I've been dealing with anxiety attacks for about three years now. Explaining how they feel is fairly easy, but trying to explain why they happen is another issue. If you have ever been (or can imagine being) in a hospital emergency room waiting for "the news", that's pretty close to what it feels like. Your mind races, your thoughts blur, and anything you think of you begin to worry about. It makes it very hard to function because you feel like any piece of your world could suddenly collapse around you. Sometimes they last all day, relentlessly making you feel like something horrible is about to happen, even though you don't what that something is. Other days they last for an hour or two and suddenly disappear. Whenever they stop, they leave you feeling ecstatic and ready to take on the world. Until, of course, it comes back again the next morning or afternoon or two days later. You never can tell. The randomness of duration and frequency are what can drive you insane. You can have two perfect days, and crash the third. Or, have a perfect day interrupted at various intervals. Like I said, you never can tell.

Why do they happen you ask? That's an even better question, because in three years I haven't figured out a good answer. Sometimes it can be something as small as being hungry or having someone or something scare you accidentally. Sometimes it's something more obvious like a midterm or a paper or missing your girlfriend. I've gotten pretty good at closing my eyes, taking deep breaths and trying to relax until they go away, but that doesn't always work. Sometimes you just have to ride them through. Another characteristic of anxiety attacks, after you've had them quite consistently, is that nearly every time you get one you think that "this is it", and you just might have a breakdown or be put in a permanently anxious state this time. Another contributing factor is probably the way I think. I took the MMPI (Minnesota Multiphasic Personality Inventory) this past summer, and it indicated that my primary personality factor was ruminant thinking. In other words, I think things over endlessly without getting anywhere (chewing the cud or getting something stuck in your head are other ways to say it). Getting a particular issue stuck in a circle in your head doesn't help to let go or relax very much.

I'm quite sure that my anxiety attacks are related to(perhaps a miniature version of) the full blown panic attacks that I'm almost certain to get in my mid to late 20's. My dad's whole side of the family, all of his brothers and sisters, have had panic attacks. The way my dad explained panic attacks to me a few years ago is that people think they're having a heart attack when they get one. You get blurry, tunnel vision, staggered breathing, and a huge adrenal kick, among other things. They have medicine for it, but you don't know when you'll need the medicine until you actually get that first panic attack, if you ever do. It's basically a waiting game. My dad was somewhat concerned about telling me about them as early as he did. Personally, I'd rather know in advance than have a panic attack spring on me and have no idea what's going on. For the rest of you, remember, I KNOW I have a genetic predisposition for it so relax, I'm not trying to scare you.

One thing that can help with panic attacks (and presumably anxiety attacks) is triptophan. Triptophan is a chemical found naturally in such foods as turkey and asparagus that has been found to help reduce symptoms of panic attacks. It was formerly available in a pill form by prescription. However, from my understanding, it has been taken off the market in the U.S. by the FDA due to a "bad batch" that was created somewhere down the line. My uncle used to get triptophan, and my dad has actually eaten turkey when he's felt stressed and on the verge of panic.

At any rate, there's some basic information about anxiety and panic attacks from personal experience.

P.S. Writing or talking about them can help get rid of them sometimes.

A typical response to hearing the phrase "panic attack" in conversation is lighthearted skepticism, or at best, kind but incompletely-understanding empathy. I wasn't even aware it was an actual condition until it happened to me and I started to read up on it; I'd always thought it was just a sort of dramatic idiom.

If you're only familiar with the symptoms of a panic attack through secondhand knowledge, they do seem pretty strange. At the drop of a hat, and potentially due to no traceable trigger, one falls prey to:

• elevated blood pressure/heart rate
• dizziness
• nausea
• difficulty breathing/hyperventilation
• the sensation that the heart has stopped or is beating irregularly
• the feeling that they are about to die
• an impending feeling of doom

Although this surely seems ridiculous to an unaffected individual, especially the last item on the list, the feelings are indistinguishable from reality to those suffering the panic attack. Depending on the severity of one's affliction with panic disorder, they may find it hard to manage previously straightforward aspects of their life, and it is not uncommon for one in the grip of a particularly intense attack to take an unnecessary trip to the emergency room. Although no outright "cure" is available, there are some prescription drugs and psychiatric techniques that can help. On a personal note, I've found that spending time in the company of close friends, or even simpler things like making your way to some fresh air can help the situation a lot.

One serious problem with panic attacks is that they are often mistaken for other afflictions, such as asthma attacks or heart attacks. The result can be (and often is) that the panic attack is misdiagnosed and treated inappropriately.

