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 (415 Responses)
  1. David B.

    I used to have panic attacks frequently, but they are rare for me now. I was treated with Paxil at one time, and it worked for me. One way I found to deal with them is to recognize the attack. Then say to yourself: "I'm having a panic attack, and it will pass." Then I pause where I am, and do some deep breathing. Singing/humming can also relax you, as it takes your mind off the worry.

    August 30, 2011 at 11:02 | Report abuse | Reply
    • David in Corpus

      Medication didn't work and I hate psychitrist, thus, I decided to embrace my panic attacks.
      I told the panic that I liked it and welcomed death. I haven't had one single attack in over two years. I sometimes feel the tickle but I just tell myself the long dirty nap is finally here (thank god) and when it goes away I am sad that I didn't die of a heart attack. Embrace death my friends, takes the fangs right out of it and if it does work, no more worries.

      August 30, 2011 at 13:19 | Report abuse |
    • conrad

      I had a similar experience. It's been 20 years since I had one, but what cured me was actually the meanness of my then boyfriend. I was melting into panic and told him I thought I might die and he said 'so what if you die'?? And I thought hmmm yeah, so what?!! I have not had one since then. Makes me think that they are mostly a matter of our thinking processes – and also I think some people are more sensitive to the normal bumps and pings of our own heart beating and breathing cycle.

      Funny way to get over them really since nobody has ever actually died from a panic attack.

      August 30, 2011 at 14:19 | Report abuse |
    • Chris D.

      This also worked for me. When I feel that I am in a situation that may bring one on, I talk/think myself out of it. This may not work for everyone, but I haven't had a full blown one in ten years. I think the key is to recognize when one is coming on and take steps to prevent it through relaxation, diversion, whatever will take your mind somewhere else.

      August 30, 2011 at 17:16 | Report abuse |
    • Maida

      I agree with you. There is a physical action when you have an attack and you body is flooded with an overload of adrenelin that must be absorbed before the attack is going to subside. If you keep yourself scared and upset more adrenelin keeps pouring into your body. I have found just slowly walking around and letting it work thru is the best things to do. I also found eating a piece of cheese and drinking luke warm water very slowly makes me feel better. I have no idea why. You do not want to do anything that is going to stimulate your already overloaded system. I also use Paxil now but had pretty much learned to live thru the attacks prior to starting the medication. I have not had any attacks since taking paxil. It is scarry but being scarred only makes it worse. Once you have mastered the ability to just let it happen you will see how much more quickly you feel back to normal.

      August 30, 2011 at 22:55 | Report abuse |
  2. GBfromOhio

    Excellent description, you feel perfectly fine, get plenty of sleep, exercise, eat heatly, have a positive outlook, then BAM out of nowhere a panic attack will occur. Essentially, you body does not produce or utilize neurotransmitters and your nervous system goes haywire. I've been on a anit-depressent for years, when I try to be macho and stop taking it, the attacks start up again. I've been taking an l-theanine supplement for the past couple of months and have tapered off my prescription to almost nothing, so far so good. Can't wait for the usual rash of delightful souls who will post "you're just weak, a mental case, looking for an excuse not to cope" yadda yadda. I held on to my job and hid the problem pretty well throughout the entire process of trying to find out what was going on, was not always easy. You literally feel like you're going to die, although intellectually you tell yourself it will pass. A crappy affliction, but I used to tell myself not to feel sorry for myself, think of people with terminal diseases or battling cancer.

    August 30, 2011 at 11:24 | Report abuse | Reply
    • CalgarySandy

      My experience with meds and panic attacks is that Anti-depressants make them worse by far. Anti-anxiety meds make me nearly crippled with depression. I have been told by a couple of psychiatrists that this normal. I had to decide which disorder was the lesser of two evils. I chose Depression. I find it easier to tolerate the inability to do things or ejoy things much more tolerable than a constant desire to kill myself to stop the panic. Some doctors refused to let me use Benzos. No reason other than they don't like them. I have changed doctors and now take low lever anti depressants and take Ativan, about 3 times a week, to cope with the panic. None of this has helped phobias.

      My issue with the doctor's advise it is assumes that panic attacks can be tracked down to a source, then treat them like you would a phobia by progressively working towards toleration. The questioner said that they come for no reason at all and I doubt that she can progressively get over being with kids. My moods and attacks mostly generate within me without any provocation. I do have some major PTSD that cannot be helped because it is not possible to keep burning down my home and telling me it will all be okay.
      Withdrawal occurs with almost all psychiatric medication. I have been to HeII and back several times due to this. It is far worse, in the short term, than quitting cigarettes or other heavier stuff. My son was on Ativan for 6 months and had no problems. I don't use them for more than 3 days in a row. If something happens on the 4th day I am able to grit my teeth knowing I will get help in a couple of days. Caution is the word for these drugs. Nothing other than weed helps me as much as Ativan.

      I had severe Post Partum psychosis. I heard voices and saw things. I was paranoid not merely scared. I was a complete mess and was told by doctors that there was nothing wrong with me and that all women go through this. I never got help for it as it did not exist. When I finally did realize I was very ill it was too late. Same with PTSD after a fire. Maybe some people can be helped but not all can and they will lie and lie and lie to you.

      August 30, 2011 at 19:31 | Report abuse |
    • Geogirl

      I was diagnosed with panic disorder about 9 years ago. I have tried the therapy route. I was empowered during it but still had the attacks. My psychiatrist told me it's a chemical thing in my brain and that I needed to be on an antidepressant for the rest of my life. I was bummed at first but with the support of my husband I learned to embrace this and decide my happiness was worth the low dose I take.

