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August 30th, 2011
10:34 AM ET

How can I control my panic attacks?

Every weekday, a CNNHealth expert doctor answers a viewer question. On Tuesdays, it's Dr. Charles Raison, an associate professor of psychiatry and behavioral sciences at Emory University, and an expert in the mind-body connection for health.

Question asked by Stephanie via e-mail

I've been having a lot of panic attacks, almost every day; sometimes when I'm working, dealing with the kids or just nothing at all. I'll get shortness of breath, chest hurts on both sides or just one side, and a lot of my heart skipping a beat. And it scares me. I'm 29 years old and in good health. How can I control this?

Expert answer:

Dear Stephanie,

I don't need to tell you that panic attacks are among the most hideous experiences a human being can have. They are such strange occurrences. While being in no physical danger at all, you feel as if you are in mortal peril. In the midst of perfectly good health, you feel as if you are on the edge of sudden death. And telling yourself that there is no real danger is of almost no help whatsoever.

My strongest piece of advice is that you make an appointment to see your doctor immediately. Many primary care doctors feel comfortable treating panic disorder or will know a clinician who does.

Like everything else in psychiatry, treatment options come in two general flavors: medications and psychotherapy.

The best proven psychotherapy for panic attacks is similar in many ways to the type of therapy that I've described several times before for obsessive-compulsive disorder. It has two main components, neither of which is pleasant, but which are in the aggregate often highly effective. First, the therapist would work with you to gradually expose yourself to situations that cause panic. Then, once you are in these situations, he or she would teach you to tolerate the terrible panic feelings when they arose.

I suspect that just thinking about doing this might have you breaking out in a cold sweat, which is why it is so important to get professional help.

Among psychotropic medications, two classes are particularly effective for panic, and they are very different from each other. Benzodiazepines, like Valium, Ativan or Klonopin, have powerful anti-anxiety effects that happen very rapidly after they are ingested. If you have long panic attacks, or attacks that come in prolonged volleys, these medications work quickly enough that they can interrupt things in mid-attack.

Most antidepressants also treat panic attacks, but unlike benzodiazepines, they require several weeks of being taken daily before their effects are usually seen. For this reason, many clinicians will start patients on an antidepressant and a benzodiazepine. Once the antidepressant has been on board for several weeks, the benzodiazepine can often be discontinued.

Let me alert you to a few challenges in these treatments. Psychotherapy is great, but depending where you live and the state of your finances, it can be hard to find and expensive. Benzodiazepines work extremely well but have addictive potential when taken long term. If you elect treatment with an antidepressant, make sure that your clinician starts you on the lowest dose possible, because - paradoxically - antidepressants can cause panic attacks when they are first taken and can certainly worsen them in people already afflicted.

The good news is that all these treatment options are effective, so it is very likely you will be able to gain control of your symptoms, find relief and continue with your life.

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soundoff (129 Responses)
  1. Raebo

    I found that all my panic attacks had a trigger, So was it the chicken or the egg that came first?
    As an example I had one driving over a bridge once, I thought I was going to die, I parked on the other side got out of my car and ran as hard as I could ( Adrenaline I was told ).
    I could no longer drive over bridges, if I absolutely had to it would for sure set one off, but I am convinced now that it was just the trigger.
    My real fear was from the feeling of impending doom and the very real shaking, sweaty palms, racing heart, and breathlessness as the attack manifested it started feeding off the real fear of dying encouraged by the physical symptoms, it was never really the bridge.
    It was just the trigger.

    August 31, 2011 at 00:47 | Report abuse | Reply
  2. Mary

    The best thing you can do if you are experiencing panic attacks is to go at once and take 2 b complex vitamiins and wait for them to kick in. You will feel better almost at once. I have suffered from PTSD for many years and this helps me like nothing else. A daily regimen of B Complex will reduce the onset of these symptoms.

    August 31, 2011 at 01:46 | Report abuse | Reply
    • Vera

      Hi Mary,

      The B-Complex might help you, but not me. I've taken it for years and daily. It does nothing for my panic, and 2 tabs of this could not possibly work fast enough to stop the panic. B-Complex does help in ohter areas for sure, but it is not a remedy for panic for me, nor for any other panic suffering person I have spoken to..

      January 29, 2013 at 00:09 | Report abuse |
  3. Reets

    2 programs I recommend for clients:
    Depression Recovery – "The Way Out" listed at http://www.drnedley.com. The program reduces anxiety, too. Based on some really simple lifestyle tweaks that enhance brain and response health. SOAR - is actually for a fear of flying. Teaches some really great techniques that work in lots of situations. Good luck!