As an asthma sufferer myself, I have witnessed people in the throes of a panic attack - and mistaken them for fellow asthmatics. The error is very easy to make, since the surface symptoms (wheezing, difficulty breathing, clammy skin, physical weakness) are very similar.

Furthermore, though patients with a predilection towards panic attacks are undoubtedly suffering from a genuine and very debilitating ailment, there is a tendency to disregard their behaviour as mere hysterics. In particular, it is a deplorable fact that gender bias is often applied (both by health care professionals and by friends and relations) - female patients are often regarded as hysterical hypochondriacs, and male patients are often treated with condescension, as cowards.

Panic Attacks just plain suck. Reality bites. I used to get them 3 times per day. VERY INTENSE. I think most of it may have been attributed to a car accident a few months prior, which I dont see how I could have possible survived. (thank you Acura). Still I wonder how it is possible to feel so horribly doomed while having one of these...

Chances are, if you are reading this, you probably have experienced this before.

This is the best advice(I am not a doctor) that I can give as an individual who has dealt with this demon.


Remember: There is a solution.


1. Talk to a Doctor/Shrink/Head doctor. Don't be ashamed, your not crazy. You just want to find a solution.

2. Intake:

Stimulants = BAD. Caffeine is commonly known to be found in Cola's, coffee, Tea, certain chocolates ect. These are common triggers in my case.

Alcohol (depressant)has also been a trigger for panic attacks for me. I really dont see why it would be, considering it causes dopamine release (a chemical that says "good boy/girl, your surviving, you feel good now") AKA pleasure.

Make sure you eat breakfast. Try some dairy (primarilly milk) I used to never ever drink milk. Now I do, because my joints dont pop and crack so much, and I feel healthier. (also... try to stay hyrdated).


3. Reasoning

Q: My heart feels like its skipping beats, or pounding out of my chest.
A: you're really scared.

Q: I check my pulse, it feels really weak. Sparattic.
A: Unfortunatly I got into this habit, which only seemed to add fuel to the fire... depending on how well I checked it made quite a difference. Veins and arteries tend to slide around a bit. if you are checking your pulse in your wrist, 5 seconds later it may appear to be weaker, due to the fact that it may have slide away from your two fingers. (don't check your pulse with your thumb)

Q: The walls seem like their bending.
A: Your eyes are focusing and responding quickly, probably due to the adrenaline.

Q: the rooms too bright, my senses are overwhelming me.
A: When your scared, your pupils dilate, your senses shapen quite significantly. Your hearing tends to increase also, and just about all your other senses.





Your best bet is to try to establish a difference between discomfort and danger.



Well thats all the advice I can dish out at the moment!

hang in there.

The world is closing in. You cannot think. Your vision starts to fade. Your hands and feet are tingly, then numb. Your fingers spasm. You feel an impending sense of doom.

Snap out of it, it's all in your head!

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Um, not exactly.

It's all in your physiology!

Read the panic attack nodes. The personal descriptions of the events share specific descriptions that can all be explained by a sudden decrease in the carbon dioxide in your blood. I will break down the events into specific physiologic responses, and next time you see someone in a panic attack, perhaps you will refrain from amateur psychology.

At the risk of inducing a panic attack, some biology and a teensy bit of high school chemistry will be involved. You can skip these parts and jump right into the jargon below.

Lesson Number One:
Carbon dioxide and acid

Ventilation means exchanging gases. We breathe in oxygen, use it to convert various foodstuffs into energy and growth, and produce water and carbon dioxide as by-products.

Our ventilation is controlled by the rate we breathe (respiratory rate, or breaths per minute) and by the amount of fresh air that gets deep into our lungs with each breath (tidal volume, measured in cc's). Our minute ventilation is our respiratory rate times our tidal volume:

Minute ventilation = RR X TV

It is possible to breathe quickly without hyperventilating. Watch a dog sitting on a porch on an August afternoon. Pant, pant, pant. Despite the dog's rapid breathing, it remains lucid enough to annoy the mail carrier. The dog has reduced his tidal volume; he takes small breaths, exchanging air in the upper airway, to cool himself off, with little air exchange in the deep reaches of the lungs.The air exchange occurs at the alveoli,tiny sacs at the end of the airways. The only air the blood sees is the alveolar air.

Conversely, it is possible to take deep, slow breaths, and still hyperventilate. Patients stuperous in a diabetic coma often do this. Even with normal or slow respirations, the patient may be hyperventilating.

Why would anybody, especially an unconscious person, choose to hyperventilate?

