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Panic Attacks (avc.com)
338 points by abhi3 5 months ago | hide | past | web | favorite | 137 comments

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.

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. :)


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

An article about morning pages: https://www.theguardian.com/lifeandstyle/2014/oct/03/morning...

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.

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.

Any good links to share?

Sure, I just updated my comment.

thanks ridewinter :)

i too have found that they have become much less frequent as i get older. but even when they happened more commonly, just knowing what was happening helped me to cope. it was much scarier when i wasn't sure what was happening (was i going insane? having a heart attack?...). so im glad to see more awareness about it now, and hopefully people don't have to go through a long scary period like i did

Same experience. The first one's brutal. The uncertainty of what's happening and the fear forms a negative feedback loop, only making it worse. Am I having a heart attack? In my 20s?! But, ever after, I found them pretty easily defused with, "Ugh. This again. Yeah, yeah..."

The anxiety itself is still unpleasant, and sometimes it can take novel forms, symptomatically, which is cute (and a good way to jade you to legitimate medical issues). Fortunately, though, I've had nothing as intense as my first or second panic attacks to date.

I've had a similar experience. Now it only hits about once every two weeks typically, much better than what it used to be.

Honestly I don't mind it as much as I used to, and maybe that was due to the sheer frequency of it earlier in my life, but in a way it makes even the most mundane calm feeling truly special, and I like that, a lot.

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.

Wow, I wish I'd read this thread a year or two ago. I'm in my early 40's, and I had a couple of panic attacks last year for the first time in my life. For the first one I was driving and had to pull over and walk around in a strange neighborhood because I was convinced if I stopped physically moving I'd die. The second time happened at work, and I got a friend to drive me to the emergency room, having tunnel vision and difficulty breathing the entire time.

Here's my epiphany though: When I got to the emergency room, they just laid me down in a bed for monitoring, and after a few minutes (and about $1k) it went away. Since then, in the couple of times I've felt it coming on again I've just told myself that if it happens I'll find a place to lie down and relax until it passes. I haven't had to actually do that, because just the idea that I can is enough to make it go away. (YMMV, but it works for me.)

Good! Now there is also the question where are these coming from? A part of you is at a tipping point. You can ignore this message and find chemicals or methods to distract or you can face yourself now and accept the growth that is going to happen.

The breathing in and out by counts thing frustrated me for a long time. It didn't help calm me at all, but the advice is everywhere.

I can easily shallow breathe into my chest all day long. That doesn't fix anxiety.

You need to breathe into your belly. Watch your belly rise and fall with each breath.

It works, but in my case it only works while I'm actively focusing on breathing, which isn't super helpful. As soon as I want to start thinking about the core problem again, my autonomic systems revert to the original problematic breathing pattern.

Instead, you have to address the core problem. The only long-term solutions seem to be:

1. Rationalizing away the core problem that's making you scared. If you're anxious that you're not achieving your goal, you can decide that's not a goal anymore.

2. Solving the problem.

Neither of these solutions are paint-by-numbers. Life is hard. Solving hard problems is hard. If you're a high motivation person and you set your goals to be aspirational, you may just have to live with the discomfort of anxiety.

The mind is always afraid and anxious. It is what it does, finds problems. By focusing the mind on problems you will get more problems.

Your body knows how to calm down. It knows how to unravel that stored emotion and feeling. You only need to allow it to come out. Breathing and observing the breath is the first step of accepting your experience. You can never get rid of your emotions - you can only accept, allow or resist and suffer.

Found that to be true as well, which is the reason I got a semicolon tattooed on my forearm. The semicolon represents `Just breathe` for me. I got the idea from an instagram post I saw and after researching a bit I found Project Semicolon which is a mental health and suicide prevention project.


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.

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).

Having gone through years of this during my university years I agree here. The general notion of 'controlling' anxiety attacks can be problematic.

Once your body is full of adrenaline it takes 10 to 15 minutes to physically calm down, there's no shortcut, and often trying to suppress the physical symptoms keeps the cycle going.

What generally works much better is to simply accept that your body is going mad for a few minutes, it's million years old biological systems you don't have any control over, fighting them isn't possible. Keeping a detached mind, breathing normally and remembering that panic attacks don't kill you (the racing thoughts are often the worst thing) helps immensely.

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.

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.

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.

> I spent a few months largely crippled by panic disorder

Yeah, that's kind of what happened with me too. Only that the panic attack itself was only 2 months ago; Out of freaking nowhere. I remember I was reading a piece of code and then suddenly I felt my hearting beating faster and just couldn't breathe properly; you really just feel like you're going to die - right where you are. And then, after it has passed, you are left with the anxiety of it all and all the bad thoughts. I had to take medications for high blood pressure because mine was like 16/9, and my normal is 12/8 (I'm 29 and I exercise daily).

