Seizure or Panic Attack?

August 31, 2007 12:08 PM

A few days ago my roommate collapsed in our hallway. Did she have a seizure?

My roommate has a history of anxiety, phobias, and ADD type problems. She is prescribed aderall which, as she explains, keeps her from napping 4+ hours per day (above and beyond her normal night time sleep)..

She also self-medicates with marijuana to a large extent, without which she can be fairly grouchy and sleepy.

None of this is my business other than the fact that I live with her and should be aware of any health issues that I might directly deal with - what she does on her time is her own choices.

That being said, on more than one occasion she has had hot flashes directly after smoking, to the point of whining and complaining heavily about how hot it is, and sometimes rushing off to tear her clothes off. She thinks this is a panic attack, and claims that it always happens when her brain has convinced her that something is physically wrong with her and she might be dying.

The latest episode was caused by a bruise on her finger, which had a slight throb to it (as bruises sometimes do). The fact that her finger was black and blue, combined with the throbbing led her to believe that there was a blood clot in her finger that was going to travel to her brain and kill her. She admits that, while this is happening, a part of her brain is fully aware that she is just freaking out and that she is fine.. but that part clearly isn't in control.

I don't know if she hyperventilated (she has never appeared to be breathing differently than normal) or what, but she fell down in the hallway heading to her bedroom. I went to see what happened, and she was on the floor twitching in a very seizure-like way, with limbs and head flopping around. Within 5 or 10 seconds she came out of it, sat up, and looked confused about what happened. I tried to get her to sit still, stay off her feet, and breath but she was out of control and she got up and rushed to the couch, where she did a face-plant into the cushions. This time she lay face down for 5 to 10 seconds, but with no twitching at all. When she rolled over and looked at me she, again, had clearly been "out" for that 5 or 10 seconds, because she didn't remember it.. when I turned around to get her a glass of water she rushed off to her room again, likely to remove some clothes. This is when I heard a second loud bang and thought she fell in the bathtub. Luckily she had only fallen inbetween her dresser and bed but she hit something along the way with her chin and split it open pretty good. I didn't say anything to her right away (if it was a panic attack, the last thing she needed was to be told her chin had a big bloody hole in it). I let her calm down for 10 minutes, during which time she was lucid and there was no more odd pass-outs, nor the frantic running-around the house type behaviour. I finally pointed out the cut and told he she might look at it in the mirror and consider going for stitches, which she did do.

For someone who is so panicked, she seemed very non-plussed with the whole affair after the fact. The emergency room doctor agreed that it was likely a panic attack but maybe because that is how she described it. I clearly told her that she was on the floor twitching but I don't know if she told the doctor that.

End of the day: anyone have anecdotal evidence that would suggest that this could have been a simple panic attack, or vice-versa?

posted by anonymous to health & fitness (21 comments total)

It sounds like histrionics to me. Not really consistent with seizure, nor with straight up panic attack. Sounds like she needs to check in with her psychiatrist, and possible see a neurologist, if seizure is at all a concern.

But, my gut instinct after reading your narrative is that she is exaggerating, over-reacting to stimuli, etc, in short, histrionic.

Also, I wouldn't say marijuana is the treatment of choice all things considered. Weed often causes or exacerbates anxiety, which it sounds like she has in spades.

Good luck.
posted by pammo at 12:25 PM on August 31, 2007

If you google "panic attack seizure" it appears that it is pretty easy to confuse the two and perhaps electrical tests are the only way to tell the difference.

Here is one article: link

I would stress though that either outcome is a big deal, most panic attacks don't present so strongly, she needs to be under the care of a physician that can help her with her myriad of problems. It sounds like she could really hurt herself in one of these episodes.
posted by stormygrey at 12:26 PM on August 31, 2007

There is enough correlation with the dissociative properties of marijuana and the dissociative moment as the inception of panic to believe this is a possibility. I have higher incidence of panic attacks as a result of pot, though interestingly, not while I'm high. I never had them at all until I got heavy into weed. I don't blame the weed, but I do consider this anecdotal evidence.

Her doctors need to know she smokes as much as she does. She might be benfitted from a different medication, or maybe even alternated administrations of THC.
posted by Ambrosia Voyeur at 12:28 PM on August 31, 2007

Fainting isn't always a demure swoon; twitching isn't unheard of, especially if it's more of a brownout.
posted by Lyn Never at 12:32 PM on August 31, 2007

i'll go with panic attack. sometimes they cause hyperventilation and heart palpitations. she may have fainted.
posted by thinkingwoman at 12:37 PM on August 31, 2007

We can all speculate but she'd be better to find a cool doc and confess everything pertinent. I don't know but it is perfectly possible that the pot and the adderall are reacting to one another. Not to mention she may be dabbling in other things she hasn't bothered to mention to you.

(And pot definitely can bring on paranoia. Back in the days I was a pot smoker, I experienced it. In fact, it is one of the reasons I gave up weed to begin with, even before I became a Christian.)
posted by konolia at 12:42 PM on August 31, 2007

Depending on your biological disposition fainting can be quite easily accomplished after sitting down for even short periods of time and getting up with immediacy. If you combine that with cannabis consumption you can be very apt to collapse at the wrong moment, but to be honest this string of falls don't sound like anything I've experienced in that realm.

