adolescent panic attacks

January 4, 2006 7:56 AM

My 13 yo daughter has been having panic attacks. If you've dealt with this, can you please share your experiences/advice?

This has been happening since last summer, about 2x/month, and after hoping it would pass, we've begun looking at therapists since she's begun having them in school. The attacks include uncontrollable crying, shaking hands, difficulty catching her breath, and what she describes as scared feelings. No particular events seem to trigger them, and they subside within 20min typically. The strategy we typically use has been to get her in a safe place (home) and refocus her attention on something else.

I will mention that otherwise she is bright, has very supportive friends/family, does well in school, is in excellent health and has no history of physical/emotional trauma. Most of the time she appears happy and cheerful, however, she has said that she feels sad a lot when she's by herself. Also, heartbreakingly, she can be sitting with the family or whatever and you can literally see her face suddenly darken, and tears start rolling down her cheeks. She doesn't know why.

We would love to hear from anyone who has managed this problem in themselves, esp. as adolescents, or in a loved one.

posted by anonymous to health (29 comments total)

They won't pass by themselves. I've been getting these with varying frequency since my early 20s. Absolutely take her to a therapist. I'd also recommend taking her to her regular doctor for a full checkup. There are some breathing exercises and mental exercises that can help her get through them, but the 1st step is to rule out serious physical or mental illness. Also, keep a record of exactly where and what she's doing when she has an attack. There may be a trigger that's not obvious-- oddly, for me some are triggered by very humid environments.
posted by miss tea at 8:03 AM on January 4, 2006

My girlfriend had a pill she'd take when she felt an attack coming on. I don't know what the drug was but it helped lessen the severity and after effects.
posted by Mitheral at 8:19 AM on January 4, 2006

The sad feelings when she's alone are tell-tale: it sounds like depression and anxiety, a common combination, and one I've suffered from. Generally, treatment is a combination of anti-depressant, anti-anxiolytic, and talk therapy.

Take heart, as (in my experience at least) the anxiety attacks respond very well and very quickly to medication. I only had to be on anxiety meds for a short while. Depression is more tenacious, but treating it will also help the anxiety.

Since this sounds like her first episode, it's important to stomp the shit out of it so depression is less likely to recur. I highly recommend the book "Against Depression" by Peter D. Kramer to help you understand what she's going through, and how important it is to treat this aggressively.
posted by frykitty at 8:21 AM on January 4, 2006

The Anxiety and Phobia Workbook is pretty helpful, but I would recommend that you get her to a therapist and to a medical doctor ASAP. Panic attacks can be handled without medication, but it takes time and a lot of understanding of exactly what is happening to you. 13 is young for panic attacks; they typically start in the late teens to mid twenties (that's when mine did) and I think you should definitely have any possible physical cause ruled out.
posted by mygothlaundry at 8:29 AM on January 4, 2006

I had anxiety attacks when I was 12. A therapist is definitely helpful. Learning how to control your body and the way it responds to anxiety is as well. Anti-depressants do help with anxiety attacks. I didn't take them as an adolescent (I don't think SSRIs were popular then). And they can be temporary to get you through the bad spot while you learn how to deal with the anxiety.

I'm more than happy to talk about this via email. My username @ the url in my profile will work.
posted by jdl at 8:34 AM on January 4, 2006

Sound advice above. These things are treatable, and it's good for you to not panic about them, but to deal with them frankly and openly, as just something to be understood and handled. Take her to see someone promptly, as panic attacks can start to ripple out, such that your daughter might start getting afraid that she *might* have a panic attack and thus decide to curtail her activities.

I'd suggest visiting her pediatrician first, then, assuming she's medically cleared, having a few visits with a reputable therapist who has experience with these things. Medications can be quite helpful, but I'd suggest not rushing into meds - see if some talk (or art or whatever) therapy can be helpful in identifying a cause and/or helping her find coping skills.
posted by jasper411 at 8:37 AM on January 4, 2006

Therapist: Me too. Helped our son a lot.
posted by Doohickie at 8:38 AM on January 4, 2006

I had severe panic attacks for years, and I still do but they are now manageable. Not going to a therapist was a bad idea, since the panic attacks did not just "go away", nor could I rationalize them away. Why is it that smart people often believe that they should be able to logic themselves out of something which has nothing to do with rational thinking?

instead of dealing with the panic attacks properly, I self medicated. In the course of years, this made the problem more acute. Finally, I went to a psychiatrist and stopped all the self-medicating. Now, I simply take heart medication when I feel an attack coming on. Stopping the physical "spiral" of panic is sufficient for me to stop the attack in its tracks. I am so much happier, as is everyone in my sober and calm life.
posted by Invoke at 8:39 AM on January 4, 2006

I have had panic attacks for the past 9 years. It sucks. It sucks real bad.

