Magnesium for Panic Attacks

Magnesium has modest anxiolytic evidence in general anxiety, but no trial has tested it specifically against panic attacks or panic disorder.

Magnesium acts as a physiological NMDA receptor antagonist and positive modulator at GABA-A receptors, dampening glutamatergic excitation. It also attenuates hypothalamic-pituitary-adrenal axis output and reduces catecholamine release, which is relevant to the sympathetic surge that characterises a panic attack.

The direct evidence base is thin. Systematic reviews of magnesium for subjective anxiety, including the Boyle 2017 review, find suggestive but low-quality evidence, with most positive trials in premenstrual anxiety, postpartum populations or mild generalised anxiety rather than in panic disorder. No randomised trial has used panic attack frequency as a primary outcome. Deficiency is a more defensible target: low magnesium status increases neuronal excitability and is more common with alcohol use, diuretics and proton pump inhibitors, all of which also associate with anxiety symptoms. Set against this, cognitive behavioural therapy with interoceptive exposure produces large, durable reductions in panic frequency, which no supplement approaches. Magnesium is best framed as a cheap adjunct with a plausible mechanism, not a treatment.

People with established panic disorder and avoidance behaviour will not improve without exposure therapy. Those already magnesium-replete have little to gain.