After 2 months visiting doctors I can say I'm "normal" again, but I have to be aware of the "long fuse" thing, because that seems to be the real killer.

> then suddenly I felt my hearting beating faster and just couldn't breathe properly; you really just feel like you're going to die - right where you are

That's exactly my experience. I didn't know what was happening. I'd never had a panic attack before and it came totally out of nowhere. Someone ended up phoning an ambulance. By the time they got there, all that remained was the shame of having to say "I'm fine, please just ignore me". It wasn't until much later that I realized that I'd been stressy and anxious for a good while.

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.

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.

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.

For anyone wondering what they feel like...imagine that feeling of when you're just about to fall back in your chair...or when you trip and think you'll fall...or when you're surprised by someone walking in on you. That initial 'gasp', sustained. For up to hours. I'd also feel a tightening of the chest, and on occasion the panic would crescendo and my limbs would start going numb and I'd start feeling faint.

The first serious attack I had (it wasn't preceded by any trigger, I was just watching T.V. and eating) sent me to the emergency room, although I knew it was a panic attack and not life-threatening it got so bad that I thought it'd be worth it for my peace of mind (sidenote: it's not, and I got a nice bill). Drinking alcohol can help, but I would recommend to just endure the attack. I don't get panic attacks randomly anymore, but I may after a night of heavy drinking (which, ironically, might begin to stave off general anxiety).

They are terrible. Fight-or-flight gone haywire. I'd know exactly what I was experiencing and could rationalize what was happening, but that made no difference. Thankfully, they are rare for me these days.

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.

Certain strains are better for younger people. When I was young things seem boring or slow and sativa would make things fun/exciting. Now that I'm older I'm never bored I usually need more time. Indica works better. Hybrid strains are even too much.

> 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.

I think they meant the weed and xanax.

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.

Depending on cannabinoid profile, intake, strength it can help with or potentiate panic attacks (which sometimes start with omg I comitted a crime. What if someone finds out? Or by the unfamiliarity of the feeling - was my drug laced with something?) For the exact reason it should be legal, so people know what they take. As a sufferer of panic attacks I can attest that cannabis had been a life saver at times, although I don't medicate (with cannabis nor prescription drugs) at all now.

Consider looking into CBD. It has the anti-anxiety benefits of cannabis without the psychoactive effects of THC which can amplify a panic attack. And none of the awful poison of benzos which will kill you if you take enough of them for long enough.

As I said, I was prescribed maybe 10 alprazolam pills for their intended use as an emergency treatment for panic attacks. This was a couple of years ago and I still have most of them. No desire for a benzo addiction here.

And trust me, I tried CBD (no noticeable effect) as well as strains of cannabis leaning more toward that side of the spectrum.

For better or worse, I just lost my tolerance for the stuff. Even small amounts have the potential to make me feel uncomfortable so rather than keep trying to like something that doesn't agree with me, I just tend to decline offers these days. No big deal. I've no problem with people enjoying what they enjoy. It's just not pleasant for me anymore.

I've had the same experience with Cannabis.

I'm convinced I have a mild allergic reaction to it. I think people don't realize that can happen.

Yes. People dismiss anxiety as "just mental ill health" or a mild problem.

For some people anxiety disorders mean years of life lost to disability.

It seems very human to extrapolate from our own mental health to assume other people experience things like we do.


Personal attacks will get you banned here. Please review https://news.ycombinator.com/newsguidelines.html and post civilly, or not at all—regardless of how wrong someone else is or you feel they are.

In my opening sentence I admitted to disregarding a legitimate mental health issue that I didn't suffer from. In the next few sentences I described getting high before going to a kids birthday party.

Not to come off as snarky, but if you interpreted my comment as looking for sympathy then I suggest you read more carefully.

I dunno, some of my favorite humans make mistakes. I can’t begrudge a lesson learned, especially if nobody was hurt.

I might be putting words into the op's mouth but, what I think the they were trying to say that this is what their life looked like right before experiencing a severe panic attack. So if you find yourself making decisions like this, you might be on a path that doesn't end well. I don't think the shaming was entirely necessary.

Showing up at a kids party stoned seems like a pretty normal thing to me. It's completely socially acceptable to drink alcohol at kids parties. Chuck E Cheese's even sells alcohol.

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.

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.

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.

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.

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.

I had exactly the same experience. Turns out that I am really sensitive to benzodiazepines. I now take 1/2 of a 0.25mg tablet when I know I'm going to do something that will trigger me (maybe twice a year). But a doctor initially prescribed 3mg a day (!) to me. I got physically dependent and had to wean myself off using liquid valium.