Take her for talk therapy and perhaps meds. Ideally the meds will be a short-term thing as she learns to manage her feelings and recognize triggers (for me, caffeine is as much of a trigger as stress is). Additionally, she should also add some more physical activity as she is doing the talk therapy & meds. Even something as simple as an evening walk with you/siblings/friends will help.

Good luck to your daughter and you.
posted by macadamiaranch at 8:41 AM on January 4, 2006

Miss T is right - the panic attacks won't go away by themselves (as a former sufferer, I thought that for a while, and they only got worse. Turns out they NEVER disappear by just being ignored.)

I had treatment for panicky feelings just over a year ago. I have had cognitive behavioural therapy combined with meds, and it works. Look it up online (and you'll see that meds combined with CBT have the best long-term recovery rate - meds alone don't tend to remove the problem completely, once treatment is completed.) CBT is a very focused, structured, short-term thing, which gets to the bottom of the automatic thoughts that bring on attacks. Logically, your daughter isn't scared of anything - she can tell you that herself. It's the automatic thoughts that she's not even aware of that cause the problem.

Please take her to get help right away - panic attacks, if left untreated, can turn into agoraphobia - which she definitely doesn't want.

Good luck - and remember that it's a hassle, but actually not that big a deal when caught early. It's relatively easily treatable, and CBT is very targeted - she's not going to be stuck "in therapy" for years talking about her feelings or whatever. This can be dealt with, and she can get on with a normal life.
posted by ask me please at 8:45 AM on January 4, 2006

A personal experience...

I got a string of panic attacks (similar to what you described: crying, shaking, feeling terrified for seemingly no reason) when I was at University, over the course of about six months. As it happened, I was going through something traumatic (being a subject in a documentary about a medical condition). When the process of making the documentary was over, the panic attacks went away.

For dealing with an actual attack, what helped me was sitting in a calm, safe place (my bedroom, with a friend) and taking giant breaths in and out, real slow. It's hard to maintain because you're scared, but if you do, it makes you feel a little light-headed and this sort of calms you. I kept taking the breaths until things seemed better. Also, letting someone else take control of what I was doing helped. e.g. "Why don't you come over here and look out of the window. Look at the trees, birds" etc.

What I found weird is that a trigger was usually a fairly tangible, obvious thing (a scary movie, or three cups of coffee) but in actual fact these things weren't the problem at all, but in fact the underlying issue made these things more unsettling than they really were.

When you look for the triggers and reason(s) for this happening to your daughter, discount nothing. It might be the smallest little thing.

I didn't go for counselling or take medication. I was close to doing the former, and am sure it would have helped. I've no experience with psychotropic medication, so I can't comment on that.

One final thing, actually. The hardest part for me was the constant low-level anxiety that I felt, rather than the panic spikes. I felt constantly uneasy. Your daughter might be getting this feeling, and I found that what helped was just losing myself in something: playing guitar, or a night with friends, or tidying my room etc.

Good luck. It sucks now, but it will get better for your daughter.
posted by pollystark at 8:50 AM on January 4, 2006

I had major depression as a child, first identified at the age of five, and it was awful, but the worst part was feeling that it was all my fault, and that I was somehow deficient for not being able to control my emotions. I would make absolutely sure that she understands that the causes of this are biological; expose her to as much research as you can, get her to a Doctor immediately, and accept the fact that medication may be your only option.

I suffered for years because my Mother didn't want me on any medication. Once I was emancipated, I went straight on the pills which made an immediate and drastic improvement, for example, pre-meds GPA: 1.5, post-meds GPA: 4.0.

We wasted a lot of time, and I still regret the fact that I was not able to get the treatment that I needed until I hit college. My life could have been totally better, and I bet you don't want your kid saying that.
posted by lilboo at 8:58 AM on January 4, 2006

Panic attacks can be linked to hormonal changes in her menstrual cycle, assuming she's menstruating, so that may be part of the equation.

I'd be happy to email you. My email is in my profile.
posted by lobakgo at 9:05 AM on January 4, 2006

This is all really good advice! I have been suffering from panic attacks for years and would like to add some things I only recently discovered:

I started working with a body worker who told me that I have the type of constitution which is very sensitive to my bodily states -- meaning, I can feel physiological changes more intensely than the average person. Over time, I have come to interpret those changes (a change in my heart rate, a tingling sensation in my extremities or palpitations) as precursors to a panic attack. It sounds like your daughter has a similar sensitivity to her emotional states. I agree that it is vital to recognize "triggers," so that they can be understood for what they are rather than signs of an impending attack. For example, if your daughter feels an emotion welling up, she can learn to feel her way through it rather than becoming anxious (I suspect) about the social ramifications of reacting to it in public.

