
Panic Attacks - abhi3
https://avc.com/2018/08/panic-attacks/
======
wasx
I've had panic attacks my entire life.Fortunately they're few and fair between
these days and I can for the most part calm myself down when I feel one
oncoming (they're almost always triggered by some event fortunately, very
rarely just random ones).

I wouldn't wish them on anyone. That feeling of "I'm trapped, this is forever,
I'm going to die, this is overwhelming, I need to escape" is genuinely the
worst thing I've ever experienced. The brain misfiring the trigger that gets
pulled when you're in a life or death situation is terrifying.

Fortunately recognizing that it's just a chemical response and I don't have an
infinite supply of those chemicals and it will all be ok in a moment is one of
the most calming thoughts and one that I always turn to when I'm panicking.
Also remembering that I've felt amazing between panic attacks reminds me that
soon I will feel that way again.

Just a few thoughts I turn to when I need to white knuckle that wave of panic
that might be able to help someone else out.

~~~
ridewinter
The start of recovery for me was reading a book by Pema Chodron about not
trying to get rid of the intense feelings and experiences like this. With
enough experience and meditation and a practice called morning pages, I’ve
learned to harness the extreme energies involved and make them a massive
positive instead of something to be scared of, holding me back. It took a long
time but fully worth the effort. :)

Edit:

A favorite passage from Pema’s book:
[https://books.google.com/books?id=a6sRdYLlmqIC&pg=PA6&lpg=PA...](https://books.google.com/books?id=a6sRdYLlmqIC&pg=PA6&lpg=PA6)

An article about morning pages:
[https://www.theguardian.com/lifeandstyle/2014/oct/03/morning...](https://www.theguardian.com/lifeandstyle/2014/oct/03/morning-
pages-change-your-life-oliver-burkeman)

~~~
mindgam3
Morning pages has been an incredibly helpful tool for me to process the
difficult emotional states associated with acute and chronic PTSD. I kind of
do the slacker version by typing them out as opposed to writing freehand, but
hey, it still works.

~~~
ridewinter
Yep. When I started I thought I didn’t have much to say. Turns out I have
ALOT. Helps me work through things and start the day out right.

------
timrichard
From personal experience, years ago : learning to control your breathing is
the key. Your fear of the symptoms can turn it into a self-fulfilling
prophecy. When you've deeply internalised the assurance that you can defeat
the symptoms any time you like by regulated breathing, you might well find
like I did that they just stop happening quite naturally. It takes time and
practice. Sometimes now when I find myself in stressful situations, I notice
my breathing has switched over to this pattern without any deliberate
intervention from me. Must be the practice.

There are many techniques out there (such as the 7-11 pattern, etc). I'd
recommend practicing with any wristwatch or clock that has a ticking second
hand. Breathe through the nose and not the mouth. In for five, out slowly for
ten, repeat until comfortable. If you're not immediately able to do that, try
holding your breath until you can begin. It's a great trick and general mental
clarity hack to have in reserve.

~~~
vinbreau
This works unless your anxiety is being triggered by the vagus nerve in which
case deep breathing only makes it worse. Had one related to an illness
recently, the vagus nerve makes you feel like you are having terrible anxiety
that is made worse at the apex of every in/out breath. Then when you can't
breathe deeply you start having even worse anxiety. This is the problem I am
dealing with atm.

~~~
specialist
I also had a mind/body anxiety snafu. I was experiencing that crushed chest
anxiety sensation without any emotional triggers.

Turns out I had a pinched nerve in my spine. The pain and nerve stuff caused
my body anxiety sensation, which then caused the emotional anxiety.

Resolved with a lumbar fusion.

Which explains why most of my prior efforts to mitigate weren't effective
(drugs, meditation, exercise, sleep hygiene).

------
gilgoomesh
Panic attacks are so mind bogglingly weird. For a few seconds (maybe a minute
or so) your brain enters a completely different mode. Then it takes a few
minutes to calm back down to regular human thought, again. It's so weird it is
difficult to come to terms with what happened.

I spent a few months largely crippled by panic disorder (intermittent panic
attacks spaced by anxiety – often about the panic attacks themselves). The
whole experience was like a crash course in understanding out-of-body-
experiences and accidental mental overreactions.

~~~
gilgoomesh
Since everyone else is saying what worked for them... I didn't fix them with
medication, breathing or lifestyle. I saw a therapist (CBT) for a few months
and she suggested leaning into the panic attack: when you feel one coming on,
deliberately try to trigger it. They whither away when you embrace them.

The underlying anxiety is a separate issue and required a few years of
practiced mental discipline. Sorry, no silver bullets there.

~~~
sjg007
Yeah that's a good way to recognize what is happening objectively at a higher
level rather than just responding to the amygdala. Your effectively observing
the moment.

------
andygcook
I’m a founder and suffer from intermittent panic attacks. This first one I had
was terrifying. I ended up going to the hospital because I thought I was
having a heart attack. Once I figured out what was happening and the pattern
for the symptoms, they got a lot more manageable. Just knowing I’m not dying
and telling myself that helps to calm me down.

The linked ESPN article in Fred’s post is really good and worth reading.
Reminds me of some of the mental health stigma that founders in the tech
industry face. This quote in particular resonates with me: “Depression,
anxiety and panic attacks are not a sign of weakness. They are signs of having
tried to remain strong for so long.”

Humans are only so strong. Intense pressure can forge diamonds, or it can
crush you underneath it. My hope is that the stigma of mental health goes
away, and training our brains becomes as normal as training any other parts of
our bodies.