      People are quick to judge about taking meds. What most don't realize is that everyone is different. I have a great job, a great marriage and a great gaggle of kids. Without my low dose my anxiety attacks are so bad that I couldn't live a quality life.

      August 30, 2011 at 23:00 | Report abuse |
    • Annie

      My panic attacks all but disappeared once I was diagnosed and treated for ADHD. In my case, once the cause of my anxiety (ADHD) was addressed, all the concomitant symptoms, including anxiety, vanished. In the past year, I've probably had two panic attacks, and they were both short-lived and relatively uneventful episodes. Contrast that with the number of panic attacks I was having a few years ago–they were a daily occurrence, sometimes even happening several times in a single day. The difference is night and day.

      August 31, 2011 at 00:14 | Report abuse |
  3. Skinny

    As a former panic attack sufferer, I can tell you that 1) they were the most horrible experiences in my life, and 2) in my case, they eventually faded. They were at their worst from ages 25-28, but have subsided almost completely (I'm 40 now). I tell you this, because when they were at their worst, one of the questions I had was: will this ever end? For me, it did, and hopefully will for you as well.

    As for the immediate need to control them... Xanax works wonders, but should be monitored. Another option is alcohol. It's clearly not ideal, and I'm NOT condoning it, I'm just saying that, if you're in full-on panic/dread, ANYTHING is preferable to NOTHING, in my opinion. Just be cautious, as it was the catalyst to a long period of alcohol abuse in my case.

    August 30, 2011 at 11:26 | Report abuse | Reply
    • mikeyg

      I don't recommend the Xanax or alcohol route. My wife was prescribed Xanax for her panic attacks and almost immediately became addicted. She then developed a cross addiction to alcohol. It took years for her to recover not only from the panic attacks, but also from the addiction to Xanax and alcohol. Many psychiatrists are too cavalier about prescribing Xanax. 10% of all patients receiving Xanax become addicted. My opinion: it should be outlawed.

      August 30, 2011 at 13:30 | Report abuse |
    • Binky42

      I also had panic attacks when I was around 25-28, and I eventually overcame them. Xanax worked wonders for me too, but I was very careful to take only the minimum amount I needed. My doctor said that she wouldn't prescribe more than 10 pills at a time, and that I should listen to my body and only take them when I absolutely needed them – not on a daily basis.

      August 30, 2011 at 14:55 | Report abuse |
    • joe129

      "10% of all patients receiving Xanax become addicted" ....citation please

      August 30, 2011 at 16:48 | Report abuse |
    • Monica

      Even IF 10% became addicted, what about the NINETY percent it helped? Should 90% of the people lose what works for them because it didn't work for 10%? Society is sick, at least parts of it.

      August 30, 2011 at 17:57 | Report abuse |
    • Rob

      I gave up on Xanax, and stopped drinking. Although they helped feel better in the moment, the rebound was worse than the original attack after the chemicals clear the system. Serotonin reuptake inhibitors, celexa in particular, really helped me out. But they come with life altering side affects too. I suffer moderate to extreme generalized anxiety most of the time, punctuated with mind numbing and paralyzing panic attacks. The panic attacks have faded over the years, but want to make reprisals periodically (like cluster headaches). I think acceptance, letting them pass, and trying to get outside of my head when they start (focus on something, anything, in my environment and place no expectations on myself for that moment, or the next moment, or the next moment, etc). Sadly, David in Corpus has a point that many sufferers will just have to learn to tolerate it and live life 'in between' and don't expect too much.

      August 31, 2011 at 12:22 | Report abuse |
  4. plbt

    I'd never had a panic attack. Then I was given ativan in the er (I was in the er for another reason). Only then did I think I was dying. Don't take that poison! It almost killed me.

    August 30, 2011 at 11:26 | Report abuse | Reply
    • CalgarySandy

      So, people like me who cannot get help from therapy or dozens of meds should stop Ativan on your say so. Guess what, everyone is different and you have no right to make generalizations like this.

      August 30, 2011 at 19:32 | Report abuse |
  5. KC

    Panic attacks are frightening. Sometimes they are caused by low iron – anemia. It is best to check with your doctor and have some bloodwork done before taking supplements. Stay away from too much caffiene and sugar. Deep breathing, exercise, and getting plenty of rest helps. You should ask your doctor about Xanax which can be taken only as you need it.

    August 30, 2011 at 11:30 | Report abuse | Reply
  6. Elizabeth

    I suggest you try avoiding EMR exposure – no wifi, cellphones, dect phones for a period of time to see if that helps. These devices can affect the heart rates in people who are sensitive to this type of radiation. European doctors – particularly those in Germany – are aware of this.

    August 30, 2011 at 11:40 | Report abuse | Reply
    • yikes

      that truly sounds like hogwash!

      August 30, 2011 at 11:42 | Report abuse |
    • Mr T

      That's the dumbest thing I've ever heard. People have suffered panic attacks long before the advent of modern technology.

      August 30, 2011 at 11:48 | Report abuse |
    • AmyAnthony

      Yeah, that's really practical especially if you have a job at an office. I'll be sure to take a "hiatus" from my Blackberry AND computer which would guarantee me getting fired. Now THAT would trigger a panic attack! Maybe I'll just retire to the mountains like Sasquatch and live on roots and berries and sleep in my own filth.

