Preventing panic attacks on an airplane flight?
April 23, 2009 8:39 PM   Subscribe

What else can I do to help prevent a panic attack on an airplane?

I'm flying next month for the first time in almost five years. I have flown four times before, and I never had a problem with panic. Hell, I enjoyed it. I love planes.

But in 2006 and 2007 I had panic attacks on trains and buses. It's not the mode of transportation that bothered me, it was being crowded into a confined space with lots of people, which would be the same on a plane.

The last couple months I've decreased my caffeine intake dramatically (which seemed to make the panic worse), been able to be in crowded situations (like meetings at work) without panic, and started meditating 10 minutes a day in the morning.

But I'll be going from the west coast to the east coast, so it's not a short hop. It'd really suck to have a freak out when I'm stuck on a plane for hours.

Anyway, does anyone here who flies regularly and deals with anxiety have any tips?

Two things I already did: 1) I requested an aisle seat, so I can get up easily and not feel "trapped"; 2) I have been watching videos on YouTube of planes landing and taking off, from the perspective of passengers.

posted by wastelands to Health & Fitness (24 answers total) 6 users marked this as a favorite
Just call your doctor and ask if you can have a prescription for four xanax - two for each direction. You will not become a bowl of jello, you will not become a xanax addict, you will not have a panic attack on the plane.

This is a very common request, especially for flights, and your doctor should have no problem with it.
posted by DarlingBri at 8:47 PM on April 23, 2009 [4 favorites]

Seconding the xanax. My mom did this on her first flight (when we all took a trip across the Atlantic!). She did great and felt confident enough to not even take any on the way back. I think just know that they were available if she needed them helped her a lot.
posted by chiababe at 8:50 PM on April 23, 2009

Personally I deal with similar feelings with a couple of OTC sleeping pills (or Benadryl pills) perhaps half an hour before takeoff. I know this may not be the wisest solution but I must say that they really do give me just enough of a relaxed feeling to help me steer my thoughts away from topics that I know will cause panic (a drink or two at the airport bar beforehand seems to have the same effect for me but I would recommend that even LESS). Even so, I suppose these are last-ditch approaches that could be of help to you? I look forward to seeing what alternative approaches folks have to offer ...
posted by DingoMutt at 8:53 PM on April 23, 2009

Response by poster: Hmm, interesting idea re: Xanax. I was thinking of taking melatonin to try to sleep, or at least mellow me out.
posted by wastelands at 8:54 PM on April 23, 2009

When I'm feeling at my absolute worst, I take 250mg of niacin and, about ten minutes later, wonder why I was ever freaking out in the first place. Here's why:

Niacin is known as a natural tranquilizer. In a study on rats, niacin had similar effects to valium on the turnover of serotonin, noradrenalin, dopamine, and GABA in the areas of the brain that are thought to be affected by anxiety—without being addictive. Some experts go so far as to call niacin "Nature's Valium." Niacin also helps decrease excess lactic acid levels and episodes of low blood sugar/hypoglycemia (from adrenal fatigue).

The textbook description of anxiety neurosis exactly matches the symptoms of vitamin B3 (niacin) deficiency: hyperactivity, depression, fatigue, apprehension, headache, and insomnia. It has been shown in animals to work in the brain in ways similar to drugs such as benzodiazepines (Valium-type drugs) that are used to treat anxiety. One study found that niacinamide (not niacin) could help people get through withdrawal from benzodiazepines, which is a common problem. A reasonable amount of niacinamide to take for anxiety, according to some doctors, is up to 500mg four times per day.

Niacinamide locks onto the same receptor sites in the brain as do tranquilizers such as Valium, and is a natural tranquilizer. The manufacturer of valium is also the worlds largest manufacturer of niacinamide. [Nature 278: pp.563-5,1979]

Vitamins are good, good stuff.
posted by aquafortis at 8:59 PM on April 23, 2009 [4 favorites]

+1 for asking your dr. about Xanax. It definitely helps take the edge off. Depending on the dose, it will likely make you sleepy.
posted by Nolechick11 at 9:02 PM on April 23, 2009

Another recommendation for Xanax. I like to have a few glasses of wine as well. But that is not something a doctor would recommend.

If you are going to take something on the plane, please try it at home first. The last thing you want is a bad reaction to a medication on the plane.
posted by cjets at 9:28 PM on April 23, 2009

aquafortis, an admittedly cursory pubmed search (terms 'nicotinamine anxiety' and 'nictotinamide gaba') reveals no clinically applicable information about use of nicotinamine as an anti-anxiety treatment. While there are some very old animal and in vitro studies which suggest it functions as a modulator of the GABAa receptor and may be anxiolytic these are not generalizable to human use. Moreover, these studies indicate a distinct mechanism of action at the GABA receptor from the benzodiazepines.

