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[grimple]

On New Year's Eve and again the next day, I called an ambulance to take me to the ER.  I was experiencing what I thought was a heart attack: very strange chest sensations, shortness of breath, lightheadedness, and I was disoriented, dizzy, and absolutely terrified.   The first visit to the ER ruled out any cardiac event.  The second visit got the diagnosis of panic attack.  I was very surprised to learn that these can come seemingly out of the blue, and their sudden onset is most common in young men and middle aged women.

I've been prescribed Zoloft and Xanax.  Having just started these medications, which will take some time to work, I hope someone reading this will have some advice for how to deal with these panic attacks.  They are the most terrifying sensations in the world.  They last perhaps 10 minutes, and during that eternity, I'm convinced that I'm about to die.  This causes unbearable terror.    Even knowing that these are panic attacks, not heart attacks, and even knowing I'm not in danger of dying from them, and even knowing I have the medication - none of this knowledge helps a whit while the panic attack is occurring.

If anyone has experience with this, please share whatever measures you took to reduce the severity of you panic attack.  Thanks in advance, and keeping fingers crossed that I won't have another one today!

[msparticularity]

Hi, Grimple, and welcome to this area. While I have never had a panic attack of the severity you describe, I do struggle with anxiety, and in the past was sometimes pretty thoroughly disabled by it--sometimes for weeks and months at a time. Also, my MIL suffered from panic attacks of the kind you describe, and I sat through a few with her.

A couple of thoughts they have probably already asked you about at the ER: are you using any medications that might trigger increased heart rate and other symptoms, and/or have you eaten or drunk anything that might? Possible substances that can push anxiety over the brink into a serious panic attack include albuterol (asthma inhaler), dark chocolate (can add in heart palpitations), and caffeine (tremors, rapid heart beat). I also get a very weird response from chamomile tea--which, I know, is supposed to be calming! :) Are you having menopausal symptoms, and/or have you changed dosage on birth control pills or hormones? And have you ever been diagnosed with PTSD or any other condition that would cause sudden loud noises or other unexpected events to trigger an attack? Figuring out whether there are triggers that you can take care to avoid, if medications or foods that used to not bother you are now interacting with your system in middle life, or if there are certain times of day (for example) when you are more anxious and may need to take more steps to calm yourself, may help you make this more manageable.

Also, do I gather correctly that you have been alone when this has happened? And do you have anyone to turn to if/when this happens again? It seems unlikely, give the meds they've put you on, that you'll have another immediately. Tut at some point you'll need to get down to a livable dosage (at least of the Xanax), so it may be worth trying to get yourself a backup plan: someone you can at least call to help talk you through if one hits. I know that talking one's self through the height of one is well-nigh impossible (at least at first), but we had good success with me talking my MIL through them; she had to live with them because she needed the albuterol to breathe, and the amount of Xanax it would have taken to prevent them completely would have kept her asleep all the time. Also, once one becomes aware that one is building, it can become more possible to head off a full-fledged event.

Again, welcome, and I am very happy to chat with you and offer as much encouragement and help as I can--as will others be once they know you are here. There are a bunch of us anxiety-prone types around!

[msparticularity]

I'm double-posting to add that I left out a really, really important thing--breathing. We over-breathe (hyperventilate) when we panic; it's part of the fight-or-flight response, since what our body is doing is gearing up to run 6-8 miles flat out and/or fight. Unfortunately, when we're not fighting or fleeing, the hyperventilation also, in turn, fuels the panic. Slowing down the breathing rate, and especially exhaling for longer and more deeply than we inhale, are essential for calming panic. Again, it can be very nearly impossible to do this alone, at least at first. My experience was that it was more helpful for me to breathe with my MIL to help her slow, rather than just telling her.

I hope that, at the moment, you're enjoying a more peaceful night's sleep, though!

[grimple]

Made it through the night fine, and just took my 1st Xanax.   Is it the drug that makes me feel groggy?  Or maybe it's just from all the excitement of the past few days.

Thank you, MsP and the others who sent messages.  It's comforting to hear about other people's experiences, and think about how to adapt their "tricks" to my own panic attacks.  I am normally someone who avoids medication.   I know that Zoloft and Xanax are commonly prescribed, but that doesn't mean anyone out there knows what's going to happen after taking them for years.  Still, when the ER doc wrote out the prescription, I sobbed with relief.   ANYTHING that might help, I'll do.   Right before and right after the attacks, a very clear thought goes through my head: I would rather die than live my life with these attacks everyday.  Or I wish that I could be taken to a mental hospital, strapped to a gurney, and drugged.   The attacks are so dreadful, leaving me so terrified and despairing!  My poor husband was with me during all of my attacks, but even having him hold me and try to talk me down didn't help because I felt I was slipping away.  