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.

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.

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?

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

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.

> 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.

>> “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!

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.

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).

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.

No, I haven't been diagnosed with any, but I know what you mean when you carry a lot of stress in posture and mindset.

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


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

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.

Meditation has showed some promising results:


Anecdotally it's very helpful to myself.

Deep breathing can be part of CBT too.

As someone who went to their doctor (experience summed up elsewhere in this thread), I'd say there are merits to following internet advice with regards to this subject. Reading others' experience and techniques (even if I didn't adhere to them) was highly beneficial to my understanding of what was happening to my body. I don't think a doctor would've given me the time of day.

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.

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.

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.

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.

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.

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

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.

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.

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

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

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.

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.

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.

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.

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!

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.

Was it just talk therapy that solved it?

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

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.

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.

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 :)

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.

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

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

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.

> 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.

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

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

Read the reply you commented on again.

Not exclusively American, but very 'modern'. I recently watched commercial TV in the UK (I usually stick to BBC) and it was appalling to see adverts for codeine advertised for day-to-day back pain. Like it's a trivial thing.

The cause of back pain is, in day-to-day circumstances, because of bad posture. It can be fixed by stopping the bad posture, with some good habits and perhaps yoga. You can make money from yoga, but not enough for national TV advertising budgets.

Luckily in the UK we don't have the completely insane position of having prescription drugs being advertised in mainstream media. I think that is peculiarly North American.

(Yes of course there are serious chronic conditions, for those you see a doctor not watch a TV advert)

I remember setting up an appointment with my doctor to discuss treatment. I ended up talking to a nurse practitioner that day as the doctor was unavailable. Her immediate response to hearing my symptoms of panic and anxiety were to prescribe me a dose of lorazepam. I was a bit concerned that therapy wasn't the first suggestion and medication seemed like a slippery slope, so I didn't fill the prescription. Probably for the best, as I've seemed to manage on my own just fine.

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...) 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.

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.

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.

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.

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.

Sounds like you were winded https://en.wikipedia.org/wiki/Getting_the_wind_knocked_out_o...

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

Thanks! That makes a lot of sense.

>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 had that happen once on my home's stairs -- hurt my back, and then opened my mouth but couldn't speak, breath, etc for a couple or minutes (or so it seemed).

But it's not a panic attack itself. Had 2 of those quite young (at 15 and like 22 or something like that) and never had them again since, but they're different experience (and quite scary), like people here described it.

Possible that it might have been, or proceeded by, by your diaphragm spasming. A hard blow to the chest or back can cause it to spasm for a while and you literally cannot breathe, which is pretty terrifying.

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.

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.

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

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), 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.

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.

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.

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.

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

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.

There's a world of difference between panic, anxiety and a panic attack.

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.

This seems like a good resource:


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.

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?

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

2. https://www.mayoclinic.org/diseases-conditions/panic-attacks...

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.

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.

Avoid coffee, for me this have been key. https://en.wikipedia.org/wiki/Caffeine-induced_anxiety_disor...

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?

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

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.

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...

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.

As stated in other comments, Xanax or other benzos can bring you down. Or you could go to the hospital and get injected with a nice strong sedative like Haldol. None of these approaches are particularly healthy longterm.

The closest thing I've found to a magic pill after years of searching has been CBD. Smoking a high CBD cannabis strain is probably the fastest way to get it in your system in an emergency. If you're somewhere smoking isn't an option, they have tinctures you can put under your tongue. Unlike Xanax or other pharmaceutical solutions, CBD is natural, has mild to no side effects, isn't addictive, and is non-toxic i.e. it won't kill you if you overdose.

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.

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.

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

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.

It depends on the person (some substances work better than others on someone, most doctors will recommend to try for 4~5 weeks and see if there is any effect, positive or negative).

Also there can be a strong placebo effect of taking the pill.

benzodiazepines are the effective treatment for panic attacks. they're flawed for a lot of reasons, however: addiction potential, rebound anxiety, reduction in emotionality / cognition, weakening of short term memory, somnolence, etc.

the medical standard of the 2000s - present would also be pushing SSRIs as the remedy for chronic anxiety, though they're quite useless for acute panic attacks.

third-line treatment might be barbiturates or similar, which would work in cases of acute panic. not sure if they are actually used however.

Yes xanax works perfectly but stops working if you use it daily and makes things worse

Exactly, its just a bandaid that keeps ripping the more you use it. Meditation and positive thinking and exercise I think help best.

Any benzo would probably work but they need time to kick in.

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