Panic Disorder: Getting Treatment in Tokyo

Panic disorder is treated in Japan with a daily SSRI, cognitive behavioral therapy, or both, and assessment and treatment are available in English in Tokyo. A first panic attack often feels like a medical emergency, and getting it checked is the right response. Once physical causes have been ruled out, panic attacks themselves are not life-threatening, and the physical symptoms usually settle with time. This article is part of our guide to mental health for foreign residents.

What is a panic attack?

A panic attack is a sudden surge of intense fear with strong physical symptoms, when there is no real danger. It brings:

• A pounding heart
• Chest tightness
• Shortness of breath
• Dizziness
• A fear of dying, fainting, or losing control

Anxiety is strongest for roughly the first five minutes and then levels off or eases on its own.

Panic disorder is the diagnosis when attacks keep recurring and the fear of the next one starts to shape your behavior: checking your body for signs, avoiding places that would be hard to leave, and planning the day around not having an attack. The fear of the next attack and the avoidance restrict daily life, and they are a main target of treatment.

Public transport is one of the situations people commonly start to avoid, and on a crowded train you cannot get off between stations. We have a separate guide to panic attacks on Japanese trains.

Why does the assessment check for physical causes first?

Because some physical conditions produce the same symptoms. Thyroid problems and heart rhythm problems are examples, so a first assessment rules them out, sometimes with basic tests. Once that is done, panic disorder is a diagnosis in its own right, with established treatments.

How is panic disorder treated in Japan?

With a daily SSRI, cognitive behavioral therapy, or both. Japan's 2025 guideline for panic disorder (in Japanese) proposes an SSRI as the medication and a structured course of CBT from a trained therapist as the therapy. Which to start with, or whether to combine them, is decided with your doctor.

• Medication. An SSRI taken every day is the medicine the guideline proposes, and its effect builds over several weeks. Two SSRIs are approved for panic disorder in Japan: sertraline and paroxetine. Our anti-anxiety medication guide covers the other medicines used for anxiety.
• Cognitive behavioral therapy (CBT). The therapy explains how the panic cycle works, changes how you interpret body sensations, and then takes you back, in planned steps, to the trains, elevators, and meeting rooms you have been avoiding. In English, this is mostly self-pay counseling that runs alongside insured psychiatric care (how the two fit together).
• Fast-acting medicines. Benzodiazepines act quickly, but they are not the main treatment for panic disorder. If one is used, it is for a short period, because of the risk of dependence. Relying on a pill taken at the first sign of an attack can also become another form of avoidance. Our benzodiazepine guide covers what to expect if one was your main treatment at home. Benzodiazepines also cannot be prescribed online, at a first visit or a follow-up, until a doctor in Japan has examined you in person for that condition (the online rules).

What can you do while treatment takes effect?

Four things help in the meantime:

• Let an attack run its course: staying with it until it eases, where that is safe, lets you see for yourself that it passes.
• Breathe out slowly: a longer out-breath settles the body, while fast, deep breathing makes the tingling and dizziness worse.
• Keep to your usual routes where you can: avoiding a place takes away the chance to see the anxiety ease there.
• Cut back on caffeine and alcohol, and get enough sleep: too much caffeine often makes anxiety worse, and alcohol can cause anxiety too.

Frequently asked questions

Q. Do I have to ride crowded trains as part of treatment?

Q. Can panic disorder be treated in English in Tokyo?