~~~
jpmoyn
While I agree that they aren't signs of weakness, I don't think they are
"signs of having tried to remain strong for so long". That sounds like an
inspirational quote image you would see on instagram. They are real and are
caused by a multitude of things, applying a cute slogan about having to be
"strong" to get them doesn't help.

------
tenaciousDaniel
I suppose my own experience differs from the symptoms of a chronic sufferer,
but I used to completely dismiss notions of "panic attacks". My thought was
"why can't they just take a breather and calm down?"

Then one day I smoked too much marijuana and then had to go to a kids birthday
party whose family I didn't know. About 10 minutes in I had what I can only
describe as a panic attack. My face turned _gray_. My heart was probably
beating somewhere around 190bpm. I was sweating profusely. I had to leave the
party and on my drive home I was worried I might suddenly die and then veer
into traffic. I nearly drove myself to the emergency room because I thought I
was going to have a heart attack.

If that was a panic attack, I can't imagine what it must be like to suffer
something like that chronically. It was utter hell.

~~~
tossaway4567
Using a throwaway due to subject matter, but I also learned the hard way that
cannabis just doesn't agree with me the way it did in my younger years. I had
what I now know to be panic attacks a few times after smoking a bit of weed
and it's not worth the risk for me anymore. It's a bummer because I used to
occasionally smoke when I was in my 20s with no issue other than maybe feeling
a bit groggy in the morning but now it's a tossup whether it will mellow me
out or leave me a wreck off a few puffs.

Had a couple of panic attacks unrelated to any sort of mind-altering drug as
well and I actually did drive myself to the ER because I didn't know what was
going on. I thought I was having a heart attack or a stroke or something
(which of course doesn't help the panic attack). Heart wouldn't stop racing,
blood pressure through the roof, dizzy, trouble speaking, etc.

I kept the rest of the handful of Xanax I was prescribed in case I have
another one someday. No desire to pick up a benzo habit but the few times I
thought I felt something similar coming on in subsequent years, half a tablet
(whether through placebo or drug effectiveness) made it fizzle out before
ramping up into a full panic attack.

It's weird because I had thought knowing it's a panic attack and not a heart
attack/stroke/whatever would "disarm" the process but it doesn't seem to
matter. Still interested in figuring out what can cause that to happen
seemingly out of nowhere.

Feels like a feedback loop where normally mild anxiety comes and goes in the
course of daily life but in rare cases, instead of "turning the mic off" it
stays on and the feedback builds to a point that is overwhelming.

~~~
thecatspaw
> Using a throwaway due to subject matter

Exactly due to the subject matter, I choose to use my regular account. Mental
health issues are not pretty, just like physical illness can be ugly. But we
do not shy away from the people who have terminal cancer, we help them out the
best they can.

For mental illness helping can mean admitting that you have issues too.
Displaying that they are not alone, that these issues are not as uncommon as
everyone makes out to be.

~~~
nickdandakis
I think they meant the weed and xanax.

~~~
tossaway4567
Ding ding ding!!

Not so much the drugs I was prescribed, but cannabis is still not legal for
recreational use where I live and either way, there's a stigma. My usual
username is easily traceable to me (at least by people who know me) and I
don't necessarily want family or employers searching out a known username and
running across tales of weed and panic attacks.

------
ChuckMcM
I remember the first time I had a panic attack it was in the middle of the
night, I woke up believing there was a thought, an idea, that if I
accidentally thought about it would kill me instantly. It was the weirdest
thing, and scary too. Eventually, and through some great discussions with a
counselor, I narrowed it down to the stress and anxiety of being a single
earner, in a field (engineering) that had been known to change directions and
leave everyone behind. I had lived through the semiconductor recession in the
Bay Area and black Monday (1987) where the DOW jones had crashed. When the
dot.com bubble burst, the fear, unspoken, was that the world would crash, I'd
be out on the streets, and there would be no way for me to provide for my wife
and family.

Oddly enough, a friend of mine suggested doing arithmetic in my head in a
panic state, and it worked quite well for me. The theory was that you can't
panic (fight or flight) reflex while your brain is in calculation mode. I
don't know whether or not that is a valid theory but I do know that for me by
focusing on a concrete problem (like trying to divide two 5 digit numbers) my
sense of panic fades right away. In later years I found I could just read a
text book, didn't really matter which one.

------
IAmGraydon
I have always suffered from some level of social anxiety, but never really
considered it crippling. Years ago, I brought this up to a doctor who promptly
prescribed me a drug of the benzodiazepine class. At first I felt like an
idiot. Slightly less anxious I guess, but I became kind of loose of the mouth
(like you get when you're drunk), forgot a lot of things, and generally didn't
like it. However, I stuck with it and a strange thing happened - as I adjusted
to the medicine, my anxiety started getting worse. At this point, not taking
the medicine had a rebound effect as well that was pretty terrifying, so I
avoided that. All the while I was trapped - I couldn't stop using it or I
would have panic attacks, but using it was also seemingly causing an
increasing paradoxical reaction. I got to a pretty bad place with this over a
few months, and ended up having physical manifestations of my inner anxiety
(cramps, pins and needles, sweating, inability to sleep, etc). Eventually the
only way out was a lengthy taper off the drug. It was literally 3 months of
hell. After finally getting back to baseline, my normal anxiety level returned
and it seemed like a walk in the park next to what I was experiencing on the
medicine.