Personally I don't understand the logic of having ADD and consuming cannabis as the two are frequently at odds with each other, especially if she is already taking Aderall.

It sounds like her lucid hysterical moments are standard panic attacks, although the way you describe them seem indicative of reactions most noted in novice cannabis consumers - "geeking out" - "the world is crushing me", responses of that nature.
posted by prostyle at 12:46 PM on August 31, 2007

Happened to me once, though it was something considerably more than a bruised finger. I'd never had a panic attack before so I didn't have a little voice telling me that's all it was. My head was exploding with white-pain and I did a fair bit of thrashing about, some involuntary and some voluntary (in the way that you shake your fists in the air when you stub your toe or bite your tongue). Didn't black out entirely. Luckily there was a doctor within shouting distance who said the same thing: panic attack + hyperventilation.

Ditto that your friend needs to quit the pot. My observations suggest that for people with mood swings and anxiety problems habitual use just makes them worse over the long run, however effective it might be for the moment.
posted by Martin E. at 12:50 PM on August 31, 2007

Fainting isn't always a demure swoon; twitching isn't unheard of

Ah, should have previewed. This is very true. I've seen countless people faint after an IV needle or injection. They almost always start by saying they feel weird or nauseated, then that they can't hear very well and they're seeing spots. They then turn pale or green, start to twitch to a greater or lesser degree and THEN go limp.
posted by Martin E. at 12:57 PM on August 31, 2007

This sounds like Vasovagal Syncope, a condition that I'm prone to. The most common trigger for me is intense pain or lots of blood. Others have reported mild seizure-like behavior while I'm out and I have observed this behavior in others experiencing this condition.

Marijuana and Adderall are both substances that can contribute to anxiety. This girl seriously needs to detox.
posted by Manjusri at 1:10 PM on August 31, 2007

More important than internet diagnosing your friend: what are you going to do about it? Are you going to be her babysitter while you are living together? Are you going to feel terrible when the time comes for you to eventually move out and she's become dependent on your support? I'm just trying to think about all the askme posts regarding crazy roommates.

Chances are, this girl will wait until the end of time to see/tell a doctor (I have anxiety, I can relate). I also have ADD, and I take a medication for each to balance each other out. Adderall can increase anxiety dramatically. The weed is not helping her, but what can you do? I'm pretty sure that you cannot force your roommate to quit. Personally, if she doesn't decide to fix this problem in the immediate future, you should be looking for a new place to live.
posted by nursegracer at 1:14 PM on August 31, 2007

This situation reminds me greatly of that of a friend of mine, who had all sorts of problems with ADD, epilepsy, phobias, pyschosis, insomnia and lots of various prescription drugs, including adderall. Your description of your roommate sounds a lot like my friend.

I say "had" because, at the age of 25, she either committed suicide, died of an accidental overdose or was murdered by her boyfriend (who also overdosed but survived) after apparently being completely clean for about 6 months.

I think that your roommate needs to talk to an addiction medicine specialist and receive appropriate mental health care. LISTENING TO YAHOOS ON METAFILTER ABOUT REAL MEDICAL PROBLEMS AND GIVING ADVICE TO YOUR ROOMMATE BASED ON IT IS WORSE THAN DOING NOTHING AT ALL FOR HER. Adderall, in particular, has a very high rate of abuse even among those who have a legitimate need for it. If her use of it is at the point where she needs to use it in order to not nap all day, something serious is going on. At the very least, it is a good idea for her to get a second opinion and talk to a doctor other than her primary care physician. Many initial prescribers of adderall are afraid to stop prescribing it because the patient becomes so dependent on it, so they keep increasing the dosage. I will let appropriately qualified professionals comment if they so desire, but my understanding is that there are a lot of neurological things that she could have going on that may have a lot to do with her drug use and mental health.
posted by iknowizbirfmark at 1:43 PM on August 31, 2007

iknowizbirfmark, I understand your suggestions about what the roommate should do, but what are you suggesting the OP do about it, if anything?
posted by small_ruminant at 1:49 PM on August 31, 2007

I am suggesting that the OP try to impress upon her roommate the need to get appropriate medical care from the right kind of professional. It doesn't sound like the roommate has really gotten that yet.

I don't necessarily have any suggestions on how to do that, since we don't have that much information. If the drug use is abusive, then maybe an intervention, if they are very close and the roommate's friends and family feel the same way. If not, it might just be a good idea to encourage the roommate to get a second opinion from another doctor, perhaps some sort of specialist who would be more able to address neurological issues than would an emergent medicine specialist.

In the long run, though, you can't help people with phobias, anxiety and drug problems unless they want to be helped, so I guess that the biggest hurdle is convincing the roommate to get some real help.
posted by iknowizbirfmark at 1:59 PM on August 31, 2007

Look, Adderall and marijuana used in conjunction do not cause this. There literally has to be millions of college-age kids and older who do both every day and this is a very abnormal response. Whether she was doing this for dramatics (see below) or not, you won't ever know, but chances are it was a simple anxiety attack perhaps exacerbated by the Adderall and marijuana. I've seen this happen with friends who were on either (well not really with the marijuana) and who were stone cold sober. Stressful times in college, among strangers, can cause some strange reactions.