      August 30, 2011 at 14:52 | Report abuse |
  7. yikes

    The best thing you can do for yourself or another who has panic attacks – don't listen to this doctor. Drugs are NOT the way to solve everything – nor is psychotherapy. Whatever happened to having your loved one help you in time of need? When I have a panic attack I let my spouse know – and if I know the reason why I tell him that too. He now knows what to do – reassure me by telling me I'm OK and giving a reasonable thought as to why I might be feeling the way I do. I take a few deep breaths, listen to him and then get distracted and then feel better. If your spouse/loved one isn't around do it for yourself. Once I was deep in a cave and convinced myself I couldn't breathe and was taking very shallow breaths – the kind where you pass out. But before that happened I listened to myself and rationalized that if there was no air no one else could breathe either. Then I took several deep breaths through my nose and slowly let it out my mouth – always works.

    August 30, 2011 at 11:40 | Report abuse | Reply
    • Yes, but...

      Your suggestion to find ways to calm down is excellent. I have a breathing technique that works wonders for me and stops them within minutes. I must say, however, telling someone not to listen to advice because you don't agree with it is not helpful. For many people finding the underlying cause of the attacks will help to eliminate them. Seeing a therapist not only helped me to learn the breathing technique, but it helped me to deal with the underlying cause. Neither of those things I could have accomplished on my own or with my very supportive spouse. What you suggest may just be a band-aid for many people when what they need to find the cure.

      August 30, 2011 at 12:33 | Report abuse |
    • kake79

      Odd that you say psychotherapy is hogwash but then go on to describe a technique used in CBT (Cognitive Behavioral Therapy). I think you may be confusing the terms psychotherapy and psychoanalysis. The term psychotherapy encompasses a wide variety of schools of thought and techniques. CBT is one that has proven in study after study to be particularly effective in the treatment of anxiety disorders.

      August 30, 2011 at 13:36 | Report abuse |
  8. Fletch

    (1) Stay off caffeine, (2) stay off artificial sweeteners, (3) get lots of aerobic exercise, (4) go gluten free, and (5) absolutely no rap music.

    August 30, 2011 at 11:41 | Report abuse | Reply
    • RescueRonny

      Great advice! I wholeheartedly agree with what you recommend. I can speak from personal experience that these lifestyle changes work!

      August 30, 2011 at 12:31 | Report abuse |
    • Virginia

      I was good with all of this until I got to the "no rap music" part. How is that relevant?

      August 30, 2011 at 18:50 | Report abuse |
  9. Dawn

    i have panic attacks everyday the only thing i do that can help is keep my MP3 player on me and when it starts put on the music and sit put all of your energy into that music the physical problems will pass fast. you have to use a little magical thinking but it works fast than pills
    good luck to you

    August 30, 2011 at 12:12 | Report abuse | Reply
  10. B Ann

    Panic attacks can be caused by hypoglycemia, which can be caused by low cortisol, which can be caused by low thyroid. If you have panic attacks, it would be worthwhile to have your thyroid levels checked, and more than a TSH. Low thyroid can also cause high cholesterol and depression, so if you have those, even more reason to get tested! tiredthyroid.com

    August 30, 2011 at 12:17 | Report abuse | Reply
  11. Jonathan

    I used to get panic attacks quite often, the first one I really remember was while I was driving. I'd been at work all day, hadn't had much to eat, had some caffeine and cigarettes and had to drive to another city at like 10 pm after work. I got about 30 min into the drive down the interstate and was breathing heavy and my hands were going numb. It was scary, I was worried I was going to crash my car, I ended up pulling over into a hotel parking lot and going in and getting a glass of water and sitting on the couch in their lobby until it passed. After that I'd get more panic attacks while driving, partially from the stress of remembering that first experience, and partially from worrying that if my car broke down I wouldn't have enough money to get home or fix it. Eventually I got really sick with some strange stomach virus or something which gave me more panic attacks just from the stress of my illness, so the doctor gave me some Ativan (lorazepam), which worked really well for me. I'd take one when I started having an attack and pretty soon I'd clam down and it would subside. Once you can get yourself relaxed the attack with gradually end on it's own, but in some situations (driving, at work), it's a lot more difficult just to chill out, and that's when medication can be helpful.

    August 30, 2011 at 12:19 | Report abuse | Reply
  12. Been There

    As the article says, see your doctor. Soon. Many times an incorrect diagnosis of panic attacks is made for conditions such as HCM.

    August 30, 2011 at 12:19 | Report abuse | Reply
    • Rob

      I want to believe doctors can help, but they cannot. Or they only pay attention to those they feel empathy for. I've been going to doctors for decades begging for help and they just assume I'm a nut case. Well, maybe they're right after all. Who knows. But simply going to the doctor doesn't assure that help is available.

      August 30, 2011 at 18:50 | Report abuse |
  13. Le Sceptique

    GBfromOhio–thank you for saying exactly what I was going to say in response to this article. I, too, held on to my job and essentially tried to tough it through, hiding as much as possible from my family. I was put on antidepressants, which have been very effective, but only in the past year was I prescribed a low dose of Xanax, which really does stop the panic and keep it from cycling into something bigger. I take the smallest effective dose and am very careful about dependence. Today I'm doing very well–so long as I stay on my meds–and I, too, am thankful that my suffering is nowhere near that of many others'.