The point of my anecdote? Medicine can often compound the problem or even
create new problems that weren't there before. Once you're in the midst of
this, it can be hard to even recognize the medication as the cause, specially
if you're taking multiple medications. I'm not suggesting that anyone stop
their medicine without talking to their doctor, but at least consider that the
anti-anxiety cocktail you're on may be making things far worse. It happened to
me, and some research has revealed that these paradoxical reactions are not at
all uncommon.

~~~
rrmm
As far as I understand (not an MD), benzos are not generally considered a
long-term anti-anxiety drug. They treat the immediate symptom for people who
need immediate relief from debilitating anxiety attacks and occasional 'flare-
ups'.

Generally, you could go on an SNRI or SSRI coupled with some form of
cognitive-behavioral therapy to try to treat the root cause of the anxiety.

But I'm not a big fan of GP MDs giving out benzos like that given their long-
term effects (anxiety, dependence, tolerance, withdrawal syndromes). GP's
don't have the time to spend with you that a psychiatrist or therapist might
in order to figure out what's going on.

~~~
hndamien
My anecodotal experience is that SNRIs and SSRIs can massively increase the
propensity, and even induce panic attacks where they were never present. My
recommendation is to first try dancing - I know it sounds dumb, but the risk
reward profile of this I think puts it at the first line of defense. I get
that it is very hard for somebody in that mental state to get up and go
dancing.

~~~
rrmm
Yes, SNRI/SSRI's can precipitate panic attacks. And I agree aerobic activity
of any sort can be very effective for controlling stress/anxiety and even
depression. The important thing is to find some things that work for you and
do them.

------
seibelj
I will chime in here just to add my voice to everyone else. There is hope if
you have chronic anxiety. I’ve had it as far as I can remember, even memories
being in my crib and crying because I didn’t know where my parents were.

Meditation, medication, eating healthy, exercise, be aware of yourself and
when you are pushing yourself beyond the breaking point. Everything will be
ok. I avoid all illicit drugs, but alcohol is an anxiolytic and it’s partly
why I like it.

One time I was on the subway, surrounded by people of all ages just relaxing
and being bored, and I was trapped in a life or death struggle for survival as
one of the worst panic attacks of my life attacked me. Then, when I thought I
couldn’t make it, I realized how silly I was being and how absurd the whole
situation was, and it gradually went away.

I still get panic attacks sometimes, but they get easier to manage.

------
drjannakoretz
Body based coping strategies are helpful those moments. Try sticking your hand
in a bowl full of ice water and leaving it in there for a few seconds, or
taking a very cold shower. Some folks even do something called Ice Diving,
where they place their entire face into a bowl of ice cubes and water. This
actually triggers the diving reflex and it automatically calms your body. But
you have to be in a place (like home) to do that. Other body based techniques
can be used too that utilize other senses such as smell and taste. Fire ball
candies are a portable option, and I've seen some people carry around tiny
packets of pepper. You have to experiment a bunch to see what works for you.
All of these ideas are derived from DBT. Behavioral Tech is the official
company of all things DBT if you want to know more about all of it.

~~~
Tharkun
I doubt it triggers the "drowning reflex", which according to Wikipedia looks
like this:

"Involuntary actions operated by the autonomic nervous system involve lateral
flapping or paddling with the arms to press them down into the water in the
effort to raise the mouth long enough to breathe, and tilting the head back.
As an instinctive reaction, this is not consciously mediated nor under
conscious control."

You may be referring to the diving reflex instead?

~~~
drjannakoretz
Yes, many apologies, I mistyped. I will correct now.

------
jrkatz
I have periodic trouble with panic attacks at night, when I'm trying to sleep,
usually linked to times of external stress. I thought it was insomnia. In the
moment, they're miserable - rapid pulse, cold sweat, numb hands, impending
doom, the whole shebang. The next day, after just a few hours of sleep,
there's hell to pay. The next night, I lay in bed afraid it's going to happen
again and that I'll get no sleep again - so of course it happens again.
Finally, after a few days I'm so tired I fall asleep the moment I hit the bed,
with no time to fret about anything, and the cycle ends.

I was trying to write about it as insomnia one day , looking over my list of
symptoms, when it clicked that it didn't sound like other descriptions of
insomnia. Once I figured out they were panic attacks I was able to take a step
back and look at the cycle, so I don't have week-long waves of this anymore.
The next night I decide I don't want to sleep - maybe I want to do an extra
load of laundry, inexplicably at midnight when I've hardly slept, absurd as it
is. It works, at least.

My cat loves the panic attacks though. I stay up later, and I'm petting her
the whole time trying to calm down. Great for her.

~~~
howard941
> My cat loves the panic attacks though. I stay up later, and I'm petting her
> the whole time trying to calm down. Great for her.

When I'm away from home I can reduce an anxious feeling by imaging I'm petting
one of the cats and feeling its rumbling purr.

