How can I deal with worsening panic issues?
May 8, 2016 11:36 AM   Subscribe

Extremely rare (once every 2 year) panic episodes are now happening every few days. I know that YANMD and that I need to see someone but I am looking for advice on how to discuss this with a GP and tips for management.

After going 10 years without an attack, I had one 5 years ago in an engineering lab on a trip to Singapore. Symptoms are always just derealization/panic + a fear that if I stop concentrating or go to sleep I might die, no shortness of breath or rapid heart rate, and now it happens a lot whenever I'm in a high bay like at Lowe's or certain grocery stores or restaurants/bars, and yesterday after a foot race I had a really bad and lengthy one outside for the first time. I didn't feel safe to drive home or even walk for a half hour while my sweet wife stayed with me. I had the same derealized feeling for the rest of the morning but kind of powered thru it.

This is way unfair to my wife and I need to address it. I'm an analytical guy and I know it's panic and in my mind I know I'm not going to die but yet there it is. I'm a heavy user of alcohol and caffeine and I know I need to at least experiment with eliminating those.

Does anyone else deal with this? Does anything work? Breathing exercises certainly haven't for me.

Are there potential physiological causes that I should be aware of? Is there a standard treatment for this from the GP, and is there anything I should make a point to tell them? I don't mean to initiate a chat but any general advice is certainly most welcome. Thank you in advance.
posted by ftm to Health & Fitness (17 answers total) 3 users marked this as a favorite
I have anxiety, but not a panic disorder, but I think some of my experiences will still be useful.

Are there potential physiological causes that I should be aware of?

It might be worthwhile to have your thyroid checked; plus your iron and vitamins B and D levels. Any of those being out of whack could certainly exacerbate underlying mental health issues. For me personally, I learned earlier this year that I had a vitamin D deficiency, and my vitamin B was borderline. Since supplementing with D3 and B12, I've noticed a big improvement to my mental health in general, and my anxiety is significantly more manageable. YMMV but worth asking a doctor about.

Is there a standard treatment for this from the GP...?

Based on my research and my own experience, your doctor will recommend cognitive behavioral therapy (do it, it's super helpful) and possibly medical intervention. I believe the first-line pharmaceutical intervention for panic disorders is usually an SSRI. For what it's worth, starting Prozac has literally changed my life and I strongly recommend trying whatever SSRI your doctor suggests. It's also possible that you'll want to have benzodiazepines on hand, though my personal recommendation is to let your doctor suggest them so that you aren't seem as drug-seeking. (It's stupid that this is a thing, but in my experience it is a thing, so... yeah.) there anything I should make a point to tell them?

The magic words for this type of appointment are "This is negatively affecting my quality of life. X, Y, and Z symptoms seem impossible to manage on my own and my [work, relationships, happiness, etc.] are suffering."

I would also acknowledge up front that you realize the alcohol and caffeine aren't helping. If you have time before your appointment to start cutting back on those, then you can tell the doctor, "I've started to cut back on alcohol and caffeine. That's [helping a little, but not enough / not helping at all / whatever the case may be]. Are there other lifestyle changes I can make that might help?"

Good luck with everything.
posted by schroedingersgirl at 11:59 AM on May 8, 2016 [4 favorites]

I'd start with the GP, and get a good workup and physical, especially if you haven't had one in a while. Also make sure to go over your medications, if you're on any, to see if any of those could be contributing to the condition.

I have the same condition; what helped for me was taking Buspar for the anxiety/panic, and to *stop* taking meds for my ADHD, as that just made the panic worse without really helping the ADHD. I'm also seeing a therapist.
posted by spinifex23 at 12:08 PM on May 8, 2016 [2 favorites]

So as someone who went through the same thing as a heavy user of alcohol and caffeine... Those two things are very, very likely causing or exacerbating your anxiety issues. I'm going to use all sorts of nonspecific language here because I'm not a doctor, and this is pretty much how I understand it:

When I was in my late 20s, after a decade of near-nightly heavy drinking, hangovers had ceased to be the headache-vomiting-flu-like awfulness, and had instead turned into regular 5AM panic attacks. I found out pretty quickly that I could kill those panic attacks with a drink.