    August 30, 2011 at 12:25 | Report abuse | Reply
  14. WaryOfNoTx

    While the premise of yikes's feedback is correct (drugs & psychotherapy do not solve everything), the statements draw dangerously close to some ideas I've heard in the past which attempt to minimize years of research showing the effectiveness of psychiatric and psychological interventions.  There are many people who might suffer from panic attacks, depression, or other forms of anxiety, and not ultimately require any treatment to get better (naturalistic recovery).  But for those whose lives are truly significantly affected by panic attacks, Dr. Raison's article does explain treatments that have been proven to be effective.  Certainly it is helpful to have a supportive spouse or family member, but those who suffer from a diagnosable Panic Disorder will tell you that panic often occurs in the absence of that trusted individual.  Again, I don't want to diminish the notion that not all people require therapy, but those who suffer from panic attacks should get this message that effective treatments do exist should they find it difficult to overcome panic on their own.

    August 30, 2011 at 12:34 | Report abuse | Reply
  15. RescueRonny

    I have had terrible anxiety for years. Medication can be useful, especially in dire situations. However, as with any pharmaceutical product there are inherent risks that must be acknowledged. The best thing to do is discuss your options with your doctor. I made some lifestyle changes and my anxiety diminished, however I was also prescribed clonazepam (Rivotril aka. Klonopin), which also helped. Just one thing, any time you use a benzodiazepine such as clonazepam (Rivotril/Klonopin), lorazepam (Ativan), alprazolam (Xanax), diazepam (Valium) and all the others, you must do so with extreme caution due to the risk of dependence and addiction. I've been through benzodiazepine withdrawal before and it is beyond horrible. Just remember, benzo withdrawal syndrome is the only withdrawal syndrome that can kill you and it can also last for years. The key to curbing anxiety is to use a multifaceted approach consisting of lifestyle changes and responsibly used medication. Relying solely on medication can be extremely hazardous.

    One last thing, if you are to use a benzodiazepine for anxiety, try to avoid Xanax. While it is exceptionally effective, it can also be seen as the most addictive of the benzodiazepines and by far the most difficult to withdraw from. When it comes to benzos, the best choice, IMO, is clonazepam, as it is longer-acting and easier to withdraw from.

    August 30, 2011 at 12:39 | Report abuse | Reply
    • kake79

      I think you're being a little dire here. First, alcohol withdrawal can kill you (delirium tremens). Second, with benzos, it's all about how frequently you take them. They should very, very rarely be taken on a regular basis (i.e. daily). Instead, they are more like stop-gap measures to have on hand for when a full-blown panic attack is coming on. I've had a prescription for Xanax for years now and have never had issues with dependence since it takes me a couple of years to go through a "one-month" supply. For long-term, regular treatment for panic disorder, a psychiatrist will look at SSRIs and SNRIs as well as Cognitive Behavioral Therapy.

      August 30, 2011 at 13:47 | Report abuse |
    • Kati

      Perhaps I'm an anomaly, but I've never suffered from addiction to Xanax* or Ativan, and I've never felt any symptoms of withdrawal...and I've been taking some form of these drugs off and on for years now. I do carry my Ativan with me everywhere I go, but the bottle still has the same 30 pills in it that were prescribed to me nearly a year ago. Clearly, I'm not addicted.

      *Xanax gave me headaches, but otherwise worked fine for my panic attacks.

      August 31, 2011 at 00:21 | Report abuse |
  16. Yes

    I have had panic attacks and anxiety for 2 years now. I've done well with Xanax, as needed (when a full-blown attack is brewing), under the tongue for rapid absorption (per Dr.), and Klonopin when I know I'm going into a panic-prone situation (long highway drive). Have been tested for all other biologic causes with negative result. It's a rough affliction, but I cope day-by-day and only use meds when necessary.

    August 30, 2011 at 12:49 | Report abuse | Reply
    • two wheeler

      Let me know next time you are taking a long highway drive and take xanax and klonopin. I don't want to be anywhere near you.

      August 30, 2011 at 16:23 | Report abuse |
    • Yes

      Not both, the minimum dose of EITHER. They don't make me drowsy, nor affect my judgement, just keep panic away. If you don't know what you're talking about, don't post. I would never put myself, or anyone else, at risk. You clearly know nothing about benzodiazepines on a low dose as needed basis. Idiot.

      August 30, 2011 at 16:51 | Report abuse |
  17. Celiac

    I had panick attacks several years ago. Treated somewhat successfully with Zoloft. However, when I was latter diagnosed with celiac disease (gluten intolerance, started on a Gluten free diet and stopped Zoloft the panic attacks did not return. I believe that the panic attacks and other nerological and physical symptoms were all tied to the ceiliac disease which is an autoimune disorder. Don't know if anyone else has had similar experiences?

    August 30, 2011 at 13:20 | Report abuse | Reply
  18. jim rizzuto

    by the number of replies, it just goes to show how many folks suffer from this. All the replies are valid, it can be caused by so many things and everyone is different. Caffeine, nicotine, cold meds, low blood sugar, Thyroid, etc. Mine are caused by heart palps – they call them PVCs. The best remedy is allowing your doctor to evaluate all these things until the root cause is found. If none is found, psychotherapy may be the help you need. Some folks cannot process stress – it's not a weakness – like I said everyone is different.

    August 30, 2011 at 13:31 | Report abuse | Reply
  19. Kritter1

    The doctor's advice for psychotherapy would not work for the woman in the article. She clearly stated the panic attacks come out of the blue when she is doing nothing in particular, while doing mundane things like working, caring for her kids or doing nothing at all. How would "exposing yourself to situations that cause panic" be accomplished in this case? That part of the article did not make sense at all!!!