------
zengid
>> _“I’m a type of guy who has a very long fuse,” Love says. “I try to be as
non-confrontational as I can, but when that fuse breaks, I explode._

This is me. I had what I feel was a panic attack / semi nervous breakdown on
the last day of my internship this summer. It was basically a 12 week
interview for a job. On second to last day I received a full-time job offer,
and there where a few times where I had embarrassed myself in front of the VP
and I was afraid If I got sick and vomited on the last day I embarrass myself
again, so my brain just locked into panic mode. I asked my team leader to give
me a ride home, and as soon as I walked in the door the panic subsided. I've
still had a few flare ups over the last week; we're looking for houses now
(our first home purchase) and I'll have to commute for a while, so I'm nervous
about that too. I may have to stop drinking coffee and practice more
meditation.

I think I just get over-exhausted and loose the ability to absorb and cope
with stress, so when it happens its like any incoming stress hits my reptile
brain directly like touching a raw nerve. I'm very happy that I've had the
last week off to relax and rebuild my stress-buffer!

~~~
nemo1618
Do you have chronic pain or another chronic condition? I'm trying to find out
if they're common among people who are non-confrontational, perfectionists,
and generally suppress their emotions.

~~~
rrmm
I'd venture to guess so. Stress has a way of coming out one way or another
especially for those people who are very 'distant' from their emotions and
feelings. Whatever the biological mechanism (chronic cortisol, inflammatory
response, muscle tension, high bp/heartrate), it eventually shows up so you
can't ignore it any longer.

Part of the cure I think is figuring out what your body is telling you through
emotions and then figuring out what to do with that information (dealing with
the stressor or finding an outlet).

~~~
nemo1618
Yeah, I ask because that's my personality type as well, and stress has
manifested in a number of chronic physical symptoms for me (primarily wrist
pain and gastro problems). Treating the symptoms as a signal, like "oh, I must
be stressed" or "hmm, maybe that's bothering me more than I realize" has
improved my symptoms significantly.

------
r32a_
Panic attacks are awful and terrifying, mine eventually turned into panic
disorder, but after over a year of working on it and taking it step by step I
was able to beat it and without any medication!

In my experience, the following helped me.

* Meditation

* Deep breathing exercises

* Exercising especially cardio.

* Cold water showers

* Learning about panic attacks

* CBT

~~~
faaabio1618
If you have health issues, please don't follow any advice on the internet (Ok,
not even mine) and go ask your doctor.

~~~
tomhoward
People here know that.

But they also know many doctors aren’t able to help much with panic/anxiety,
not because they’re ignorant or incompetent but because the causes and
effective treatment options vary so much from person to person, and the whole
topic is not very well understood by anyone, really.

One of the treatment options suggested above (CBT) is a conventional medical
approach.

The others are often reported to be beneficial for some people and are not
commonly reported to do any harm, so it is fine for someone to suggest them.

~~~
d0lph
Meditation has showed some promising results:

[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3772979/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3772979/)

Anecdotally it's very helpful to myself.

Deep breathing can be part of CBT too.

------
fzeroracer
I've had to deal with panic attacks my whole life and most of the time I can
link it up to an invisible stress meter building up until it triggers an
attack. Sometimes I sort of mentally ignore how much stress I'm putting on
myself due to work, life circumstances etc which doesn't make me realize how
much stress I'm actually under until a panic attack finally hits.

Breathing exercises and realizing that that I'm going through a panic attack
usually helps defuse it a little though most of the time you can only just
wait it out.

------
patwalls
My first panic attack was triggered by smoking weed when I was 17 years old.
Since then, it's been a lingering thing that has never left my mind and has
kept me on a constant edge, especially in social situations.

I've found avoiding caffeine has helped a lot.

~~~
zaroth
That sounds very difficult to carry around. I think for people who haven’t had
panic attacks even impossible to really comprehend.

Have you tried any other treatments like CBT or EMDR? Sometimes after a
traumatic event the brain can be guided into reprocessing / repacking the
memory of the event in a way that somehow relieves these kinds of after-
effects.

~~~
weaksauce
It truly is awful. Try to imagine what you think dying is like and then that
is what your brain puts every single system into overdrive trying to achieve.
It triggers a fight or flight response and also is a feedback loop of awful
that will only subside once your adrenal glands are tapped out and tired. You
really can’t stop it once it has begun and no telling yourself “it will be ok”
will help it even though you intellectually know it will be fine.

------
watertom
I had crippling panic attacks for almost 10 years, doctors, drugs, nothing
helped, I quit one job before I got fired due to poor performance because of
my panic attacks.

High doses of L-Ascorbic acid eliminated my panic attacks. I slowly worked up
to 60mg per KG of bodyweight. I weighed 250 (113kg) works out to ~7 grams per
day. I slowly worked up to 2g before breakfast, 3g before lunch, and 2g before
dinner. Once I started taking 4g per day the attacks lessened, and when I hit
6 they went away for good.