I would also take issue with your equation of pellagra (b3 deficiency) with anxiety disorders-- pellagra involves a constellation of symptoms that go far beyond mood disturbance.

Vitamins are indeed good things, as the nasty consequences of b3 deficiency attest, and I don't want to counter your well-intentioned advice, but clinical evidence for an effective anxiolytic effect of b3 is pretty slim on the ground, though feel free to point out the applicable studies. Especially considering the short duration of use, the OP will likely be far better served with a benzodiazepine, as many others have suggested in this thread.
posted by monocyte at 9:30 PM on April 23, 2009 [2 favorites]

My experience with niacin was that my skin flushed and I felt like I was going to pass out if I took it on too empty a stomach or without enough water. I do not recommend it.

xanax or the equivalent [I sometimes take lorazepam] is great. You can get it just for flights, you stay totally with it, just not stressed out and not panicky. It's great and doctors are usually okay prescribing it for just this thing.

While I think deep breathing and all the stuff you are doing is also useful, if you're really worried about "oh shit I have to get out of here!" panic as opposed to just being nervous, I'd try the xanax as well. Just don't drink on the flight because it often magnifies the effects of alcohol.
posted by jessamyn at 9:51 PM on April 23, 2009 [1 favorite]

If the panic attacks you get produce tingling in hands and feet, or, like mine used to, make your throat go numb, you're hyperventilating and getting too much oxygen in your blood. Easiest way to fix is to breathe in and out of a paper lunch bag. Not elegant looking, but, since you're inhaling some of the the CO2 you've exhaled, it will bring your body back into balance. Sucrose tablets or sesame seed bars/candy are also good if you get the instant hunger than sometimes accompanies a panic attack.

If you've never taken Xanax or other things to relax you, I'd ask your doctor for one to test first so you'll know how your body reacts. One less thing to worry about on the plane. And, good for you in tackling this head on.
posted by x46 at 10:51 PM on April 23, 2009

Response by poster: x46, naw, mine is racing heartbeat, feels like my heart is going to explode in my chest. But, yeah, I think hunger is correlated with it. I'd often get them in the evenings when I hadn't eaten since lunch at work.

I've taken Klopopin before, and a shitload of different anti-depressants so I'm not too worried about body chemistry.

I'll probably just go the melatonin route, and have my lappy with movies/games and noise-reducing silicon earphones to distract me.
posted by wastelands at 10:56 PM on April 23, 2009

Yeah, the most reliable short-term solution is medication. But for long-term you should explore some sort of cognitive therapy.
posted by randomstriker at 11:10 PM on April 23, 2009

Response by poster: randomstriker, I essentially did that on my own. I forced myself to stay on crowded trains and endure the panic, keeping rational thoughts in my mind. Same thing I did when I was younger and dealing with OCD bullshit: just tell myself I didn't have to give in to compulsions, and resist doing so. It works.
posted by wastelands at 11:28 PM on April 23, 2009

I find a giant rubber band to be immensely helpful when it comes to panic attacks. Keep a thick rubber band around your writ. When you feel an attack coming on, snap it as hard as you can. The sudden, sharp pain will knock your focus off the panic attack. Repeat as necessary.

On my second-to-last flight (this was my first flight in 8 years), I had the benefit of Ativan to help me through, but I used the rubber band trick in the taxi on the way to the airport. The return flight was a different matter. I had packed my meds in my luggage, and we were running late, so I had to go through the flight Ativan-free. The rubber band saved me (and made me realize that I don't need meds to fly).
posted by zerokey at 6:01 AM on April 24, 2009

Think about the triggers when you were on the bus or train- are those the same triggers you'd get on a plane? I'm not a huge sufferer of panic attacks, but when I've had them, it was because I wanted to leave and couldn't. Too many people in my way. Or, like on a bus, you *could* get the driver to stop, but the anxiety of that adds to the anxiety of wanting to be off. But on a plane, getting the driver to stop and let you off just isn't an option. So you don't even have to worry about considering that. Plus, you love planes! Flying is (as Cartman would say) hella sweet. Focus on the exilleration of the flying.
posted by gjc at 6:01 AM on April 24, 2009

Xanax, for sure. I have also found this book to be very helpful: Don't Panic, by Reid Wilson. He helps you react to your panic in a rational way. It's very calming. I review his book whenever I am getting ready to take a flight. He also has a series of cassette tapes on how to be calm when flying, but it's a little hard to come by.
posted by bristolcat at 7:20 AM on April 24, 2009

IANAHCP (health care professional) If you're having panic attacks, xanax is a great tool to keep on hand. During an attack, put 1 under your tongue for fastest absorption. I've gotten relief from 1/4 tablet, but I seem to have a peculiar metabolism. A cold, wet washcloth on the face also helps a panic attack; it's a physiological effect, not psychological.