    August 30, 2011 at 13:34 | Report abuse | Reply
    • CML

      I have experienced panic attacks when anticipating situations that are stressful (visiting my parents), but often they come "out of the blue". Sometimes when I look back later I can find what innocuous thing triggered me, but sometimes I cannot and it remains a mystery. It is very possible for them to hit when you are in a safe situation. For me, I had to learn the impetus behind the panic attacks in order to recognize the triggers. Sometimes I feel like Sherlock Holmes trying to sort out a mystery when I am trying to figure out why I had one in the grocery store while buying vegetables!

      So while avoiding stressful situations helps sometimes knowing what is causing them can help to decrease or eliminate them. Often it is the fear of the unknown source that increase their intensity. Now that I know why I have them (much less often btw) they are less scary and my curiosity about their genesis distracts me enough that they subside quickly.

      August 30, 2011 at 14:20 | Report abuse |
  20. Tony

    I've encountered a few panic attacks over the past couple of years but much more frequent was terrible anxiety – I'm talking days on end. I went to a phyciatrist that basically told me that since you don't hear voices, you're okay. He gave me some Lexipro and that made it much worse so I quit taking it. The anxiety has consistanly diminished over the past year though I'm not sure why. I just recently went to a new doctor and he had me take a blood test. Evidently, lack of vitamin B12 can cause anxiety and nervous system disorders. Turns out I was B12 deficient. I've been taking the vitamin B12 supplements for about a week now and I noticed immediate results. Much less anxiety so far. My point here is get checked out by your doctor. The problem could stem from many possibilities. Hopefully, I will find lasting results with the B12 supplements.

    August 30, 2011 at 13:37 | Report abuse | Reply
  21. Double D

    How about a panic attack at 30,000 feet when you are just 30 minutes into a 6 hour flight. I had panic attacks all the time and I felt like I lost reality and it was horrific. My doctor taught me how to breathe and focus on something around me such as a tree blowing in the wind, or someone near by that is doing something and what I found was this took my mind off of the panic and it started to subside. I still get small attacks, but I can easily get them under control by changing my focus.

    August 30, 2011 at 13:41 | Report abuse | Reply
  22. fran drake

    Do try to take the natural route.... No caffeine, eat food in its natural state versus processed food in a box, bag, etc... no sugar, get 8 hours of sleep, and get at least 30 minutes of exercise daily, get a massage, do yoga, etc... avoid meds...

    August 30, 2011 at 13:43 | Report abuse | Reply
    • cg123

      Yes. And also change the way you think: turn negative thoughts into positive ones. Be grateful for the chance to live life even if it's a painful life. Be grateful for every breath.

      August 30, 2011 at 23:14 | Report abuse |
    • Kati

      Caffeine and sugar are natural.

      August 31, 2011 at 00:24 | Report abuse |
  23. sarah S

    I used to suffer from panic attacks when i was in high school and a couple years after. it was a result of depression since both my parents had both passed away. then i got in a relationship with a horrible guy which made the whole thing worse. when i was 18 i finally went to the doctor and she gave me xanax. it stopped my panic attacks

    August 30, 2011 at 14:21 | Report abuse | Reply
    • conrad

      Sweetheart, I think with what you've experienced you certainly have a right to have panic attacks. I'm sorry you don't have your Mom and Dad around, I'm sure that is very hard. I hope you find that the world is full of loving people who will 'mother' you in their own way. For my part, I send you a reassuring hug and offer this – only choose to have a boyfriend who truly loves you from the very beginning and who regularly shows you kindness. If nobody is around who will do this, it is better to spend time without a boyfriend, even if it takes years for a good one to come along. You have the right to accept yourself as you are and nobody has the right to abuse you. Offer yourself the kindness and understanding your own loving mother would.

      August 30, 2011 at 15:45 | Report abuse |
    • CML

      Well said, Conrad.

      August 30, 2011 at 16:45 | Report abuse |
  24. Mr Panic

    I have had Panic Attacks for close to 15 years. At first they were horrible as I had no idea what they were.

    I would always get them before a migraine. I did a lot of research on panic attacks and found the more I knew about them the less scary they became. Knowledge is power.

    When I get attacks, I recognize it for what it is, I know I'm not cracking up or going to die, I breath and meditate for a little bit and poof, it goes away. No drug hangovers, no co pays, simple, easy. Do what your body is telling you to do, calm down.

    I also find that smelling tea helps too (weird but works for me)

    August 30, 2011 at 14:24 | Report abuse | Reply
  25. B in Dallas

    I agree with most comments in here! Do NOT listen to this doctor!!! Drugs are not the answer, I had panic attacks after 911 and the economic issues that it caused me. I was put on Xanax which I believe was leading to addiction. I got to a point that if I didn't have Xanax whether I needed it or not, I would panic! Follow the advice of many others in this blog! Once I learned that a panic attack is syply a chemical release of adrenalyn, I simply recognized it for that and told myself that it would pass. Sometimes I would recite the 50-states in alphabetical order or something to divert my mind but it worked! They pass pretty quickly and ultimately go away on there own. I have not had a panic attack since I used this method in 9-years! DONT TAKE MEDS!!!!

    August 30, 2011 at 14:30 | Report abuse | Reply
    • Sheryl M

      GREAT ADVICE!!!!! I totally agree with your method!

