Panic Attacks

[Raidra]

Can anyone give me some advice re: panic attacks? My mom has a major amount of anxiety and had a panic attack yesterday. She's looking for medication either to help her anxiety overall, or just to take during an attack. The problem is, she can't take anything that's habit-forming. She just came out of rehab for oxycodone (it was medically necessary until very recently), and she reacts poorly to Ativan and possibly also to another med, which I'm forgetting.

She also wanted info on any possible herbal remedies she could try, but the only thing I could think of was Rescue Remedy.

She is in therapy, but to be honest, it seems to make things worse, at least right after a session (they dredge up stuff she'd rather forget). I know it will help in the long run, but it will take a while.

She's spoken to a pharmacist at CVS and gotten a rec, but she wanted me to ask around, too.

Thanks!

[lalasmama]

I used to be on propranolol. It's a beta-blocker, I believe. More or less, I used to when my anxiety ramped up. The anxiety went up, my blood pressure went up, which then made me sweat and freak out more... and then I would pop a propranolol, it would force my blood pressure down, and I wouldn't be able to get anxious about anything. It was really kind of funny; I could not get anxious/mad/upset for hours afterwards.

Unfortunately for your mom, I think *anything* can be habit-forming, whether its typically thought of addictive or not. If she believes it's going to work, and gets some comfort from that knowledge, it can easily become a situation where she feels like she needs it to get through certain situations. Propranolol isn't supposed to be habit-forming, but that doesn't mean it can't become a habit to take it when she's upset, and any medicine used like that could lead to addiction... even a tylenol, realistically.

[Tondi G]

for panic attacks I didn't have mush luck with xanax and ativan ... the only thing that worked well was Lexapro. I stayed on it for about a year and then weaned off. I still have some anxiety and the occasional bout with panic attacks but it is nothing I haven't been able to work through on my own. I do like rescue remedy for a quick spray when I am feeling anxious. My neighbor has used a spray called Fear-less also a homeopathic like rescue remedy. My DH likes rescue remedy as well.

[Melaine]

I was on Prozac and it worked for this, but it lost effectiveness and also caused weight gain. You might have her read up on cold shower therapy on earthclinic.com. I have used cold showers off and on to treat my GAD and it does help.

[mytwosons]

IIRC, any of the SSRIs can treat anxiety.

Gaba is a supplement that I find works well for anxiety. Also, many people are low in magnesium, which helps with anxiety. She could up that to bowel tolerance.

ETA: How are her hormone levels? I'm in perimenopause and when my hormones are out of whack, my anxiety sky rockets.

[egoldber]

SSRIs are helpful for long term treatment of panic disorder, but they don't generally help a panic attack when it is actually happening. Often docs give a benzodiazepine (Ativan, Xanax, Valium, Klonopin) to help with an attack in the moment. But benzos can definitely be habit forming, so I am not sure what the protocol would be for someone with a history of drug addiction.

[m448]

I had good results from L-Theanine in treating my anxiety. It's one of the components of green tea but in pill form isolated and concentrated. I stuck to Suntheanine branded stuff (it will list it on the back of the bottle) for standardization and usually bought it off vitacost.

[Green_Tea]

If she's concerned about the addictive nature of some drugs, but is open to alternative remedies, an appointment (or several) with a naturopath might help. They can order bloodwork and other tests just like an MD and check for vitamin and nutrient deficiencies that can aggravate anxiety, plus they're well schooled in how different supplements and herbs can interact to help or exacerbate problems.

[ThreeofUs]

She needs a sympathetic psychiatrist, if you're wondering about meds. Ask around for a recommendation, and go with her. They usually prescribe 2 meds. One for any low-level issues (like paxil) and one to take as panic attacks begin to surface. If her first experience with an "establishment" psych was poor, move on to a second - it can take a while to find the right match.

ITA that, if you want to go the natural route, she'll need someone to help her understand what's going on with her body. That means lots of tests, and usually a license. Again, ask around for someone good and well-established.

GL to you and your mom. PT coming your/her way.

[vludmilla]

I would avoid benzodiazepenes at all costs. I would also consider a new therapist. It is not effective to treat anxiety by dredging up the past as you said. She needs a competent cognitive behavioral therapist to get over the panic attacks. CBT is the gold standard treatment for panic and is very effective for most people.

[m448]

Also in the same vein as therapy I found EMDR to have worked out pretty well for me. I did it with a certified therapist last fall for some PTSD plus other issues and it was quite a breakthrough.

[Raidra]

Thanks so much, guys. I'll look into the herbal/homeopathic recs and the cold shower thing this afternoon during naptime. I'm sure she would go to a naturopath if I told her to, but money is also an issue. She and my dad are both out of work and while he's getting unemployment, she's having trouble getting hers set up (she was on disability for a little while, which just ran out). She's also got to get COBRA for a month to cover the rehab, then she's going on another low-cost insurance once that runs out.

Anyway. Most benzodiazepines are out for her. She had every possible side effect, and it was NOT a pretty sight. Plus, her doctor kept her on it (Ativan) for way longer than recommended. Thankfully, a lot of the effects have already faded (specifically the paradoxical effects), but the others will take a long while to go away, if they ever do. The psychiatrist at rehab gave her Clonazepam to help her wean off the Ativan, but she's not noticing any effects at the low dose she's on, and she's afraid to increase it. She's already on Effexor and has been for probably ten years. I told her that she should talk to her doctor and therapist about trying something else, since she had a massive bout with depression while she was very sick and it didn't seem to help at all. Since she's been feeling better physically, her depression seems to have eased up a lot, so that's good news.