Ask your doctor to check your meds; prozac gave me panic attacks, and some asthma meds caused panic attacks and more. Good luck.
posted by theora55 at 7:43 AM on April 24, 2009

Nthing Xanax. This is what I do when I fly.
posted by at 9:50 AM on April 24, 2009

I essentially did that [cognitive therapy] on my own.

Doing it on your own isn't always as effective as getting professional, qualified help. Give it a try.

A cold, wet washcloth on the face also helps a panic attack; it's a physiological effect, not psychological.

Indeed! It's called the mammalian diving reflex.
posted by randomstriker at 11:35 AM on April 24, 2009

I am a very scared flyer, and it is definitely the claustrophobia aspect that makes it bad for me. I agree with the xanax suggestion, but there have been times where I needed to be very sharp and alert upon arrival and xanax would have been counter-productive for that.

I have found that taking dramamine right when they call for boarding puts me in a sleepy state by the time we take off, and I have no trouble sleeping for the duration of the flight. Dramamine wears off cleanly for me as opposed to Benadryl, which makes me feel much more foggy. YMMV.

Another thing that helps me greatly is to sit as close to the front of the plane as possible. I've found that the view of the narrow, tiny tube packed with people as far as I can see makes me feel MUCH more anxious than just a few rows of heads and then the bulkhead in front of me.

I read an article several years ago about ways to cope with anxiety and one thing they mentioned was that the scent of apple-cinnamon was a natural anxiety reducer (I'm sorry I can't find the article to link it here). I happened to have some potpourri sachets that were apple-cinnamon, and I would just slip one into my carry-on and pull it out and smell it when I started feeling that rapid heartbeat. It was also a nice thing to have when stuck next to a person with really rotten breath.

And of course, simple deep breathing (without a paper bag) stops the physical symptoms of anxiety and is always my first defense against panic attacks.
posted by Brody's chum at 12:40 PM on April 24, 2009

Ooo, let me tell you about my new favorite drug: Bonine. It's available over the counter in the same section as Dramamine, and for the same purpose, but for me it's light years better. My main problem was panic that occurred when the plane sped up or tilted, so maybe I panic when someone else might get queasy. Bonine not only makes me immune to the positional panic, it makes me mellow in a non-dopey way so I can still function once I land.

Melatonin makes me groggy, so I take it only when I intend to sleep. For a recent 7.5-hour flight east across 6 time zones, I took Bonine and then took 1 mg of melatonin to make myself sleep because it was night where I was going. I had a lot less jet lag than usual.
posted by PatoPata at 1:00 PM on April 24, 2009

Nthing the Xanax.
I have panic attacks too because of the whole small space thing so the doctor always gives me some to help me. I also drink a lot of water to stay hydrated and stay away from caffeine. I also take my ipod or something to distract me during the flight. I find it easier, if my mind starts towards thinking about the small space, to kind of distract it and move away from those thoughts with something really entertaining. If you notice yourself thinking about the space, think about what's the worse that can happen? If you have a really bad panic attack, you will just pass out until your body stabilizes. I'm also really sensitive to pressure changes, so I make sure I have medicine for that too and again something to distract me. Sort of like outsmarting myself.
posted by Polgara at 8:53 PM on April 24, 2009

Response by poster: Thanks for all the great answers in this thread, everyone. I can't decide on a best answer here. :-)
posted by wastelands at 4:40 PM on April 25, 2009

I can relate to the "confined space with too many people" anxiety, and have frequently experienced this on buses and trains. Funnily enough, I am not affected on planes at all. It's got to do with the noise. The constant loud white noise on the plane drowns out my anxiety somehow. It's like it releases me from one of my senses (hearing) and takes the anxiety with it.

Not saying your anxiety is necessarily the same as mine, just offering my (very liberating!) experience.

Generally, my best advice would be rigorous exercise a few hours before your trip. This way you will get the natural calmness and relaxing hormones flowing through your body. And be sure to have a benzo in your pocket as a safety net.
posted by heytch at 3:58 AM on August 28, 2009

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