      August 30, 2011 at 15:01 | Report abuse |
    • Binky42

      Meds helped me overcome my panic attacks when nothing else would. I tried every mind trick that exists, and saw half a dozen "experts" – none of it worked.

      August 30, 2011 at 15:01 | Report abuse |
    • why size matters

      Anyone whose post about controlling panic is peppered with exclamation points, needs to re-think their content and delivery (!). Medication is a great first-step to get control before implementing behavioral interventions. Behavioral modification takes time and if you can no longer do your job due to panic symptoms, medication is a great starter until congnitive control can take hold.

      August 30, 2011 at 19:32 | Report abuse |
  26. Deb

    My sister got panic attacks very frequently, and dizziness too. Her symptoms started in middle school about 20 years ago. Recently she was diagnosed with MS. After reading that vitamin D helps with MS symptoms, she got hers tested (the neurologist was unhelpful) and discovered she had 11, normal is between 32-100. Severely low. Three days after super doses of Vitamin D she was surprised to have a huge improvement in panic attacks and dizziness, which has continued to improve over the past 2 years, though she is not perfect. She found her Vitamin D levels needs to be at least 50 to avoid panic attacks. THIS IS A TRUE STORY. If you're suffering, it is something important to check. And don't let your doctor tell you 30 or 35 is enough. It's not enough. My sister takes 6,000 IU daily to maintain a level of 50. Most people don't need that much. Since you can overdose on Vitamin D, work with your doctor to make sure you take the right amount.

    August 30, 2011 at 14:34 | Report abuse | Reply
    • AmyAnthony


      August 30, 2011 at 14:54 | Report abuse |
    • Chris

      Yes, there is research to show that an adequate Vitamin D level is important for responding to stress. Vitamin D is necessary to maintain proper levels of calcium, and doctors have known for years that calcium helps us deal with stress. Vitamin D also carries out functions that affect neurotransmitters in the brain. So having optimal levels of D could make a difference in panic attacks in several ways. No one doubts that supplementing with D has helped those who suffer with Seasonal Affective Disorder, so it would be worth trying for Panic Attacks. Also, as previous poster said, it could be important to have doctor monitor Vitamin B-12 levels, too.

      August 30, 2011 at 23:32 | Report abuse |
    • Kati

      I grew up in Arizona and currently live in Southern California. I most assuredly do NOT have a vitamin D deficiency, and yet I get panic attacks...

      August 31, 2011 at 00:26 | Report abuse |
  27. Binky42

    I had panic attacks for a few years. I have no idea where they came from, but I took Xanax as needed for about a year (mayb 5-6 pills per month), and it was enough for me to be relaxed and finally overcome them. Therapists/psychiatrics/counselors didn't do a darn thing for me. They just liked to empty my bank account and gave me useless advice that did NOTHING to help me at all! Skip the shrinks, take a few pills, and you'll be fine.

    August 30, 2011 at 14:52 | Report abuse | Reply
  28. smkent

    One thing to keep in mind when taking medications is that it might not be the first rx or dosage that works for you. Everyone is different and it can take quite a while to find the right medication for you. Don't get frustrated and just assume medication doesn't work for you. In my case it took a combination of pills and months of finding the ones that worked.

    August 30, 2011 at 14:52 | Report abuse | Reply
  29. Sheryl M

    I suffered from major anxiety attacks but only when driving, no road rage, just pops on me at any time while driving. I can't drive the interstates anymore I have to find back roads to travel. I have never been in an accident nor have I ever had a ticket for anything in my history of driving of 38 years. I have found when I feel an attack coming on that subtracting by 3's from 100 is a way to make the mind work on something else! Try subtracting by 6's or 7's is a lttle difficult. I refuse to take any drugs of any kind, And who-ever suggested drinking alcohol to help with attacks has lost their mind!! I ca't imagine driving a vehicle half looped and having an attack at the same time, WHOOPS there goes a perfect driving record!!!

    August 30, 2011 at 14:55 | Report abuse | Reply
  30. kcsenecal

    My therapist recommended that if I start feeling an panic attack coming on to blow bubbles. I know it sounds crazy, but it works. You start thinking about something else and you slow your breathing down so you can blow them. Try to blow the biggest bubbles possible.. Obviously if you are at work just step into the stairwell or outside to do it. Let your immediate supervisor know that if you start gettting overwhelmed you made need to step outside for a moment. The bubble thing works. Or you can color or keep a notepad handy and write.

    August 30, 2011 at 15:01 | Report abuse | Reply
  31. unique

    Where I used to work we used
    Vistaril 50-100mg twice a day and that worked great.

    August 30, 2011 at 15:16 | Report abuse | Reply
  32. OhMyDarlin

    I suffered from panic attacks as a child around 9 years old and had them off and on until my 40's. I can remeber being so young and pacing the floor at night feeling like a caged animal and felt like I was going to die. I did not get diagnosed until I was in my late 20's when one night I went to the emergency room thinking I was having a heart attack and was told it was a panic attack. I felt totally mental and stupid at the same time, however, the ER doctor gave me some good advice which was when I felt an attack coming on that I should get a brown paper bag and breath into it as usually you hyperventilate from breathing so fast. I would tell myself I was o.k. and try and stay calm knowing that the attack would pass. I asked the doctor what caused the attacks and he told me that it was because I did not handle stress properly and it will come out in one form or another – therefore my panic attacks. Once I knew that I worked on ways to deal with stress in a better way. I had to get rid of my stinking thinking and take problems one at a time and not the whole truckload at once. I am closer to 60 now and I have not had a panic attack since early 40's. Thank God I learned how to deal with stress.