    August 31, 2011 at 01:51 | Report abuse | Reply
  4. Sarah

    The advice in this article is spot on. I suffered from debilitating panic attacks 6 years ago, and received therapy for 1 year and took the benz. and zoloft after several months. I was not on xanax for more than 1 or 2 weeks as I didn't likethe way it made me feel, and once the zoloft kicked in (I am still at the smallest dose) it felt like a huge weight was lifted off my shoulders. Say what you will about "prozac nation", but I thank God all the time that someone was able to come up with zoloft and help me live a normal happy productive life. I really can't describe the difference. It's amazing to not have that kind of affliction anymore. I still worry and can get stressed and cry but it's normal, not like before.

    August 31, 2011 at 10:29 | Report abuse | Reply
  5. Oldteach

    I suffered panic attacks for years – usually when things were going well. They would wake me up in the middle of the night and I would suffer through them. Walking, chewing gum would sometimes lessen them slightly, so I finally broke down and went to my doctor. My usual doc was not in that day so I went to a female doctor I had never seen before. Waves of disbelief just rolled off her as I described my symptoms. Then she said, unkindly, "Well, you know they're all in your head." YES, I knew that. But I was SO angry, and (now this is hard to believe) I haven't had one since. It's been more than 20 years and I always have a Xanax in my purse (hardly ever have used) but I have never had another full blown attack.
    Don't give up on finding out what works for you. I am always amazed at the number of people, once I mention panic attacks, that also have them. I am grateful to that doctor in an odd sort of way that I do not have to rely on medication. These attacks are debilitating and interfere with everyday life.

    August 31, 2011 at 11:13 | Report abuse | Reply
    • Vera

      Okay, Oldteach, let's start by pointing out that there is chronic panic attacks (which I have) and there are those that come at a certain time in your life and then are gone. The drug you used didn't CURE it, it only masked it. That's all it does. So, even if you didn't take the drug, if you had the kind of panic that was temporary, it would have left you anyways after awhile and not returned. Having said that, hey whatever works and doesn't harm you in yet another way. One has to choose one's poison. Finally, the doctor who told you it was "all in your head" knows nothing about panic, so you should not be agreeing with her. Because it is not all in your head, it has to do with you chemical makeup also. Happy to learn you no longer suffer from panic. I have for years, tried many, many drugs and some of them are really dangerous and addictive. Right now I'm trying to learn Cognitive Behavior Theraphy, (CBT) but it takes a long time, it's expensive, and it's really hard to find someone who really practices it. I had 8 different therapists tell me that they did CBT–none of them did. It was a very costly lesson, both financially and emotionally. Took me years to find someone who really does (a social worker) and I'm hoping it works out. Just started CBT so we'll see. Anyway, good for you!

      January 29, 2013 at 00:18 | Report abuse |
  6. Chris Honry

    Don't EVER take anti-depressants if you have panic attacks- they do just what they say, they the opposite of something that would calm you down. You'll feel fuzzy and dull but they won't stop panic at all. I got over mine, which were very bad for a year, just by sheer force of will.

    August 31, 2011 at 11:59 | Report abuse | Reply
  7. Serena15

    The best thing to do to get immediate relief from your attack is FREEZE it out. If it's winter, go outside without putting on a coat, and stay outside until you're practically freezing. If it's not very cold out, the first thing to do is turn on the air conditioner, any fans, open the window, whatever makes things fresher and colder. Then fill up your sink with cold water and plop your head in it for several seconds. The head-down position will relax you and get blood to your brain. Don't hold your breath too long, though. Then splash the water all over you and DO NOT DRY OFF. If you start to shiver, great. You were probably already trembling from the attack anyway, so what's the difference. The shivering and cold will distract your body and brain from the panic, and you WILL calm down.
    (I suppose a cold shower would also work, especially if you don't dry off after. I just haven't tried that yet.)

    September 1, 2011 at 09:09 | Report abuse | Reply
    • Vera

      Serena15–cold water, weather, etc., does the opposite for me. When I am in the panic mode, I can't even put my hands in cold water–it makes me feel worse, not better. And what if you have asthma or COPD, like I do. You certainly are not going to go outside without a cold until you are freezing, because you might also wind up dead. So, like anything else in medicine or therapy, what works for one doesn't necessairly work for another. Buy, hey, it might work for someone besides you..

      January 29, 2013 at 00:23 | Report abuse |
  8. deemarie

    Valium, Ativan or Klonopin makes it even worse cuz you know you're not all there. They make me even more unsure of myself not to mention make me dead tired. Methadone is the only thing that really works. Gives me confidence and believe it or not improves my memory and ability to retain and learn 200%

    Severe and sudden increases in norepinephrine are associated with panic attacks.