In terms of relaxation techniques, breathing is vital. Specifically, breaths where the exhale is longer than the inhale, typically four counts inhale and six counts exhale. Physical exercise is also very important both for increasing a sense of physical well being and also for helping to reframe certain physical states (such as a racing heartbeat) as neutral or even positive rather than negative.

Finally, therapy is very very important. I would try just therapy first before resorting to drugs as your daughter is still young and we don't yet truly understand the physiological effects of antidepressants on a developing body. Naturally, the determination to prescribe would be up to you, her therapist and a psychiatrist. As for the orientation of the therapist, I think CBT as mentioned above, group therapy (which would be a supportive environment for her to meet other anxious teens) and short term psychoanalytic psychotherapy are all viable options.
posted by Some Day... Soon at 9:27 AM on January 4, 2006 [1 favorite]

I would not only recommend therapy (after ruling out medical causes), but cognitive-behavioral therapy in particular. With it, my panic attacks have gone from fairly often to fairly rare without any meds. And I know that I have the skills to counter them and not need to to rely on something outside me, which has helped reduce them further.
posted by dame at 9:30 AM on January 4, 2006

I went through similar to what your daughter did when I was about 16 or 17.

I had a sudden series of panic attacks (3 nights) and was rushed to the hospital by parents on the 3rd night - we didn't know they were panic attacks; they felt like I was going to die. After a full checkup, I was referred to a psychiatrist, and after an interview the diagnosis was panic-anxiety disorder and depression.

What made the difference for me was the surroundings I was in. Not just in terms of physical, but most importantly the people and the stimulation around me. The first year was absolute hell - some other things in my life were falling apart at the same time, people at school thought I was faking it for attention (including some of the administrators!), I lost touch with a best friend, I was lonely. That made me completely miserable because I had no one to lean on to. Also, school itself was tedious - it was exam time, but I couldn't be bothered with exams and I took a month off school before sitting for my papers. (I did decently.)

The following year went much better, and was pivotal to me being off medication during the end of the year. Now out of school, I took the year off and did all sorts of random stuff. Dance, journalism, radio, volunteering, travelling, whatever. It gave me something new to focus my energy on and I made new friends too. I got back in touch with the best friend I lost earlier, which helped a lot - she could relate to what I was going through and listened to me even when I was freaking out. I finally had something to be happy about, and that's what helped me get out of my hole.

I was given two pills: Xanax and Aurorix. Xanax calmed me down but it also left me unable to feel much emotion - I was pratically a zombie. Aurorix gave me a major headache, and after a while this was switched to Serzone, which worked better. (I didn't notice major changes myself, but my family said I had calmed down considerably) I hated medicine though, and after 2 years of medicine + counselling, whereby my dosage was being cut down towards the smallest possible amount, I stopped. It's been 2-3 years and I have not needed any medication.

I'm here for you if you need to talk, or if your daughter needs an email buddy. divabat @ gmail . com.
posted by divabat at 9:47 AM on January 4, 2006

I used to get them in choir.

What helped is having a prior agreement with the worship leader that if I started feeling one come on, I could go find a quiet room and calm down before it got too bad.

Let me say I do NOT believe your daughter is faking but you need to be careful that she does not start using these as an avoidance mechanism. Perhaps being able to take thirty minutes in a quiet room at school then returning to class instead of escaping to home?

And I also agree you need to have her see a doc. In my case I have other issues and if she has depression please please please have that treated.
posted by konolia at 10:00 AM on January 4, 2006

I had some serious panic and anxiety issues that began in high school, and reached a crippling peak just after college. I really wish I could get some of those years back. Fortunately, I'm just fine now thanks to Paxil, a drug which worked very well for me (now available in generic form, thankfully).

I've written about this a lot, both here on MeFi and on my personal site. Indeed, if you do a bit of searching you'll find piles of info to share with your daughter. While the details don't matter much, just knowing that she's not alone and that others have experienced what she's going through may be helpful. The turning point for me came when I realized that I wasn't insane, and that what I was dealing with was fairly common.

If medication is prescribed, be very careful with it. Some of the side effects haven't been communicated as well as they ought to be to doctors. This is especially true in the case of Paxil, which has some serious withdrawal symptoms and can cause suicidal feelings - especially in young people.