    August 30, 2011 at 15:29 | Report abuse | Reply
  33. ArleneJ

    As a practicing hypnotherapist I see many people with panic attacks. teaching them to control their respiration allows them to slow their heartbeat and without the racing heartbeat there cannot be a panic attack.. While they control breathing they repeat over and over silently "I am safe" Works every time. For Real. Slowing your heart rate and a speeding heartrate cannot happen at the same time. No racing heart no panic attack.

    August 30, 2011 at 18:22 | Report abuse | Reply
  34. Marie Morrison

    I started having panic attacks when I was a teenager. I really did think that I was going to die. The more I read about these attacks, the more I realized that I was not alone and that these feelings of dread were not real. So, whenever I would have an attack, I would very calmly say to myself, "Ok, this is just a panic attack, I'm not dying and I'm going to be okay." It always worked.

    August 30, 2011 at 18:47 | Report abuse | Reply
  35. wendy5

    i get they last eight hours; i shake its awful; they had me do paxil for 5 years i quite them; still got them but i found what makes them go away for me; 1st i found what makes me get them to begin with; i get really tense and hold things in; i quite caffeine i think i may be allergic to it; go read about allergic reaction to caffine; i dont drink sodas so it had to be 1 cup of the coffee or tea i drink in the morning i can water the stuff down and still get jitter; i also found just going online and read the symptons and i feel better; started walking also big difference in stress reduction; changed eating to all vegs fruits grains; no sugar ;caffieine;or meat; i hope i beat them for good; things things would attack going into a grocery store awful awful stuff

    August 30, 2011 at 18:51 | Report abuse | Reply
  36. dx2718

    What I'm getting here is that a lot of people suffer from panic attacks but that different treatment works for different people. It definitely doesn't hurt to eat healthfully, get enough sleep and exercise, and minimize stress, but ultimately some people will need psychotherapy or drugs. Personally, I have tried a bunch of non-pharmaceutical options, including neurofeedback, biofeedback, and even acupuncture. So far nothing has cured me. Benzos are a temporary solution, and make things worse long-term because of withdrawal. I haven't tried SSRI's. Pregnancy and cycle-related hormones seem to drastically increase the problem. However, there was one hormone that mitigated it: prolactin. Mothers-to-be with anxiety and panic, breast feed your babies as long as possible (if it helps you like it helped me). It's good for them and you'll feel fabulous.

    August 30, 2011 at 19:06 | Report abuse | Reply
  37. Californian

    Oh, the narrow mindedness of western physicians! There is another option. I used to have panic attacks. They faded away when I began practicing yoga in earnest. You learn to control you body, to quiet and focus your mind, and to use your breath. Once you learn how to calm yourself, you may begin to see changes you need to make in your life to address the psychological reasons behind your attacks. Don't buy the "drugs or psychoanalysis" bs.

    August 30, 2011 at 19:46 | Report abuse | Reply
  38. pab

    I've seen acupuncture and herbs help with this. It's alway good to have a complete check up with a medical doctor, but in addition, try to find a good acupuncturist who has studied herbs. Also ask the acupuncturist if they have treated this condition before and try to find someone who has been practicing for at least 5 years. Good luck.

    August 30, 2011 at 19:51 | Report abuse | Reply
  39. Bobby

    I have been using a CES machine ( Cranial electro-Stimulator).. It is has been effective for my depression and anxiety without side-effects..

    August 30, 2011 at 19:52 | Report abuse | Reply
  40. Tom

    Celexa put my attacks to rest. Good stuff.

    August 30, 2011 at 19:56 | Report abuse | Reply
  41. Mike

    Celexia and klonopin will eliminate anxiety symptoms after several weeks of treatment. Those of you who say "don't take meds" obviously have never dealt with serious anxiety before. Celexia is taken every day while klonopin is taken before or during any anxiety attack. Also, the celexia eliminated my irritable bowel symptoms that I had for 20 plus years.
    The first two weeks on this medication is rough but If you stick it out the benefits are amazing.
    I feel great nowadays and can get up in front a room full of people without any issues.

    August 30, 2011 at 20:40 | Report abuse | Reply
  42. LongSuffering

    Surprised that nobody has mentioned EMDR. After almost 30 years of suffering, it's the closest thing to a miracle I've found. It has gradually eaten away at the anticipatory anxiety, which almost always leads to a panic attack. I'm starting to do things and go places that I hadn't in years. Unfortunately my health insurance does not cover it, but it's been worth every penny. Wish I'd discovered it years ago. Anything's worth a try, isn't it? The British Ministry of Defence is now offering EMDR as one of its therapies to its armed forces. SSRI's were horrible, caused more anxiety and now appear to cause heart attacks and strokes (see recent studies), as well as osteoporosis. Klonopin works but I worry about what that's doing to me too. I'm always amazed at how doctors and people in general dismiss panic attacks when they are truly one of the most frightening things that can happen to a person. Best wishes to everybody trying to deal with this horrible illness.

    August 30, 2011 at 20:40 | Report abuse | Reply
  43. Rich

    I started getting anxiety attacks when Obama was elected. The doctor I went to see said he was also getting them. His advice was to pray and hope that the dictator looses in 2012.