L-Ascorbic acid is an anti-stressor hormone in animals, humans have a mutation
that prevents us from making it in our livers.

~~~
sciencewolf
Wait we're talking about Vitamin C here? Really?

------
m3mpp
I've had them all my life, the first at 21, in my mid 40s now, spent a good 10
years of my life with crippling episodes, were I couldn't go out, drive, and
have panic attacks lasting for hours. At the worst, it was so bad, I lost 30
pounds in 1 week, couldn't eat, couldn't sleep with a mind racing 24
hours/day. It's so exhausting for the mind that you start having visual
hallucinations, you start thinking about ending your life etc, and then
finally, you collapse, what you could call a complete breakdown.

And here's the interesting part, things that you don't necessarily experience
till it goes full blown, it's when you reach that point, the end of fear
basically, your mind becomes calm. You don't necessarily realize it in the
instant but that's it, you've stared into the abyss and it's not as awful as
you imagined. At that point, you still have anxiety but that's it, it doesn't
control you anymore, you're out of the 2 states loop, panic or fear it may
happens. It's still painful, but it's not hell anymore, you know how it's
gonna end, there's no more question.

Now, it's an incredible experience, can even become an spiritual one, it did
for me, experiencing first hand how reality is subjective and how the mind
works.

All in all, I wouldn't trade all those experiences for anything, it gives you
an understanding of the human condition that not a lot of things can give you.

------
Ftuuky
I've only had one panic attack in my life and it was out of nowhere as well. I
was riding the subway and suddenly I had this urge to run away, as if I was
late for something but didn't know what. I got out of the subway and just
collapsed in the platform, unable to breathe, shaking uncontrollably. It was
terrifying. Reading about the "long fuse" makes a lot of sense to me. I avoid
confronting other people and always try to be the "team player" and I guess I
just snapped that one time.

~~~
kozak
Collapsing and not being able to breathe sounds like something more serious
than a panic attack.

~~~
coldtea
Both can happen during a panic attack. Or both can feel like are happening.

------
cfusting
I suffered from panic attacks throughout my 20's. Recently I went to a
cognitive behavioral therapist who guided me through a hyperventilation
technique to simulate the physical symptoms of a panic attack. The results are
amazing: practicing this technique three or so times a week for a month
completely rid me of panic attacks. I recently was feeling stressed about a
work trip and "tuned up" the night before by going through a session and had
no issues.

The therapist said this cures 99% of patients. The "golden feather" in a CBT
therapist's hat.

The technique:

Sitting down, as rapidly as you can, take a deep breath in and blow it out. Do
this 40 times. Blow out all your air and hold your breath for as long as you
can (1 - 2 minutes for me, stop when you start to get convulsions or you may
pass out). During this time observe your tingling hands, light headed feeling,
sweaty palms etc. This is a normal result of an excess of oxygen in your body.
It cannot hurt you. Now take a deep breath and hold it for 15-20 seconds.
Start immediately and repeat two more times for a total of three. Repeat three
times a week for a month. If you start to feel panic more often, start your
treatment again (this is rarely necessary).

The first time will be the scariest. After that it gets MUCH easier I promise.
It may be helpful to see a CBT therapist to talk you through it the first
time. It will change your life.

That technique coupled with a mild anti anxiety medication has completely feed
me of anxiety and panic.

I hope this helps others :)

------
grasshopperpurp
I never had panic attacks until the age of about 23. I adopted a dog (a
Blackmout Cur) and brought it home for the first time, and it went off like a
tornado as soon as it stepped foot in the door. I got it calmed down, and
everything was fine. When I went to bed that night, though, the reality of the
situation struck me, and I thought I was having a heart attack. The entire
night, I hummed 'Rio Grande' by the Great Speckled Bird in my head, because I
always found it to be a soothing song, and it just made it worse and worse.

The next few months, I would get panic attacks as soon as my head hit the
pillow - nothing to do with the dog at this point. Though, the dog was quite a
handful. I'd take it for two hour walks, and after a 5-minute rest, it'd be
back to rampaging.

Now, I'll get a panic attack once every few years - still, always in bed. I
usually have no idea what sets them off.

Edit: I got my first dog so late, because I'm allergic to dogs, and I was a
sick kid. My parents didn't want to exacerbate my allergies. I have dogs do
this day, and I just deal with the allergies.

------
appleflaxen
Nobody has mentioned how effective it is to rebreathe when you feel a panic
attack coming on.

I've had them for 50 years, and the single most effective thing I can do
remains finding a paper bag to breathe into when I feel the hyperventilation
begin.

I suspect most other sufferers know this, but just in case this is a new
problem for anyone.

------
NeedMoreTea
Has happened to me once. All of a sudden I couldn't breathe and I had an ache
in my chest. No doubt I was hyper ventilating, but I was also sweating and
getting vision effects. Which had me convinced I was about to die of a heart
attack.

I don't want to derail, but this strikes me as very odd:

 _" Right after it happened I went to see my regular doctor and got a
prescription for medication that can calm me down in that situation"_

I mentioned it to doc at next visit, quite some time later. He also decided it
was probably just a panic attack and unless they start to repeat to forget
about it. It wouldn't occur to me to seek and carry medication for something
that happened once in a lifetime. Unless it had turned out to be the symptoms
of something serious and life threatening.

~~~
Moru
If the panic attack is triggered by you being affraid of getting a panic
attack, it might be possible to avoid it if you are carrying something you
think helps. On the other hand just forgetting that at home might trigger the
attack again. It's important to know why you are getting panic attacks in the
first place. They can be caused by serious stress and burnout.

~~~
beager
In my late 20s that did help me quite a bit, to carry a medication that could
help me if I did have an attack. However, making the decision to not carry it
after a while was supremely empowering, and helped cement the notion that I
could manage my anxiety and calm myself down. And I do, on a regular basis.

To each their own I suppose. Also, if you’re reading this and struggling with
anxiety or panic attacks, you’re not alone, but the thing that helps you cope
may be unique to your situation, so please work directly with a therapist or a
doctor!

------
chrisfinne
My son was getting them for a couple years and the frequency was increasing.
He was missing school. We tried all sorts of techniques that you can google.

Finally took him to a clinical psychologist that focuses on them and I was
embarrassed on how few sessions it took this guy to solve them.

