Good afternoon i've been experiencing intense anxiety & panic attacks since the past 10 months (october 2018) onwards due to which daily functioning has been adversely affected. The major symptoms are constant heart palpitation and pain, nausea, trembling hands and extreme difficulty to function. This can be part of the panic attack which is not associated with any stressful events or thoughts but rather quite spontaneous and all of a sudden unexpected panic attack which causes severe heart palpitations, and pain, nausea, trembling hands and adversely affecting the daily functioning. I've been through severe anxiety and panic attacks many times in my life since 2008. After undergoing intense anxiety and panic attacks for many months, it eventually decreases and I will start experiencing calmness for many months. But the anxiety and panic attacks start all over again for several months. The doctor had prescribed escitalopram & had taken it since 2017 but it's not effective now as i've been experiencing severe anxiety and panic attacks for about past 10 months from now and while i'm going through anxiety and panic attacks, escitalopram prescribed by the doctor is not effective. I am a lady of 24 years. Can I kindly request for a medical advice and evaluation? Look forward to hearing from you. Thank you kind regards nimmy anna.