I think she likes her therapist, but I obviously don't know the specifics. My mom had a traumatic childhood and she never sought help and tried to repress it. A lot of her fears and anxieties are directly related to what happened to her, so I think that's why they're discussing her past, so she can process it and learn to deal with the way it's affected her.

[Indianamom2]

I can relate to the anxiety/panic attacks.

I've tried Paxil/Paroxetine with success in the past (both are SSRI's) and am currently having good luck with Notryptiline (a tri-cyclic antidepressant). The Nortyptiline seemed to work pretty quickly and I don't believe it's habit-forming. It can cause weight gain though, just as an FYI.

I was also given Klonapin (clonazipam?) to try for immediate relief in addition to the other meds. I think it can possibly be addictive, but I believe the doctor told me it wasn't as likely with that medicine. I never ended up using it, so I don't have any real experience with it.

Good luck!

[pinkmomagain]

For anxiety/depression she should also be considering: magnesium, vit d, and fish oil. Lots of outdoor time and exercise (even just walking). I know this doesn't address the panic attacks specifically, but all should help with anxiety/depression in general to some extent.

[Toba]

I've been on several meds for panic/anxiety ... most of them make you gain a ton of weight. Two years ago, I found a new psychiatrist (whom I've seen TWICE in two years) and meet with the most amazing therapist ever frequently. She is also an LPN and writes scripts for all my meds (she meets with the psychiatrist on a regular basis, so he knows what's going on). When I first started with them, I was a complete mess and they put me on Tofranil, which they said is the gold standard for panic disorder (I looked it up when I got home and wiki really did say that it was the gold standard). It is a very old drug (Dorothy Dandridge died from an overdose of it in the 1960s), but is gaining new popularity. It is a PITA though to get on the right dose. It apparently has a *very* long half-life and before each time I was upped, I had to get a blood test done to see how much of it was in my bloodstream. I could go on for pages but honestly, it was a great relief for me. Not long before I was put on the drug, I had been diagnosed with IBS (Irritable Bowel Syndrome) and IC (Interstitial Cystitis) and had to start taking meds for those problems. Both doctors that diagnosed me told me that in their practices up to 90% of their patients that have IBS and IC were panic disorder sufferers. To that end, I had been on Tofranil for several weeks and all of the symptoms of both IBS and IC were completely gone and I could stop taking the meds for IBS and IC. So, it definitely does work.

I am now weaning off the Tofranil and going back on Cymbalta to lose some weight and because I need a neurostimulant to get myself motivated again.

Every time I was on a drug for panic/anxiety (and there were lots) I was *always* on a benzo at the same time. The one I've been on the most is Xanax. Even though I was feeling better, I did need a rescue drug at certain times. And it's weird because I am fiercely protective of my Xanax. Both my psychiatrist and therapist said it's common because when you don't have a rescue remedy, that in of itself can cause panic attacks. I take 2 mgs at bedtime and 1 or 2 mgs during the day for anxiety (that's another important thing ... to learn what your triggers are and to learn the symptoms of an impending attack so that you can take Xanax or whatever before it goes full blown ... I still have issues with that). I rarely take any during the day, but I need the nighttime dose to calm down (I have OCD and insomnia too) and actually fall asleep (which, for me, is hugely important ... if I don't have a good 8 hours of sleep with all the meds I'm on, I am a panic riddled mess the next day). Benzos are very rough to get off (and can cause *severe* panic/anxiety if you wean too quickly), but I have successfully done it several times with the right doctor monitoring the weaning process. I honestly don't know of anyone though that takes meds for panic without taking a rescue med too.

One other drug you might look into is called Vistrol (not sure of the spelling) ... it is a non benzo rescue med that was once prescribed to me. It worked if I took it on a regular basis, but really didn't do much for me in the way of a rescue drug. My PCP also says that plain old Benadryl works too in an emergency.

Hope your mom feels better soon!

[Jo..]

Hugs to your Mom. Panic attacks are awful. Awful. I wound up in the ER twice because I was sure I was having a heart attack. I also have a blood clotting disorder which made me even more convinced.

In the throes of a huge full blown can't breathe attack, I have found a half of a xanax tab to be a lifesaver. I realize these can be an issue with people with a history of dependency, but I am addicted to almost everything under the sun, and my docs are so stingy prescribing them that I know they would never allow me to form a habit. I take maybe 1-2 per MONTH.

On a daily basis, I am on a combo of Cymbalta, Buspar, and Abilify. After 5 years and countless meds, this is the combo that works for me. I have also found that regular exercise helps TREMENDOUSLY and has enabled me to decrease my medication.

[Raidra]

Thanks guys. :) I know she's on Vit D and fish oil. I'll check about the magnesium. She was just prescribed hydroxyzine (an antihistamine) to help calm her when she gets panicky. They took her of the clonazepam and upped her dose of amitriptyline (which she uses as a sleep aid). I've been trying to get her to get out and exercise more, but it's slow going. She readily admits that being outside especially keeps her mind off things, and that being busy helps. I suggested that when she starts to feel panicky (hers are triggered by dwelling on her financial situation and on her mother's recent death) that she get up and try distracting herself with exercise or something. She only really has trouble when she's just sitting around.