Following up on konolia's point: My anxiety got so bad that I was physically ill. Still, I (with some help from my parents) forced myself to go to work every day and tried to keep a regular schedule. Giving in to the anxiety and avoiding everyday activities made the symptoms worse. Insofar as possible, I think you should help her to keep as normal a schedule as possible. No missing school, etc.

As others have already offered (great to see this kind of support on MeFi), feel free to contact me via the email in my profile if you'd like to discuss this further.

Good luck to you and your daughter!
posted by aladfar at 10:16 AM on January 4, 2006

I find helpful interesting to write down what exactly I'm experiencing at the time, then flip the page over and pretty much lie -- start writing about doing something else that I'm not experiencing. Not merely "I am not having this problem" but something starkly untrue but at the same time, hideously boring (as not to evoke strong emotion).

What they feel like to me is that I either must (by some undeterminable purpose) repeatedly do a particular action, fail and must restart, while on a deadline, and faster each time; that I'm being manipulated in a surreal way -- once I it seemed convincing that I was a cabinet knob and someone was rolling me around in their fingers, which never made any sense; or that a particular subject incessantly deluges my mind that I can't think of anything but whatever the subject is, such as when I thought I could see microscopic details of everything in the room even from such a distance as across the way and the sensory input was an overload, and closing my eyes didn't seem to help. They're frustrating and scary at the same time, and I've only had probably 7 in my lifetime (I'm 28).
posted by vanoakenfold at 10:29 AM on January 4, 2006

My panic attacks are hormonal and come on at completely random times (relative to stressors), to the point that I thought I had a very mysterious food allergy until I was in my mid twenties. The misunderstanding served me well, though, because I deal with the attacks for what they are: a misfire of adrenaline that just needs to be managed for a few minutes and then it will pass, even though I may think I will actually die. If I have one in the car, I will pull over, but otherwise I focus on what I was doing when the attack started and try to push on through, or go sit somewhere quietly for a minute if I think I'm going to cry or make other startling noises.

However, these are pretty similar to what my blood sugar crises feel like, so you need to get her a full panel of bloodwork (thyroid issues can also cause similar episodes) and rule out physical causes.

CBT is great for learning how to manage an attack regardless of the cause, but I would hesitate to automatically assume an anxiety disorder in a girl in the throes of puberty.
posted by Lyn Never at 10:36 AM on January 4, 2006 [1 favorite]

I've had panic attacks caused by depression and anxiety, as well as panic attacks caused by medication: prozac in one case, asthma inhaler in another. She should see a doctor, and the doctor must be able to work with her to get any medications prescribed really accurately.

A cold wet washcloth on the face really helps me control a panic attack. It stimulates the mammalian dive reflex, and affects heart rate, or it's a really effective placebo.
posted by theora55 at 10:43 AM on January 4, 2006

I can't speak to eliminating them really - the only things that worked for me were a form of meditation - but as Theora55 notes, stimulating the dive reflex is a great way of treating them once they happen. Face first into the coldest water you can get into a sink/bowl also works very well, even better than the cold washcloth, and can sometimes stop them within seconds.
posted by luriete at 12:14 PM on January 4, 2006

I have to say that I've done the therapy/meds route and it DIDNT help me. I have social anxiety disorder, panic disorder and depression. I was on zoloft for a while (no noticeable change after a year), and then on paxil (no change, but my body became addicted to it - if I didn't take it on time every day, i'd vomit/dry heave). After almost 3 years on meds, I said "eff this" and got off of them.

I have found that the best therapy for me, without a damn doubt, is my online journal. I first started blogging as a suggestion from my therapist - remarkably, that's the only bit of sound advice I got from the woman. For the most part, my journal is a bunch of nonsense... but when I'm having a panic attack, I've found that focusing on what I'm typing helps me tremendously.

I also have a Pookie that helps me out. He usually goes everywhere with me (stashed in my backpack for obvious reasons), but I've trained myself to think that if he's with me, I'll be ok. It sounds crazy, but it's seriously the only reason why I haven't gone insane yet. Since your daughter is still in school, I'd suggest something small but has a lot of meaning. An exboyfriend of mine would carry his rosary on him at all times, and he rarely had an attack. It doesn't matter what the object is, as long as your daughter can focus on it and take herself out of the situation.
posted by damnjezebel at 12:21 PM on January 4, 2006

When I sought therapy for anxiety/depression, the therapist recommended regular exercise as an alternative to medication. It was nothing short of magical in its effect. Why not try this with your daughter? It may make an enormous difference in her anxiety. Then again, it may not directly affect her anxiety, but she will have improved physical and mental health in other areas -- and that may better enable her to handle her pursuit of a solution.
posted by Miko at 1:36 PM on January 4, 2006

I had a bunch a few years back, over the course of a few months. My cousin gave me a few books and - I know this sounds strange, but - in the midst of a panic attack (my last, incidentally), simply sat there and very calmly said "It's ok. You're not going to die, and you're not going to be hurt. See? You're alright." Sounds sort of simplistic, I'm sure. But it totally calmed me down, and I've never had one since.