    Maybe try Suntheanine. Taurine. Magnesium and calcium. Green tea. Guanfacine

    September 2, 2011 at 21:10 | Report abuse | Reply
  9. marie

    i've struggled with panic attacks for a decade now. my last experience lasted for over 8 months with an average of 20 severe panic attacks a day. i couldn't eat, sleep, go to the stores, or do anything. my triggers vary and are difficult to pinpoint, however, i can with all certainty tell you that anti-depressants DO NOT work. they made me worse each time i tried to take them. i've found that what works best is "cures of magnesium." what that means is that i take high doses of powder magnesium everyday for about 3 months, then i stop for 3, and so on. it helps tremendously and has been my only relief – apart from reading, knitting, and sudoku (hey, idle hands are the devil's playground, if i stay busy, it reduces my focus on the anxiety and panic attacks). i still get anxious from time to time but can completely manage it. i'm so sorry you're going through all this, it's extremely difficult and the doctors always go with medication, but it doesn't work. good luck. keep your chin up and remember, it's only a panic attack. it will pass.

    September 22, 2011 at 16:19 | Report abuse | Reply
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  14. hyperventilating

    I do agree with all of the ideas you've introduced for your post. They're very convincing and will certainly work. Still, the posts are very brief for novices. May you please extend them a little from next time? Thank you for the post.

    May 16, 2012 at 20:18 | Report abuse | Reply
    • Hogan's Goat

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      July 5, 2012 at 16:04 | Report abuse |
  15. Phil L.

    Thank for all the comments above. I had my first panic attack at 60 years old after a health crisis and know that anxiety can strike, really at any age. I've never really experienced any kind of anxiety before and was stumped as to what it was I was feeling. I can also suggest a number of book resources that were helpful to me.

    June 15, 2012 at 23:18 | Report abuse | Reply
  16. Solomon

    HI Everyone,
    I like to say something who really affected by Panic Attacks. I was in this attack for last 3 years. Even today i got a panic attack for simple reason. Even tablets did not help me. I was used to take olanzapine, respirodon, nitrazapine,sodium volporate.
    But i found a simple solution, which was told to me by my brother. Initially i ignored. Then i started following it. It is very helpfull. Just some somewhere comfortabally and pray to Lord jesus(this is what i do). I ask lord to remove the spirit of fear which is inside me. Once i started to pray i start to yarn continously and started feeling that the spirit of fear started leaving me. After a while i become normal. Before i started praying i use to smoke, but it didnot helped me. But praying to lord jesus and asking him to clear the bad spirit inside me really helps. I dont know whether you all will beleive it or not. But its 100% true. If you really want to come out this panic attack without tablets, please talk to your nearer Church Priest(Pentacoste Priest is recomemded) ask him how to take out bad spirit inside us. He may teach you , in case if you dont understand what i say. Please beleive in Jesus, he really helps. Iam one of them :) . I dont like to share my email address, but for the sake of people like me, iam sharing my email address ( nkamesh@hotmail.com ) . You can email me if you really want to know how to come over it. Thanks

    July 5, 2012 at 15:41 | Report abuse | Reply
    • Bible Clown©

      "I ask lord to remove the spirit of fear which is inside me. " That's silly; panic attacks are just you breathing too fast. Breathe into a paper bag while you pray and it will work faster. Calming yourself down is what's making you better, not miraculous intervention.

      July 5, 2012 at 16:02 | Report abuse |
    • Judi

      Amen to that. I believe in Jesus, and talk and walk him daily about my panic attacks and I read the bible. I take medication and hope someday to stop taking them but for now they block an attack. I have had them for 20 yrs.. I believe Power in Prayer.. thank you.. IFor the medical side whatever works for each individual, I take medication and use cognitive therapy ( meaning faceing the fear and relaxing my body and learning to breathe.. Walking with God everyday does help! Thanks for posting..hugs to all .. God Bless

      July 7, 2012 at 15:31 | Report abuse |
  17. Hogan's Goat

    It's usually hyperventilation attacks and nothing to do with "panic" at all. Slow your breathing, hold for twenty seconds between inhale and exhale, and you shpuld feel better right away. It's PHYSICAL not mental, and you don't need to get high every time you feel that way.

    July 5, 2012 at 16:06 | Report abuse | Reply
  18. Daviyanap Panfilc

    I've observed in the world the present moment, video games are classified as the latest trend with children of all ages. Periodically it may be out of the question to drag your son or daughter away from the activities. If you want the best of both worlds, there are numerous educational games for kids. Great post.