    August 30, 2011 at 21:38 | Report abuse | Reply
    • justin

      Myopic, un-ironic, and white. Racist much, Rich?

      August 30, 2011 at 22:52 | Report abuse |
    • justin

      Almost forgot. I'd check the MD grades on Dr. Perry. He's HMO.

      August 30, 2011 at 22:53 | Report abuse |
    • Kati

      Rich is a troll.

      August 31, 2011 at 00:28 | Report abuse |
  44. Chad Parker

    While driving over a long bridge the eastern shores of Maryland, I suddenly started panicking and thought that I was going to pass My son controlled the car and then it took me a while to calm down. I never had that experience before, but even after nine years, I am scared to drive on a long bridge although I had driven on hundreds of them before without any problem. The problem with panic attacks are that the very thought of awful first experience brings about another attack. I took Paxil for a couple of weeks which clearly helped me Deep breathing exercise, yoga, meditation and relaxation are very helpful in the long term.

    August 30, 2011 at 21:40 | Report abuse | Reply
  45. pete

    I used to have them years ago,but not anymore.Never used doctor`s or drugs.I just recognized what caused them,and tried to avoid that situation.Like alot of people already said,just say to yourself ,you survived the last one ,you will survive this one.IAnd guess what?You didn't die either.

    August 30, 2011 at 21:46 | Report abuse | Reply
  46. Ivana

    Hi Stephanie! Please forget the meds. That's the worst thing you can do to yourself. I did have panic attacks myself for about a year every single day/night and went through a rough road to get rid of them, but it was worth it all the way. I do not regret it. I went from psychiatrist and meds to the natural wellness that included yoga, meditation, acupuncture, exercise, massages, breathing, and walking. The natural approach won! I have not had a single panic attack for a few years now and am very happy. Try and be patient. Day by day you will feel better. The thing is that you have to learn how to stop thinking about it as you get into a circle and cannot stop thinking about panic attacks. I could not find a way to stop it, but boy, natural wellness does a miracle. Also, check your vitamin B and D levels. It is possible you depleted some of them and could be a reason for your attacks. Please, forget the doctors and treat it naturally. Good luck and all the best to you! You can get over it!

    August 30, 2011 at 21:48 | Report abuse | Reply
    • AGeek

      You're the worst kind, frankly. After dealing with PA/PD for 23 years now, it took both your approach AND medication to become marginally functional. Don't dismiss what actually works for some people.

      August 31, 2011 at 00:25 | Report abuse |
  47. justin

    People who come to psychotherapy just want to have a better strategy to avoid because all of their avoidance strategies suck. The elephant in the room is that, well, avoidance just doesn't work. Rather, it creates a positive feedback cycle. Get to a psychologist for some CBT and finally live free. Anxiolytics...well..they are habit forming, addictive, can result in life-threatening withdrawal, and, well, are cliche. Life's too short, and drugs are too expensive. Again, get thyself to a psychologist.

    August 30, 2011 at 22:49 | Report abuse | Reply
  48. onetrickpony

    At the risk of sounding foolish, try breathing at 4 breaths per minute, instead of 15x per minute and see how you feel after an hour or two. If you breathe too fast, it changes the body to become more acidic, which causes many ailments.

    August 30, 2011 at 23:21 | Report abuse | Reply
  49. Ruby

    And this is why I shun medical doctors. What terrible advice to give anti-depressants/psychotropic drugs! My teenage son has had anxiety for many years (and thought he had asthma) and I finally had him properly diagnosed by a naturopathic doctor. My son has/had adrenal fatigue/adrenal insufficiency. He was low in cortisol so when he got stressed, even by something little, his adrenal glands did not have the cortisol to put out, so out came adrenaline. How does one feel when they have an adrenaline rush? Anxious, shaky, out of breath, and exhausted. His "orthostatic hypotension" (blood pressure drops when you get up) and eyes which stayed dilated when a light shone in them were other symptoms. So was his lack of success in school, mostly from not being able to do sustained work with dilated eyes and exhaustion. In fact, educational testing pinpointed his problem as being visual and visual motor. Everything else was normal.

    He was given some natural cortisol for his "low" times (a saliva test determined this), a low carb diet, frequent snacks, high protein, B vitamins and zinc. Within two months, his eyes began to pinpoint with light again, he could read better, people remarked on his "personality change," and he's now a B/C student, becoming more involved with activities, such as guitar which he never had the confidence to try or energy to pursue, and is working part-time.

    Anti-depressants. Now how would that have done a better job than properly identifying and treating the PHYSICAL problem, not mental one, of anxiety??

    August 30, 2011 at 23:24 | Report abuse | Reply
    • AGeek

      Naturopathy? Really? Why not just take your son to a genuine Witch Doctor? "Adrenal Fatigue" has no more basis in science than saying the moon is made of green cheese. Your so-call "physical" problem is completely invented and a diagnosis made from non-specific symptoms. If you suspect abnormal adrenal function, there are known physical conditions like Addison's disease (an auto-immune disease) which account for the majority of cases. Get your son to an endocrinologist for an *actual* diagnosis and stop d-cking about with the idiots before you actually hurt your son.

      August 31, 2011 at 00:32 | Report abuse |
  50. Jeremy

    Oh yes, Benzo's are the best. Klonopin works very well for me! I also am on Risperdal and Paxil as well. But yes, try Klonopin. Good, good drug!!

    August 31, 2011 at 00:39 | Report abuse | Reply
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