~~~
ghostbrainalpha
Was it just talk therapy that solved it?

Or does your son have to do ongoing treatment like meditation / prescription
medication?

~~~
chrisfinne
Just talk. Maybe 5 sessions?

It basically boiled down to (in his case) "so your heart is beating fast?
that's ok. not a big deal."

It is always amazing to watch an expert in any field distill a seemingly
complex problem into a simple one with a simple solution (at least in my son's
case).

Obviously, his decades of expertise was able to eliminate a world of root-
cause possibilities and guide the conversation to help my son believe this
simple conclusion.

He'd also induce panic attacks by having him breathe through a narrow straw.
Probably helped to demystify them and practice dealing with them.

------
imartin2k
Personally I'm happy that I don't have to rely on medication (although I
understand that it gives peace of mind to have access to it, just in case.
This in itself might prevent future attacks)

In my own experience, the key to coping with panic attacks is the right
breathing technique to prevent hyperventilation from happening.

Ever since I had a few panic attacks many years ago, I am using a technique
which works great for me: Short deep inhaling and very slow, long exhaling.
Every exhale has to be significantly longer in duration than every inhale.

I've been in many situations in which I felt the first signs of a possible
attack, but with this breathing technique, I always was able to stop it from
actually happening.

------
ca98am79
I was diagnosed with sever panic disorder in my early twenties. I tried
everything (therapy, medication) but nothing really helped.

I eventually became agoraphobic and wouldn't leave my house.

I did a 10-day vipassana meditation course
([http://dhamma.org](http://dhamma.org)), where you can't read or write or
listen to music or talk. You basically just meditate the whole time.

I had very bad panic attacks during the 10 days, but eventually meditation
actually helped me to deal with it.

I'm now in my forties and meditation is the only thing that truly helps me
with panic attacks.

------
Taylor_OD
I've got near crippling social anxiety. It's hard because intellectually I
know my brain is creating and responding to fear that is all artificial.
However in the moment that's nearly impossible for me to realize or take in.

I've been having more and more conversations with friends and co workers about
anxiety recently and that's helped a bit but realistically this is something
that I'm going to have to do real work on.

~~~
nicklovescode
Have you tried propranolol? The research shows it’s quite effective for this
kind of thing

~~~
Taylor_OD
I'm pretty resistant to trying any drugs when there are drug free options with
high success rates (CBT). But thanks for the recommendation.

------
choult
My mental health has been suffering for the past couple of years for a variety
of fairly definable reasons, but I actually had my first one last night. It
was triggered so I kind of knew what was going on, but I really wasn't
prepared for the smack of adrenaline and the half hour cooling down period of
just trying to stop shaking and lose the desire to cry.

Luckily it was not debilitating, and happened in the car five minutes from
home, so I could get to a sofa and work through it; it also helped that I had
somewhere to be with friends that was in no way connected to my triggers and
so I could use that as a useful distraction.

I think the scariest thing for me, now, is that now I have to add
panic/anxiety attacks to my understanding of my own condition, which up until
now has been either some very black (but ultimately rational) periods of
suffering, or just general low mood to the point where I have dismissed the
idea of medication.

But this is now probably a game-changer for me.

------
codemusings
> Right after it happened I went to see my regular doctor and got a
> prescription for medication that can calm me down in that situation.

This seems so stereotypically American to me.

> But the real solution has come from many years of trying to understand the
> root causes of the panic and anxiety and working to deal with them.

What the doctor should have helped doing in the first place.

~~~
davidmurdoch
"Stereotypical Americans" don't have a "regular doctor" let alone just go to
one without a second thought about the costs of doing so.

~~~
codemusings
I would only imagine so. Which of course makes this whole situation of a
seemingly low barrier to getting drugs prescribed even worse.

~~~
weaksauce
Read the reply you commented on again.

------
nicklovescode
I'm a founder that has struggled with this (but it's basically been solved for
a while). When Panic Attacks ([https://www.amazon.co.uk/When-Panic-Attacks-
drug-free-therap...](https://www.amazon.co.uk/When-Panic-Attacks-drug-free-
therapy/dp/0091929601)) is a great book. Just being able to identify it and
know it's not dangerous helped me the most.

I loved his anecdote of doing jumping jacks while having a panic attack. The
lightheartedness of the way he approaches the disorder is kind of nice.

One weird thing that helped me was reading everything I could possibly find on
panic attacks over some short period of time. Every paper, book, medication,
etc. Unlike some disorders, the truth seems to mostly be positive (non-
dangerous, relatively straight-forward ways to beat it), and so the more you
know the better you'll be at approaching it.

------
empath75
I've always had sort of low key intermittent anxiety, but when my dad almost
died from acute pancreatitis, I became hyperaware of anything unusual going on
with my body -- and turning 40, there's a lot that's new going on. I made
repeated visits to the doctor over the course of a few years, convinced I was
dying of one thing or another. Realizing one day that almost all of the
various symptoms I had were symptoms of anxiety, it was like a weight lifted
off of me.