    July 29, 2012 at 23:45 | Report abuse | Reply
  19. cameron

    Great post ...Panic attack's are hard to get over until you can recognize the many bodily symptoms that can make them up
    Once you've established it is panic attack's your suffering from (after visiting your doctor) you can start to overcome it..
    I suffered for a year with my panic/anxiety condition but there is so much great information out there now that other's dont have to suffer ..
    regards
    Cameron
    http://anxietysolutionscenter.com/

    August 18, 2012 at 05:00 | Report abuse | Reply
  20. Jerry L

    Great Post. I can't wait to send my Panic Away once and for all. Every little post helps. Keep up the good work.
    http://www.panicattackblog.net/panic-attacks-and-anxiety/what-are-panic-attacks/#respond

    P.S. I'm going to try some of the techniques you listed! I'll respond back to let everyone know if they worked! Good Luck all! :)

    August 21, 2012 at 15:08 | Report abuse | Reply
  21. Jesse P

    Had to reread just to make sure I got everything. Great article and great post.

    http://reviewthatforme.com/self-help/panic-away-review-does-panic-away-work/

    Almost forgot to say Thanks! I really appreciate all the time you put into this blog

    August 21, 2012 at 15:10 | Report abuse | Reply
  22. ranjana

    Every points for
    how to prevent panic attacks
    in you artical was really great.What a wonderful artical.

    http://www.stressanddepressionfacts.com

    December 22, 2012 at 05:07 | Report abuse | Reply
  23. Silvya

    Nothing works better for me than the one move technique, if you have never heard of it check out the panic away program

    January 29, 2013 at 14:43 | Report abuse | Reply
  24. amrit kumar anand

    I am 23 years old Male. I am a victim of panic attacks. I'm eating medicine three years of panic attacks but did not have any change. I want to do the job, but am unable to do the job., Please help me. I am a resident of India. 9,926,393,418 my mobile number., Please, please help me and show me the way.please..........

    February 5, 2013 at 10:15 | Report abuse | Reply
  25. justin

    I have been having panic attacks for years I think they started from being a drug addict and alcoholic. I know they are not anything more but sometimes I can't talk myself down. I have been on all the meds antidepressants and benzodiazepines. Recently I dropped the valium before that it was xanex and klonopin and after a awful 2 months of detoxing I finally feel ok but panic attacks are back I don't really know that antidepressants do anything at all and probably will stop taking them too I don' t want to take benzos again because they are addictive and even though I try not to I do abuse them even though I quit doing everything else. what else can I do sometimes they are so unbearable I leave work early or I will be with my kids and not able to give them my undivided attention cause I want to go hide in my bedroom(I used to sit in front of hospital because I was sure I was having a heart attack or stroke even though I don't know what the symptoms are). It is kind of embarrassing and definatly not helping my career or home life should I look for a new dr. even though this is a new one the old one couldn't deal with me anymore. I already see counselor and she said I may need benzos even after telling her about my addiction and all the horrible things that happened as a result of it. this is very hard to deal with and people that don't have a clue what it is like they laugh and say oh your fine but I'm not.

    May 21, 2013 at 21:14 | Report abuse | Reply
  26. juanan

    If you have panic attacks like i had (now i can control them thanks to this) take a look at this site:

    http://panicattacksolution.tk

    I'm really sure that it will help you the same way that it helped me and lot of people more. Please, take a look at it.

    June 5, 2013 at 10:53 | Report abuse | Reply
  27. Audrius

    Hi, these are helpfull thoughts. Here are some best programs related to self help. You need some help? You need feel free of your problems? That will help you! http://www.howtofeelfree.com

    July 25, 2013 at 16:18 | Report abuse | Reply
  28. Lewis

    There is life, death and in-between. We get anxious because we don't always know when, where, why or how we will acknowledge this fact.
    http://agoraphobiasucks.com/

    September 21, 2013 at 08:12 | Report abuse | Reply
  29. Kabza

    hi, i used to suffer from panic attacks and anxiety here's wat worked for me nd every1 else http://tinyurl.com/kro32db

    October 23, 2013 at 07:44 | Report abuse | Reply
  30. misard

    Well, the first time I had a major attack they put me on xanax but it messed with my head really badly and I had memory issues. My discharge papers noted that while medicated by it I had little to no acknowledgement of externally inflicted bodily harm/pain. What I do remember is waking up the next day with a swollen ankle and multiple bruises that hurry like hell from walking into things or just letting the car door close on me.
    Later, someone recommended me this treatment, and I’m very grateful with it, i can go anywhere i want without problem, no anxiety, no panic attacks, i'm a new person. Read this article, it helped me a lot : panicsolutionkey.com

    November 10, 2013 at 09:27 | Report abuse | Reply
  31. melissa

    Hi I'm melissa iv been having really bad panic attacks so bad to the point where I can breath my chest hurts and both of my sides hurt I start to get really hot dizzy and get the shacks.I get panic attacks all the time sometimes all day long ill have them.and the panic attack last for hours how can I make them stop I can't handle it anymore...the pain or uncomfortable feeling hurts so bad I usely pass out or cant breath...and when it gets really bad I cry my self to sleep at night that's how bad they are please help me and tell me what I need to do.

    November 25, 2013 at 01:17 | Report abuse | Reply
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