That said, and this is entirely anecdotal, but I was friends with a few sorority co-eds a long time ago. It was test time so the amphetamines were flowing, none of them being abused per se, but I doubted most of them needed amphetamines to study. A few wanted to smoke to "take the edge off" and completely flipped out. One even went to the emergency room.

I don't think it was fake, as in completely acted out, I do think it had a lot do with attention seeking and dramatics reinforcing itself. Some people really can't handle even the most benign drugs. I think a lot of it had to do with her being very, very anxiety prone and I can't imagine the internal feedback about initially losing control with the marijuana and the speediness of the amphetamines. If she's not in a good place before getting high, she shouldn't get high. Very few drugs "take you there", and they are all incredibly addictive, which is probably why they are addictive. Marijuana has a very short to non-existent list of serious side effects. Most people have a fine time with it, but some people just don't have what it takes. If she's consistently "freak out" over smoking you guys may need to tell her she should cut back. Perhaps ask her if anything is stressful in her life?

It should be fairly easy to see if there's a paticular stressor she's like to get off her chest that's been bothering her, if she's merely anxiety proned, or if it is some sort of combination and she sort of likes the attention.

I hate to conclude on this note, but for the aforementioned sorority amphetamine/marijuana blowout the trip the emergency room seemed to make it more real in their minds. That something did happen to them, it was not their control, and it was very serious. If I had an event like you described above, the first thing I would be to detox for a while to make sure the drugs themselves aren't causing this.

Of course you know your roommate better than us. We're all coming here with our biases. If this becomes or is a common event, I would look at getting a new roommate.
posted by geoff. at 2:04 PM on August 31, 2007

iknowizbirfmark, the poster asked for anecdotal evidence for what their roomie experienced, not for what advice they should offer. I think they're just trying to get some better ideas on what might have happened, not how to solve their roommates problems.
posted by oneirodynia at 2:08 PM on August 31, 2007

I am suggesting that the OP try to impress upon her roommate the need to get appropriate medical care from the right kind of professional. It doesn't sound like the roommate has really gotten that yet.

The question is not "should I try and get my roommate to see a doctor or not?" People are doing a pretty good job of answering the question that's been asked.
posted by oneirodynia at 2:11 PM on August 31, 2007

I must clarify before I get pounced on: I am less inclined to believe that drugs caused this and more inclined to believe that her personality or state of mind at the time caused this (people faint for a thousand reasons). Adderall and marijuana are probably the most socially acceptable or easily available drugs for the 18-25 set. As a result of this I have seen them used to create attention to oneself without being branded a "drug users", complete with scare quotes.

Not that one cannot get addicted to the combination of Adderall and marijuana, they certainly can, but in my limited experience those addicted to amphetamines seem to possess certain characteristics which I didn't see in the Op's story. Not that these two sets of characteristics are mutually exclusive, just that this is the Internet and saying "I don't know" isn't as fun.
posted by geoff. at 2:23 PM on August 31, 2007

As to what to do about it, my family's sensitive approach to these sorts of things is to passive aggressively ridicule someone into getting help.

example: Hey Joan, don't take off yet- Aly's about to toke up. If you wait a few we can watch her have one of her I'm-too-cool-for-medical-help seizures!"

ymmv but hey, it works for us. Or, you at least know better than to indulge where anyone can see you.
posted by small_ruminant at 4:31 PM on August 31, 2007

The term "seizure" covers many, many forms of abnormal electrical activity in the brain, and sometimes these can be caused by bad reactions to different drugs- and, quite possibly, aggravated or triggered by emotional trauma. Your roommate may have an undiagnosed seizure disorder. She may have had a seizure and a panic attack, or a seizure set off by a panic attack, or maybe even a seizure set off by the combustion of Aderall and pot. I don't have epilepsy, but I did have a series of seizures that took the form you describe here- a sudden loss of consciousness as if I had fainted, and no memory of what had happened upon coming to. It sounds like she needs a thorough evaluation from a more knowledgable shrink than the one I imagine she's seeing now, and an evaluation by a neurologist.

I should probably add here that I do not want to suggest that it is somehow your job to get her to do either of these things.
posted by foxy_hedgehog at 7:36 PM on August 31, 2007

I'm sorry, I meant to type this five minutes ago, but I couldn't stop laughing. I got to the "second loud bang" and was pretty much in hysterics. Seriously, tape that shit next time.

OK, now to answer the question - yes, I have witnessed a seizure directly following a pot smoking session. It only lasted a few seconds, and was an isolated incident - that is, it didn't occur again anytime in the following two years.

Ambulance and doctor both said there were several possible causes, some serious, some not. If it occurs again, further tests and/or medical opinions might be warranted for your roommate.
posted by Liosliath at 10:30 PM on August 31, 2007