I go back to the doctor who prescribed Zoloft and Xanax to me in two weeks.  He told me that Zoloft takes a few weeks to work, and so I should have the Xanax on hand should I feel an attack coming on.  In two weeks, he will give me a full physical and it's at that time that I will ask for a reference to a psychologist/behavioral therapist.   I hope my insurance will cover it!

As for risk factors, I don't smoke or drink alcohol, but I do drink a cup of coffee in the morning.  I can't yet figure out my triggers.  I'm worried about work all the time - that despite doing my job very well, my fear is that the horrible state budget will get me fired, and I'm the only financial support for my household.   This worry is low-grade and ever present and drives me to work constantly.   HOWEVER, the first panic attack occurred in the car with my husband. We were returning from the grocery store from having bought goodies for New Year's Eve.  We'd had fun, we were talking and laughing, I felt fine.  Then it happened. 

If panic attacks are triggered by stress, then why in the world would I get one during winter break?  And this is actually the first winter break in which I let myself actually relax.

[voxprincipalis]

What you describe is frightening when it is happening to you, but it is also 100% normal for a panic attack. That is what a panic attack is.

I'm normally not one for those little sappy acronym things, but in this case I think that one of the old chestnuts is both apt and helpful:

FEAR =
False
Evidence
Appearing
Real.

Although you are not going to die in that moment, it certainly seems like you will. That is false evidence, but it appears real to you in that moment.

Cognitive behavioral therapy will probably be able to reduce both the incidence and the severity of the attacks somewhat, but it is nice to have meds as a backup. If you started the Zoloft as well as the Xanax, it is more likely (IMHO) that it's the Zoloft making you feel groggy, but Xanax can also do it, although in my experience to a much lesser degree than the Zoloft. These side effects go away.

Don't worry about figuring out why they happen until they are a little more under control. Obsessing and being hypervigilant about possible triggers, etc., are only going to keep you in a state of chronic anxiety. If you were to go to the ER because you'd been in an accident, the most important thing to do FIRST is to stop the bleeding and stabilize the situation; then you can worry about why it happened. Get a little more distance first and wait until you feel a little more in control.

Therapy will probably be really helpful for you, given the chronic anxiety you describe. You might also take a look at some online support forums, just to see that there are other people reporting the same things you have; normalizing an experience can be really helpful in getting a handle on it. Remember, they are scary but not "real" in the sense that there is no actual danger to you.

Good luck!

VP

[grasshopper]

If panic attacks are triggered by stress, then why in the world would I get one during winter break?  And this is actually the first winter break in which I let myself actually relax.

The chronic condition is caused by stress, usually the low-grade, ever-present kind of stress you describe. But panic attacks themselves can be triggered by anything. Often it's something mundane and silly. I've had panic attacks triggered by some of the most laughable things.

Don't worry about figuring out why they happen until they are a little more under control. Obsessing and being hypervigilant about possible triggers, etc., are only going to keep you in a state of chronic anxiety.

This is a good point, and probably depends on the severity and frequency of the panic attacks. But recognizing triggers and arresting the anxiety before it escalates into panic is the single most important thing to do when controlling this illness. Very few panic attacks occur out of the blue. Most often, there are signs that one is coming. If you can learn to recognize these signs, it's easier to prevent the anxiety from escalating to full blown panic.

The problem with allowing panic to happen is that the longer we live with panic, the more likely we are to accumulate triggers. But if you are aware of your initial triggers, you can watch for signs of anxiety, and control it before you hit full-out panic mode. The less you panic, the less chance that you will develop more triggers.

I really think, though, that it's important to do this with the help of a therapist. Don't wait two weeks for the referral, and then another month before you can get an appointment. Get a referral now. And if you can't, check out some of the community or campus counselling services to tide you over until something more permanent comes through. There's no point in waiting on this.

[msparticularity]

Don't worry about figuring out why they happen until they are a little more under control. Obsessing and being hypervigilant about possible triggers, etc., are only going to keep you in a state of chronic anxiety.

This is a good point, and probably depends on the severity and frequency of the panic attacks. But recognizing triggers and arresting the anxiety before it escalates into panic is the single most important thing to do when controlling this illness. Very few panic attacks occur out of the blue. Most often, there are signs that one is coming. If you can learn to recognize these signs, it's easier to prevent the anxiety from escalating to full blown panic.