I've got it more or less under control now. I've figured out when to notice
when an anxiety attack is coming on, and just lay down and relax. And cutting
down on caffeine helped _a lot_. Anything that's a stimulant triggers them for
me. I now have like half a cup of coffee in the morning and nothing for the
rest of the day.

------
Uberphallus
I've had a few, and the only way I can describe is it being the same sensation
as if you're in a bad neighborhood, and suddenly you get surrounded, or a drug
dealer seems to be very shady in the exchange, or some tweaker looks at you
like you killed his dog.

In those situations I keep my shit together and think rationally, but when it
comes out of nowhere, you add to that threatening sensation the confusion of
not knowing where it comes from. So you think you're having a heart attack, or
a stroke, or who the fuck knows. It's a feeling of impending doom.

I see it the same our tendency to see faces on surfaces, our brain is wired
that way. It's also wired to sense danger, adrenergic pareidolia, so to speak.
And sometimes there are neither faces nor threats.

------
wpietri
I really appreciate when industry leaders talk frankly about things like this.
In current culture, this can be easily treated as an admission of weakness and
penalized accordingly. The more high-status people that speak up, the more the
stigma will dissolve.

------
ariehkovler
I've only had a 'true' panic attack once. I was running for a train and I
slipped on the stairs and landed hard on my back. My throat closed up, my back
ached and I couldn't shout, or call for help. Suddenly I couldn't breathe at
all. I didn't know it was panic; I thought maybe I'd broken my back or
something. Which of course made the panic worse.

I remember thinking "This is it. This is how I die, here on the station
platform, alone, with nobody noticing." It was a terrifying, helpless feeling.
It passed after maybe 30 seconds, as soon as I managed to take a gasp of air.

It was only once and more than a decade ago but even typing this is kind of
freaking me out.

~~~
jms
Sounds like you were winded
[https://en.wikipedia.org/wiki/Getting_the_wind_knocked_out_o...](https://en.wikipedia.org/wiki/Getting_the_wind_knocked_out_of_you)

Of course being winded could induce panic too, but not being able to breathe
in that circumstance has a physical cause.

~~~
ariehkovler
Thanks! That makes a lot of sense.

------
faissaloo
It's really strange because I still maintain a good amount of self-awareness
during my panic attacks so I'm like 'yeah gimmie a sec my brain's just being
silly' while also in the midst of crying and hyperventilating.

------
krmmalik
I'm going to politely disagree here and say solving panic attacks doesn't take
years but instead minutes. I suffered many panic attacks in my mate twenties
and early thirties and then learned some simple techniques that solved the
panic attacks in one fell swoop. The whole process took less than two minutes.
I've since helped a few friends with the same and they have positive
experiences in the same way.

If anyone's interested you can look into the work of Dr Bradley Nelson and
more specifically his book The Emotion Code. I use a combination of Timeline
therapy and emotion release and it does wonders for panic attacks.

~~~
nicklovescode
Most people I know that have read or written on this subject agree it can
often be cured in minutes (even after a decade of pain). David Burns has a
weekend program that often solves these situations quite quickly.

However, I'm not so sure about The Emotion Code's pushing of "organ energy
fields" or Dr Bradley Nelson's "message from above" to go write a book pushing
this

------
stef25
I've had just one of these and it was horrible. Lying in bed, I started to get
subtle pins & needles in my feet which moved up to my knees and the numbness
just kept moving up.

I thought I was having some kind of stroke so I jumped out of bed and by the
time I was in the kitchen 10 seconds later I was fighting not to faint, which
I thought would lead to me dying. I kept pacing around the kitchen table
quickly, basically walking laps for about an hour until it subsided.

Told my girlfriend to call an ambulance as soon as I hit the floor, which
luckily didn't happen.

------
longears
I found that potassium gives me anxiety and panic attacks. I noticed this
after drinking an electrolyte drink, and also eventually traced it back to
fish and to chicken broth, both of which are high in potassium.

I now eat a low-potassium diet, which fixed the problem.

My potassium levels are normal. My doctors have never heard of this effect. I
can't explain this, I just know it works for me, and I have some confidence
from looking back at my food logs that it's not a placebo effect.

------
paulpauper
I have never had this problem. I have felt panic but it never became a full
blown attack. I'm not sure what the difference between an attack and anxiety
is.

~~~
thecatspaw
the difference is gigantic.

The usual kind of panic for me is "oh shit, I forgot to do this, if I cant fix
it Im getting fired" kinda.

For me a panic attack is "oh shit, I forgot to do this, if I cant fix it Im
getting fired. ooooooh no I cant fix it because im a idiot and <some stupid
reason>. Im gonna get fired, not get another job ever again because I was only
at this job for 6 months. Fuck, is this it? convenient life, gone, just like
this? Why can I not just be neurotypical, with a working brain? What happened
in the last few years, I used to be such an upbeat happy guy. my whole life
will be like this. Full of bullshit, can't dos and more. How can my partner
still be happy with me? All I do is be a cynical asshole"