Carbon dioxide mixed with water makes carbonic acid. Breath by beath, our body controls the acid in our blood. The body, when things are normal, keeps the pH close to 7.40. Increase your minute ventilation, and your acid immediately drops (and the pH rises). Hold your breath, and you increase your acid (and your pH drops).

CO₂ + H₂O <-> H₂O₃ <-> H⁺ + HCO₃^-

Our kidneys ultimately control the amount of acid in our blood, but the kidneys, smart as they are, take a day or two to titrate the blood. The lungs have an immediate impact on your pH.

Hurry up, my eyes are glazing over...

A person in a diabetic coma has bucketloads of fatty acids; the body's pH drops dangerously low. By hyperventilating, the body reduces the carbon dioxide available to make carbonic acid, and raises the pH enough to keep one alive. Physicians call this "blowing off CO₂."

Despite all the hype about global warming, the amount of carbon dioxide in the atmosphere is essentially nil. It has increased 30% since 1750, and it is wreaking havoc with the environment, but as far as the body is concerned, the air we breathe contains no CO₂.

The partial pressure of CO₂ at sea level is 0.3 torr.Your body normally keeps the CO₂ at 40 torr in the arterial blood, more than 100 times greater than the atmosphere!

Enough science! Pant...gasp...gasp...pant....

Increase your ventilation, your acid goes down. Decrease your ventilation, acid goes up.

Lesson Number Two:
Ionized calcium concentration affects your muscles and nerves

While calcium is the most abundant mineral in your body, only ionized calcium has effects on nerve impulses and muscle contractility. Decrease the amount of ionized calcium and your nervous system becomes irritable. You may feel tingling. Muscles may go into spasm.

In severe cases, psychiatric changes can be seen with low ionized calcium levels. The amount of calcium available in ionized form is directly dependent on the pH. If you raise the pH by lowering the acid, less ionized calcium is available to work. If you hyperventilate, you raise your pH.

Lesson Number Three:
Cerebral artery flow is dependent on the carbon dioxide concentration in the blood

You do not want to go to work. The alarm clock stuns you awake. Sunlight is peering through the blinds. You slap the snooze button as you pull the covers over your head.

The alarm growls again 10 minutes later; an arm reaches out from the covers, and hits the snooze alarm again. Your head remains cocooned.

The alarm racks your brain once again.

You get up, and your head throbs. Each beat of your heart pounds your temples. You have a vascular headache.

You did not drink last night. Your period was two weeks ago. You feel fine otherwise.

Increasing carbon dioxide in the blood increases blood flow to the brain. CO₂ is a potent cerebral vasodilator. Conversely, lowering CO₂ squeezes the cerebral arteries.

(Not too long ago trauma doctors routinely hyperventilated head trauma victims to reduce bloodflow to a brain swelling in the skull, to prevent brainstem herniation. It may have reduced bloodflow, but patients did not do well, and this is no longer recommended.) Your cerebral arteries are clamping down as effectively as someone partially strangling you. Your adrenaline will surge. You will feel a sense of impending doom as the adrenaline surge triggers your "fight or flight" reaction.

---

Putting it all together:

Your body knows what it is doing, for the most part. You do not even think about your breathing. Once you start thinking about breathing, however, a cascade of events can be triggered.

You start to increase your ventilation. Your CO₂ drops.

The world starts to close in a bit as your vision fades just a bit. Vision is highly dependent on good cerebral bloodflow. Notice how in the death scene, the fallen hero's eyes look unfocused, yet she can still hear and talk.

You release adrenaline now--your pulse rises from this hormonal rush. You shake, might even feel clammy. All this is a direct response to the adrenaline. It is a physiologic response. It is not just in your head.

Now things get worse. Your fear increases your breathing. Your available calcium now drops. Your hands and feet start tingling, and your hands go into painful spasm.

A crowd envelops you. Invariably some well-meaning bystander will offer this advice: "It's all in your head. Just relax."

Feeling like you're dying (and the feeling is very, very real), advice like this is counter-productive.

Eventually, the cerebral arteries no longer permit enough bloodflow to the brain to support consciousness. Out you go.

(You will wake up again--once unconscious, the cortex no longer pretends to be superior to the reptilian part of the brain, and your breathing will normalize.)

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I used to have medical students deliberately hyperventilate to prove to them that these changes are real. I no longer do; the good old days when medical students willingly subjected themselves to a variety of barbaric exercises have since passed. I do not recommend that anyone try this at home without at first getting approval from your doctor. You can induce seizures and all kinds of fun things.