Turns out that mild alcohol use can lessen anxiety symptoms for a long, long time, but if your body becomes used to high levels of alcohol, your central nervous system starts getting wonky. Your neurotransmitter levels get all kinds of weird. When your body is withdrawing from alcohol, the neurotransmitters that were depressed by the alcohol kick into overdrive as they bounce back. If you're a daily heavy user of alcohol, this starts happening every morning as your central nervous system starts coming back online after the booze wears off. If you drink every day, the unpleasant effects tend to last until you take your next drink, which perpetuates the issue.

Caffeine may help you get through the day with a hangover, but it's worsening the anxiety issues.

If you've already got underlying anxiety or depression issues, over the years, alcohol and caffeine that used to be your friend become your worst enemy.

Physiologically, this is possibly a bit part of what's going on. Get evaluated. Do your best. I'm not an AA person, and I haven't given up my vices entirely, but I've worked to become a moderate drinker and a "one cup of coffee in the morning and then tea all day long" caffeine person, as well as being on a low dose of Wellbutrin. It has absolutely changed my life.

Hang in there. You're on a tough road, but there are lots of us who've walked it before. Feel free to reach out.

Oh, and if you're a heavy drinker, start taking B-complex and D supplements daily. You're probably low on both, and being low on those can cause or worsen anxiety and depression. It helped me quite a bit.
posted by erst at 12:21 PM on May 8, 2016 [3 favorites]

While SSRIs are frequently recommended for anxiety issues, especially by GPs, you may also be offered an option to try something like Xanax. In general, medication is great for getting through life while dealing with issues with panic and anxiety, but I highly recommend CBT as well. If your doctor gives you an SSRI and you don't like it, do not just stop taking it cold turkey. Please wean off of it with a doctor's assistance. Not everyone gets SSRI discontinuation syndrome, but if you do it's extremely unpleasant and can be avoided with proper weaning. Many of the medications offered for anxiety do not play nicely with alcohol, so be prepared for that.
posted by xyzzy at 12:35 PM on May 8, 2016

I also got panic attacks rarely, maybe once or twice a year or couple of years, when for some reason they became much more an issue in my life after having one attack out of the blue (also while traveling abroad). I don't know what "high bay" means, but I was only susceptible to them in crowded, enclosed places, like trains or grocery stores. The one and only thing I found that helps when I am already so anxious that I can feel the possibility of an attack right around the corner (within seconds, you know that feeling when it comes) is really cold, ice cold things. It helps a lot with the derealization and the panic. It just brings you right back to your body somehow. So when I am like that I usually try and go to a grocery store right before getting on the train to go home, so I know I have a frozen burrito or bag of corn to put on me if that any second now feeling starts. I put it on my hands or forarms. It increases anxiety in the sense that it draws attention to you (though people as always pretend they don't see) but at that point it helps more than hinders. I just found out yesterday that they make a super cooling spray to carry around for hot flashes so I will likely buy that now. Also, even a minor lack of sleep greatly increases my anxiety, and the likelihood that I will get to the feeling of the panic attack around the corner.
posted by Blitz at 1:10 PM on May 8, 2016 [1 favorite]

As noted frequently here, I take Celexa for anxiety and panic attacks. A small dose works really well for me.

Tell your GP about your panic stacks see what she says. Mine said, "have you ever tried Prozac?"
posted by Ruthless Bunny at 1:36 PM on May 8, 2016

I am dealing with the exact same issue right now. I take two antidepressants - Wellbutrin and Effexor. My dosages have been all over the place because I live out of the country and don't have a reliable psychiatrist here. I've also cut down on my Klonopin, and this seems to have caused me to increase the amount I drink. I notice that when I'm on a low, steady dose of these drugs, my quality of life increases drastically. (Though, Wellbutrin is not recommended in most cases as it can make anxiety worse.)

Just from personal experience, I would really recommend seeing a doctor and considering a low dose SSRI or SNRI. Be careful with benzodiazepines though (Klonopin, Xanax, Valium, Ativan, etc.) - they are unbelievably helpful but can be extremely addictive, especially for people who drink. But I'll be following this post to see what others recommend.
posted by chocolatespaghetti at 3:31 PM on May 8, 2016

Your GP may want you to try a benzodiazepine as needed. While it's true that you should use them sparingly and definitely should not combine them with alcohol (or opiates, though I hope that's not an issue for you), they can be very helpful in stopping a panic attack in its tracks. That, in turn, helps break the cycle of association of certain places or experiences with panic attacks. Once they've done that, many people find it reassuring just to have them available in case they really need them, actually using them only rarely. I would definitely suggest trying an SSRI or Buspar and therapy as well, but the ability to shut an attack down midway can be really helpful at the beginning.
posted by praemunire at 5:02 PM on May 8, 2016