Sorry, this turned out a bit longer than expected. It just leads down a
rabbithole really quickly, and getting out of it is like climbing mount
everest

~~~
byproxy
I wouldn't necessarily call that a panic attack. Panic attacks are a physical
manifestation of some underlying anxiety. I've, personally, never been able to
focus on any other thought than the fact that I feel like I'm going to die
when I have one.

------
pacomerh
I had them years ago and I found Mingyur Rinpoche's lesson on YT, and
listening to his lesson helped me a lot. He made me realize something key. To
add to that, just the fact that he also had them made me realize I was not
alone. The technique he uses to deal with this issue applied to me
wonderfully. It didn't take me years, it took me days, of course everyone's
case is different.

------
amelius
This seems like a good resource:

[https://anxietynomore.co.uk/](https://anxietynomore.co.uk/)

~~~
_cereal
Hmm. To me, it seems not. Or at least, it seems an everyday expertise
knowledge, derived from direct experience. He does not seem to be a qualified
expert. The goal here is to sell the books.

~~~
amelius
From the website:

> the purchase of the book is totally optional, so please do take the time to
> look around my site

Also, the book is only 13 pounds, so I don't they they are making a lot of
money out of it. Perhaps they use the money to keep the website running?

~~~
_cereal
Yes, I read that sentence before writing and your argument about the website
expenses can be valid. It does not change my main point: when it is about
health one should search for information from qualified professionals. For
example:

1\. [https://www.anxiety.org/panic-disorder-panic-
attacks](https://www.anxiety.org/panic-disorder-panic-attacks)

2\. [https://www.mayoclinic.org/diseases-conditions/panic-
attacks...](https://www.mayoclinic.org/diseases-conditions/panic-
attacks/symptoms-causes/syc-20376021)

A personal experience can be illuminating sometimes but it cannot be
considered an alternative approach. For this reason, I do not consider it a
good source. Just my opinion.

~~~
amelius
You could be right, but on the other hand many qualified professionals
prescribe Zoloft or Xanax and be done with it. A personal account (which in
fact many of the comments here on HN are) can be very helpful, if only as a
reference when talking to real professionals.

------
walkingolof
Avoid coffee, for me this have been key.
[https://en.wikipedia.org/wiki/Caffeine-
induced_anxiety_disor...](https://en.wikipedia.org/wiki/Caffeine-
induced_anxiety_disorder)

------
taylodl
Not to belittle panic attacks, for which I've suffered a couple during my
lifetime and yes, they are quite scary, but am I the only one clicking on this
thinking I'd be reading about kernel panic attacks?

------
wolco
I use to get one every morning into work crossing over one bridge. After years
it never went away (never chanhed jobs either) but I started working from home

------
wolco
Does anyone get them after programming all day? Feels like my brain is in a
different mode and the transition back can bring them on.

------
m3mpp
Our western/christian way of seeing the world has a lot to do with this
condition. The illusion of control, this permanent struggle for betterment and
perfection is a very good recipe for anxiety, depression and mental illnesses.
Add to that the loss of faith, and that's it, you get millions of people on
antidepressant...

------
modzu
so are there really just magic pills you can take that stop panic attacks?
this guys carries them around but doesn't say if he's had to use them.

~~~
freakout
No, there aren't. But physicians aren't psychiatrists and often the first
treatment people get to treat panic attacks comes from their physician, and is
something like a beta-blocker. By and large these are ineffective.

That said, the placebo effect can be strong.

~~~
cryoshon
can confirm firsthand that beta blockers are not useful for panic disorders
despite being widely indicated for them. the beta blockers are intended to
treat the physical symptoms of anxiety like shaking, sweating, and fast
heartbeat. IMO they're a therapy which is really targeted at the doctors, who
will feel better if they are able to prescribe something which theoretically
helps the patient but doesn't carry any major risks like other therapies
might.

it turns out you can still have extreme anxiety and a panic attack if the
overt physical symptoms aren't there, however. anxiety is a state of mind as
much as it is a set of physical symptoms.

~~~
nicklovescode
Do you have research to support this? Propranolol for instance is psychoactive
in addition to hitting plasma norepinephrine / blood pressure etc

~~~
freakout
I was on propranolol for 4 years or so because I was having panic attacks but
had an irrational fear of antidepressants, which is what most doctors
suggested I try. My logic was A) I'm not depressed, and B) I don't want to
mess with my brain chemistry and become normal and boring. I was young.

In a case of cruel irony, I actually became quite depressed during the time I
was taking propranolol. (Recent studies suggest this is not coincidence.) It
also had no effect whatsoever on my baseline anxiety, which remained
uncomfortably high, though it did prevent me from having the actual attacks
that I considered my worst symptom.

At one point I stopped taking propranolol for a year. The highlight of this
year was losing a prestigious international post-grad fellowship when I had a
complete anxious meltdown during my final telephone interview. When it was
over, I vomited. After that, I finally gave in and told a doctor to give me
the antidepressants (in my case, 75mg venlafaxine).

For me, the effect was immediate, and I can only compare it to a case of cured
tinnitus. All of a sudden, this uncomfortable thing that I could feel at all
times and that I was always conscious of possibly overwhelming me was gone.
Presto. I must say I immediately felt remorseful and a bit stupid for
prolonging my suffering for as long as I did by refusing to try
antidepressants.

I stayed on venlafaxine until a couple years after my wife and I started
dating, at which point I felt like I could taper off, and I did. I'll leave it
as an exercise to the reader to look up how much of a pain that can be.

So, my recommendation to fellow anxiety sufferers is to not be afraid to try
antidepressants even though you may feel anxiety is the opposite of
depression. At least don't settle for a half-cure until you've explored all
your options.