While I agree that obsessing over possible triggers can be enough to increase the anxiety, I shared a list of possible physical triggers because it's surprising, really, how often it's something minor that "flips the switch" and sends generalized anxiety into full-blown panic. In my MIL's and my grandmother's case, as I mentioned above, it was albuterol. In my mother's, it was dark chocolate giving her palpitations and feeding the panic. I am far more vulnerable to sudden loud noises: like many others with PTSD, I have a vastly exaggerated startle response.

The other thought I had, in relation to your post this morning, is that sometimes being happy and carefree can backlash and send me into a spiral of anxiety. Part of my internal tangle is a belief that it's not safe to be happy, that being happy just invites retaliation and disaster from the Universe. Crazy thinking, but also remarkably persistent and not so unusual, as it turns out.

[voxprincipalis]

Don't worry about figuring out why they happen until they are a little more under control. Obsessing and being hypervigilant about possible triggers, etc., are only going to keep you in a state of chronic anxiety.

This is a good point, and probably depends on the severity and frequency of the panic attacks. But recognizing triggers and arresting the anxiety before it escalates into panic is the single most important thing to do when controlling this illness. Very few panic attacks occur out of the blue. Most often, there are signs that one is coming. If you can learn to recognize these signs, it's easier to prevent the anxiety from escalating to full blown panic.

While I agree that obsessing over possible triggers can be enough to increase the anxiety, I shared a list of possible physical triggers because it's surprising, really, how often it's something minor that "flips the switch" and sends generalized anxiety into full-blown panic. In my MIL's and my grandmother's case, as I mentioned above, it was albuterol. In my mother's, it was dark chocolate giving her palpitations and feeding the panic. I am far more vulnerable to sudden loud noises: like many others with PTSD, I have a vastly exaggerated startle response.

The other thought I had, in relation to your post this morning, is that sometimes being happy and carefree can backlash and send me into a spiral of anxiety. Part of my internal tangle is a belief that it's not safe to be happy, that being happy just invites retaliation and disaster from the Universe. Crazy thinking, but also remarkably persistent and not so unusual, as it turns out.

Oh, yes, I did not mean to imply that learning about the triggers wasn't important! It just seems to me that stopping the bleeding is the absolute first order of business, before figuring out how one can avoid getting cut again. I think you are able to reflect on and assess any emotional state much more clearly when you are not caught up in the throes of it; this goes for anxiety, fear, love, anger, depression, etc.

VP

[msparticularity]

I think you are able to reflect on and assess any emotional state much more clearly when you are not caught up in the throes of it; this goes for anxiety, fear, love, anger, depression, etc.

VP

SO true! We didn't even figure out how significant my anxiety was until I (accidentally) was medicated enough to reduce it significantly. OMG! It was, truly, a whole new world.

[mdwlark]

I recommend in addition to what you are doing that, if at all possible, you choose a therapist who is experienced in systematic relaxation, guided imagery, and similar techniques.  In addition to talking about and analyzing triggers, they train your body to react to stress in a new way.  Your medications can protect you while some of these skills are developed, and you can balance mental techniques, knowledge, and medication to find the right mix to keep you well.  The new learned responses develop slowly over time.  EMDR is a newer technique that is controversial and hasn't had a lot of research, but people with PTSD report positive benefits from it, along with other imagery techniques that have more research backing.

[grimple]

sorry - I revealed too much might've outed myself

[grasshopper]

sorry - I revealed too much might've outed myself

Well, whatever you're revealing or concealing, I hope that things are looking up.

[mdwlark]

sorry - I revealed too much might've outed myself

No, there are thousands of people in your situation.  We hope you find some balance soon. 

[mntwins]

Two good resources:
The Anxiety & Phobia Workbook by Edmund Bourne
and
Help and Hope for Your Nerves by Claire Weekes

[post_functional]

I've had panic attacks this bad.  I have found for me that they correlate with unnoticed additional consumption on my part of caffeine.  Like OP, I also don't smoke or drink alcohol.  But I sometimes drink more caffeine out of habit than I notice.  A cup of coffee in a waiting room that I barely think about, getting a soda with lunch, etc.  

Of course, all people's levels of sensitivity are different.  Try cutting out even the one cup of coffee in the morning.  I find that when I allow myself to reboot without caffeine for awhile and get some rest, I'm getting the nourishing kind of energy-replenishing rest that I'm denying myself with the stimulant of caffeine.  It becomes a vicious circle.  I'm tired, I need caffeine, caffeine keeps me from getting rest, making me tired, etc.

Chime on the rest of the excellent advice offered here so far.