What do people with ADHD take for panic attacks?

February 16, 2024 5:08 AM

If you take stimulant meds, like Adderall, what do you do if you get a panic attack?

Previously, I had a tiny Xanax prescription (0.25 mg) for the occasional acute panic attack--this goes back decades, and my ADHD diagnosis is relatively recent. So the panic attacks are not caused by stimulant meds; it's just a lifelong thing that my brain likes to do every now and then with no warning.

That tiny Xanax worked great and I never needed to seek additional help or add more meds to the pile. I loved how reliable and straightforward it was: when I'd start to feel the tunnel vision, etc., just take a quick 0.25 and go about my day. This was at most twice per month. No dependency and well below the threshold (I think?) for increased Alzheimers risk.

My new psych doctor, however, says it's illegal for her to prescribe both an ADHD med and any benzodiazepines--that I have to choose one. So I've currently got my ADHD meds and a boatload of other pills to take for anxiety...but none of them works as well as Xanax, and I don't need anti-anxiety help every day anyhow. And I'm skeptical that a blend of four different medications is more beneficial than just one that I know works very well and use sparingly.

I'm well aware of all lifestyle modifications that reduce anxiety, so please no advice to do breath work and limit caffeine & alcohol and take magnesium. I already do those things. I'm just curious about how others manage with ADHD and occasional flare-up of acute anxiety/panic disorder.

posted by anonymous to Health & Fitness (8 answers total)

If you live in the United States, then your doctor is wrong or lying to you about prescribing both being illegal, and you should find a new doctor.
posted by Theiform at 5:33 AM on February 16

Yeah I'd clarify (probably via your own research) whether your doctor meant "illegal" or "against the policies of this practice" because the latter is super common and I've never heard of the former. (My wife has no difficulty getting her psych to prescribe both Adderall and Ativan, in MA.)
posted by restless_nomad at 6:04 AM on February 16

I take lorazepam when dealing with an acute panic attack. But, if I did not have access to that, I would take a clonidine (which is originally a bp med, it has sedative effects, and I was prescribed it for ADHD) or I would speak to my doctors about taking an as-needed beta blocker blood pressure med. These, in my experience, stop the physical panic symptoms.
posted by fourpotatoes at 6:27 AM on February 16

Yeah I think illegal is the wrong word in this context. I know in the past that when I started ADHD meds I had to discontinue sleep aids I had been prescribed because the doctor stated that their system didn't allow them to give uppers and downers to a patient simultaneously.
posted by Ferreous at 6:35 AM on February 16

Hydroxyzine is an antihistamine and it makes the worst parts of my panic attacks more manageable.
posted by Acari at 7:08 AM on February 16

Illegal is probably an oversimplification, however, sometimes, there can be some severe consequences for prescribing these meds together!!!

Some pharmacies will flag doctors and patients who provide stimulants and diazepine to the same patient. Bonus points of an opiate is included too. The pharmacy can then (lifetime) ban/refuse to fill scripts in [any/all] of those categories for a particular patient or doctor. (ask me how I know!)

The patient and/or doctor might also be added to certain databases related to drug abuse and over prescribing, which can impact additional pharmacy bans and etc. Or... Nothing happens, and a patient can be on that combination of medicines for years...

knowing the risks... You might be able to get your PCP to prescribe you a small dose, like take 1 every four hours for the next 3 days... OR ask if your psychiatrist can do something like that.

When I took Adderall, as a female, I found that the dose effectiveness varied during my cycle, and my doctor worked with me to manage the dosage within it. So, a slightly higher or lower does, also impacted/reduced my anxiety levels.

I'm on Concerta now, which works differently for me, and while less effective, feels more organic. I sort of just shrug off the occasional panic attack or anxiety, as a normal part of life, and do extra soothing to stave off before or calm down after one hits, So I don't get anxious over anxiety... BUT would absolutely advocate for an occasional pill, if managing anxiety felt unmanageable...& I have that kind of relationship with my doctors.

If it's a new psychiatrist, You could track the times that you wish you had it and bring it up at your next couple appointments and just keep asking them what your options are for the tough moments?
posted by bindr at 8:59 AM on February 16

Unfortunately, I'm finding that it's about impossible to get a benzo prescription these days and I'm not even on any ADHD meds. I used to take Klonopin at very rare intervals and although I presented my doctor with a two year old bottle of 19 pills from an original 30 pill prescription to prove I was not an addict, they will not renew it. I can't even get Xanax in July for my panicky, miserable, fireworks fearing dog. And nothing works quite the same for him or for me.

That said, I have tried the following:

Hydroxyzine - did absolutely nothing for me, but it works for some people

Buspirone - it took a while: the first few times I took it, nothing - but now it actually helps a bit. Mostly it makes me very sleepy, so I just go to bed.

Beta blockers: were actively bad. This was a while back so I don't remember the specifics, I just remember the "never do this again" feeling.

Lexapro: This is prescribed for combination depression and anxiety. I took it for years then decided I wanted to stop. I did notice an uptick in panic attacks when I stopped but they eventually slowed back down. So it is at least somewhat effective but it certainly is not a magic bullet.

EMDR - this is learning a series of eye movements that can stop a panic attack in its tracks. Seems too woo to work but I have actually found that it does! Not as well as benzos, but, at least it's free and always available.

Getting up and walking around, drinking water, cursing your fate, reminding yourself that nobody has 8 heart attacks a month for 30 years so this probably isn't actually a heart attack - yeah, well, you already know about these.

Good luck!
posted by mygothlaundry at 1:45 PM on February 16

I take metropolol (a beta blocker) and it works well for me if I notice the symptoms early enough. I also have heart palpitations that are sometimes made worse by my adhd meds and it helps with that too.

My adult brother started taking Quelbree (an SNRI used to treat ADHD) and said it has helped him a lot. I am looking to try that as an alternative to stimulants, which may be another option for you to discuss w your doc.

Good luck! Panic attacks suck. I have a friend who occasionally gives me a couple [REDACTED]s that I keep on hand for emergencies but rarely need them.
posted by a.steele at 12:23 AM on February 19