Be extremely clear with yiur GP that this is significantly and negatively impacting your life. Like use those words. Don't try to downplay it at all. Tell them it's interfering with sleep, work and family. It is very important that you explicitly say that it's preventing you from normal daily activities.
posted by stoneweaver at 5:03 PM on May 8, 2016 [1 favorite]

2nding what stoneweaver said about the language to use with your doctor. My doc didn't take me all that seriously about my anxiety until I made an appointment just to discuss it and laid out how my life was impacted. Especially the things I used to do but couldn't do anymore; such as, grocery shopping. The grocery store aisles made my heart pound and my palms sweat. Be specific about when the attacks have happened.

Also a family member just finished an outpatient treatment program for panic disorder and coffee is the first thing they had her get rid of. I cut back on coffee when I had panic attacks, but I also made sure my blood sugar was constant by never drinking coffee on an empty stomach.

With that in mind, ask your doctor to have a full blood panel done(a good doc will do it anyway). Probably a glucose tolerance test, too.
Best of luck to you.
posted by It'sANewDawn at 6:05 PM on May 8, 2016

Xanax worked wonders for me when I had panic attacks and anxiety attacks (these started from age 6 and continued until I got a handle on it through first Xanax and then CBT around age 31)

That said, of course you know alcohol and caffeine can do weird things to brains and endocrine systems, particularly if you are atypical in either area. Can you correlate any of this excessive usage to an increased likelihood of episodes? Try keeping a log of your consumption of both going forward and see if you can find a pattern.

The other big thing that worked for me was breathing exercises coupled with very logical, and kind, self-talk ("I am having a panic attack, I need to breathe slowly, quiet my mind, and remember that this is not going to kill me. I'm just having a weird thing happen right now, and it's going to pass soon and I'll feel better. Everything is fine, I have all the help I need if I need it.")

Best of luck. Panic attacks suck.
posted by ananci at 6:07 PM on May 8, 2016

To stop or manage a panic attack, you can use a cold wet washcloth on the face. It stimulates the mammalian dive reflex and the physiological effects are prompt. I also find Xanax quite helpful for sporadic use.
posted by theora55 at 6:24 PM on May 8, 2016

Your doctor will most likely tell you to cut way back on the booze and caffeine. For me, I was also eating like shit (alcohol makes me do this!) and sleeping like shit (again with the booze and coffee) so there were four factors there, all exacebrating each other.

Buspar helped immensely, and you know what? In two years I've only taken two or three pills total. So just KNOWING I have the Buspar helps. If I feel one coming on I'll either take Valerian or a few drops of Rescue Remedy. I have no idea if this actually does anything but since anxiety can be psychosomatic I'm sure placebos help. I also do a lot of yoga, a lot of running and a lot of meditation.

Best of luck.
posted by Brittanie at 2:17 AM on May 9, 2016

Buspar helped immensely, and you know what? In two years I've only taken two or three pills total. So just KNOWING I have the Buspar helps.
For the record: "BuSpar is designed to be taken every day to prevent anxiety symptoms. It does not work if it is only taken as needed or only when anxiety symptoms are present."

My panic attacks got much less when I started paying attention to my triggers, eating nutritious food and sleeping on a regular schedule, and I had a regular meditation schedule. My therapist recommended 5 minutes a day to begin with. Once I had the habit established, I'd add a minute on every month until I got to my desired time. Yes, it's slow, but the goal is to practice the meta-attention while *not* panicking, &long periods of meditation can provoke anxiety if not approached carefully.
posted by saveyoursanity at 9:54 AM on May 9, 2016 [1 favorite]

I am taking Buspar in the method my doctor prescribed it to me, which is "as needed."
posted by Brittanie at 10:20 AM on May 9, 2016

I had issues very similar to this and a combination of therapy and Wellbutrin has virtually eliminated it.

Mine ramped up a little more slowly but at one point I was getting them nightly. Now I generally only have attacks if something particular phobia-triggering or extremely emotionally upsetting happens, as opposed to getting them more or less at random 10+ years ago.
posted by thefoxgod at 4:55 PM on May 9, 2016

I didn't want to sit this one but every single answer helped me. Y'all are awesome.
posted by ftm at 6:00 PM on May 17, 2016 [1 favorite]

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