For instance, nausea, increased heart rate (a small mean increase is noted in the SmPC), and gastrointestinal discomfort are recognised adverse reactions to GLP-1 receptor agonists and may occasionally mimic or trigger anxiety symptoms in susceptible individuals. Insomnia is also listed as a common side effect in the SmPC. Additionally, dehydration or electrolyte disturbances from vomiting, or hypoglycaemia (particularly if Saxenda is used with insulin or sulfonylureas) may produce symptoms that mimic anxiety. The process of significant weight loss itself can be psychologically challenging and may unmask or exacerbate underlying anxiety disorders.

Patients with a pre-existing history of anxiety disorders, panic disorder, or depression should inform their prescribing clinician before starting Saxenda. Careful monitoring of mental health status throughout treatment is advisable, particularly during the dose escalation phase when side effects are most pronounced.

Managing Panic Attacks During Saxenda Treatment

If you experience panic attacks or heightened anxiety whilst taking Saxenda, several practical strategies can help manage these symptoms effectively. It is essential to approach this holistically, addressing both the physical and psychological aspects of anxiety.

Immediate management of panic attacks includes:

• Controlled breathing techniques: Practise slow, deep breathing—inhale through your nose for four counts, hold for four counts, and exhale through your mouth for six counts. This helps counteract hyperventilation and activates the parasympathetic nervous system.

• Grounding exercises: Focus on your immediate surroundings using the "5-4-3-2-1" technique—identify five things you can see, four you can touch, three you can hear, two you can smell, and one you can taste.

• Physical relaxation: Progressive muscle relaxation, where you systematically tense and release different muscle groups, can reduce physical tension associated with panic.

Longer-term management strategies should include:

• Lifestyle modifications: Ensure adequate sleep, limit caffeine and alcohol intake (both can exacerbate anxiety), and maintain regular physical activity, which has proven anxiolytic effects.

• Psychological support: Cognitive behavioural therapy (CBT) is the gold-standard psychological treatment for panic disorder and can be accessed through NHS Talking Therapies services. Many areas allow self-referral to these services.

• Medication review: Discuss with your GP or prescribing clinician whether Saxenda should be continued, dose-adjusted, or discontinued. According to the SmPC, if side effects occur, delaying dose escalation or temporarily reverting to the last tolerated dose may be appropriate under clinical supervision. Your clinician may also consider whether the timing of your injection affects symptoms, based on your individual experience.

• Nutritional considerations: Ensure you're meeting nutritional needs despite reduced calorie intake, as deficiencies can impact mood and anxiety levels.

Keeping a symptom diary documenting when panic attacks occur, their severity, potential triggers, and their temporal relationship to Saxenda injections can provide valuable information for your healthcare team to determine the best course of action.

When to Seek Medical Advice About Saxenda and Mental Health

Prompt medical consultation is essential if you experience concerning mental health symptoms whilst taking Saxenda. Whilst there is no established causal relationship between liraglutide and panic attacks, any significant change in your psychological wellbeing warrants professional assessment.

You should contact your GP or prescribing clinician if you experience:

• Panic attacks that are new, frequent, or increasing in severity

• Persistent anxiety that interferes with daily activities or quality of life

• Low mood, depression, or loss of interest in previously enjoyed activities

• Suicidal thoughts or thoughts of self-harm (seek immediate help via 999, A&E, or the Samaritans on 116 123)

• Significant sleep disturbance related to anxiety

• Physical symptoms such as chest pain or palpitations (call 999 if you suspect a cardiac cause; for urgent but non-life-threatening concerns, contact NHS 111)

Your healthcare professional will:

• Conduct a thorough assessment of your mental health history and current symptoms

• Review all medications and supplements you're taking for potential interactions

• Evaluate whether symptoms began or worsened after starting Saxenda

• Consider alternative causes of anxiety, including thyroid dysfunction, cardiovascular issues, or other medical conditions

• Discuss the risks and benefits of continuing Saxenda versus alternative weight management strategies

• Arrange appropriate investigations if clinically indicated

• Refer you to mental health services if specialist input is required

According to NICE guidance on weight management (TA664), treatment decisions should be individualised, and medications should be discontinued if adverse effects outweigh benefits. Remember that on the NHS, Saxenda is prescribed through specialist weight management services and typically limited to a maximum of 2 years.

Do not stop or change your Saxenda dose without medical advice; however, if you experience severe symptoms or suspect a serious adverse reaction, seek urgent medical care where you may be advised to stop the medication. The MHRA's Yellow Card scheme (yellowcard.mhra.gov.uk or via the Yellow Card app) allows patients and healthcare professionals to report suspected side effects, contributing to ongoing medication safety monitoring.

Prioritise your mental health and wellbeing. Your healthcare team can support you in making informed decisions about your treatment, ensuring both your physical and psychological health are optimally managed.

Frequently Asked Questions