Turns out she got it from a book which basically explained that it's (obviously?) related to "fight or flight," but when there's nothing to fight or flee from, you just sit there, totally suffering. Hearing that you'll be ok sort of calms that reaction. That being said, YMMV. I don't recall the title, and a quick call to her just now reveals that she doesn't either, and sold the book at a garage sale.

Also, definitely talk therapy. I personally think kids are wicked over-medicated these days, but never underestimate the power of just talking.
posted by nevercalm at 2:04 PM on January 4, 2006

Turns out she got it from a book which basically explained that it's (obviously?) related to "fight or flight," but when there's nothing to fight or flee from, you just sit there, totally suffering.

That was my understanding of it too, nevercalm - it's some hiccup caused by the fact that the body still thinks that there are sabre-toothed tigers around, even when the mind knows logically that there aren't. Um, I'm not being too scientific, am I? But basically, I wanted to reiterate my earlier point that this is a very, very common problem (as we can see by the number of MeFites with experience of it) and that effective help is available. Good luck!
posted by ask me please at 2:29 PM on January 4, 2006

Seconding The Anxiety & Phobia Workbook. Would also recommend that you make sure she realizes that this is not an uncommon problem, as she may be feeling a bit freakish or mad at herself about this.
posted by WCityMike at 3:02 PM on January 4, 2006

I would hestitate to pick up any advice about medicating a preteen from the internet. I've suffered from General Anxiety Disorder/depression since I was in elementary school and I am very thankful for my meds, but I would not have chosen them as a first line of defense for this.

Meds affect children differently than they affect adults. My understanding is that there are few, if any, controlled studies about the effects of certain meds on children. This is from literature produced by the NIMH:

Based on clinical experience and medication knowledge, a physician may prescribe to young children a medication that has been approved by the FDA for use in adults or older children. This use of the medication is called "off-label." Most medications prescribed for childhood mental disorders, including many of the newer medications that are proving helpful, are prescribed off-label because only a few of them have been systematically studied for safety and efficacy in children. Medications that have not undergone such testing are dispensed with the statement that "safety and efficacy have not been established in pediatric patients." The FDA has been urging that products be appropriately studied in children and has offered incentives to drug manufacturers to carry out such testing. The National Institutes of Health and the FDA are examining the issue of medication research in children and are developing new research approaches.

Just be careful, go slow, be willing to seek out second opinions. Everyone is different in what will help them to combat anxiety and everyone may have different triggers. Years later, I found out that thyroid issues and sleep apnea were contributing factors to my depression/ anxiety. Exercise, especially yoga, helped. As did talk therapy and such. But, most importantly, I think if my parents had listened to me and had taken my symptoms seriously (instead of acting put out and annoyed), I think I would have been much better off from the beginning. The fact that you are expressing support to your child is a wonderful thing.
posted by jeanmari at 3:32 PM on January 4, 2006

I've been having panic attacks since I started menstruation. I did the therapy route and the antidepressant route, but therapy didn't do much good, because it was biological, and the antidepressants made me full-blown psychotic. (Scary, omfg psychotic...bad juju for me. Brain chemistry is different for everyone, I think.)

The only thing that has ever worked for me is xanax. Teeny, tiny amounts of it though. My prescription is for the little 1 mg blue ones. If I feel an attack coming on, I take half of one under my tongue until it disappears, and 90% of the time, it' stops the attack from happening. If it doesn't, I can usually take the other half and it'll stop before I become incapacitated. Only rarely have I had to use more than one pill.

I think they have an even smaller dosage than the 1mg too, so they could adjust it by body weight, since I'm sure I outweigh your daughter.

Best of luck to her and you. For people who've never had panic attacks, it's probably impossible to understand how debilitating they can be. The total loss of control over the symptoms is the hardest part. It's like being betrayed by your mind. Sufferers often talk about how they feel "weak" because we can't stop the attacks, and we feel like we should be able to control it. Thus, a depression cycle can start because if we can't control our mind...what can we control...sort of thinking.

Good for you for helping your daughter find a solution. I wish you both the best.
posted by dejah420 at 7:48 AM on January 5, 2006