Medication Revisited

I have written about my views on medication in the past but I felt like I should revisit it. 

Browsing through panic disorder message boards on the web, it has surprised me how many people are taking multiple medications in order to escape from their panic disorder.  I completely understand the thought behind this: They say that a panic attack can be the most frightening experience of a person's entire life.  And I can say that it is for mine so far.  Even Vietnam war veterans have said they would rather go back to that experience than go through another panic attack.  Why would you not want to take a pill and make it all go away?  I get that.

One major problem I have is the notion that taking a benzo or SSRI is treating a person's panic disorder.  This is wrong.  That is like saying that giving pain killers to a person that broke their leg is treating the broken limb.  It is not.  Yes it alleviates the symptoms, but take away the medication and you are back at square one.  The only way to treat panic disorder is to understand the biology behind it and use CBT to retrain your brain to respond differently to your thoughts.  I hope that by reading through the rest of this blog you can start to understand why this is the case. 

Medication to panic disorder is just a security blanket: Imagine you are on a crowded bus and start to feel panicked so you reach into your purse to grab a pill.  But you can't find any.  What do you think this will do to your anxiety level?  To the severity of your panic attack?  Yes, it will be WORSE.  Remember, with this disorder you need to show your amygdala that a panic attack is not scary or dangerous.  By taking a pill, you are telling it that yes the experience was scary or dangerous so you took a pill to make all of those feelings go away.  You are only going to make it harder for yourself when you decide to treat your panic attacks for good.

What bothers me is how many people try the CBT thing and decide "It doesn't work for me".  In my opinion, these people were not trained to properly use these techniques, or else they have not spent enough time working hard to learn the techniques.  For the first 4 months of my therapy, I thought I was trying, and I thought I was doing everything right.  But you know what?  Each panic attack scared the hell of out me and I wasn't able to use the skills properly.  It takes a LONG TIME to be able to do this.  It takes a lot of practice and a lot of patience.  But if you tell me that it "doesn't work for you"....I will just have trouble believing that.  If you work hard and honestly give 100% of yourself, it will work.  Trust me.  Please put down your medication and start actually treating your anxiety disorder!!

Uh oh...new sensation

Sorry for the long delay in posts.  I felt like I was writing to myself and no one was finding the site.  If you are reading this and have any questions or comments please please do not hesitate to contact me (panicremission@gmail.com).  I understand if you want to remain anonymous so just leave a comment on the site or create a random email address.  This disorder can be debilitating if not managed properly and I want to help in anyway I can.  Thanks guys.

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Okay so by now you hopefully have a pretty good handle on riding out a panic attack.  It sort of runs through the same motions each time and you just breathe through it and continue what you were doing.  No big deal.  But sometimes there is a new sensation that can throw you off - maybe your panic attacks are largely focused on chest pain and chest tightness but then one time you feel like your throat was closing up.  And you haven't experienced that before.  You get scared and suddenly you are back to fearing the panic attack, or at least fearing this new sensation to the point that it leads to a panic attack.  I like to do two things in this situation.

1) I don't normally advocate looking up sensations online.  I am a hypochondriac, as I am sure a lot of people with panic disorder are.  Looking up medical stuff online is just a bad idea, it will make you feel worse, not better.  The ONLY time I think it is okay to look up a sensation is to confirm that it is due to anxiety (and you probably should just take your own word for it, and not even look online).  If you are EVER going to look something up online, type the following into google "[your sensation here], anxiety".  There is also this website that lists anxiety symptoms: http://www.anxietycentre.com/anxiety-symptoms.shtml  I sometimes find it helpful to review the list, and just remember how many crazy sensations you can feel as a result of anxiety.

2) Put some humor into it.  You have trained yourself to be okay with a physical sensation.  Be okay with having a headache, being dizzy or having chest pain.  And now suddenly you have this sensation that your throat is tightening up and you can't breathe.  Its almost like your body is *searching* for a sensation that will get your attention (at least sometimes it feels like that!).  When this happens I try to have the attitude like "Well I see you've found something new to try, amygdala...you're going to try to get me to believe that I can't breathe huh?  Well you are doing a pretty decent job, I mean my throat feels pretty tight.  Unfortunately, I can still breathe.  See?  I'm breathing in....and now I'm breathing out.  Good try though."  Sometimes I will be working or doing something and feel a sensation and I will even smile a little and be like "oh amygdala, what are you up to now you troublemaker?"

You just have to do whatever it takes to get away from *fearing* the sensation.  I know it is hard, but fear is what fuels panic so you never want to give it that fuel.

Remission and Relapse

Okay so with all of your hard work and talking to your amygdala and riding out a panic attack, the panic will definitely lessen but I am hesitant to say that it will go away completely (but for some people it might!).  For the rest of you, it definitely won't bother you as much, and you will be able to continue to live a normal life but it would be a lie to say that you will never have another panic attack in your lifetime.  So I consider this to be a "remission".  In medicine, remission means that you have a chronic illness but that you are not experiencing symptoms at the present time.

Unfortunately, bad stuff can happen - maybe you lose your job or a parent is sick and you start to feel a lot of stress.  The symptoms may slowly start to creep back up to you.  You have to try and recognize that you are feeling this way because you are stressed out.  Not because you have a life-threatening illness.  With this new stress, it is possible that you will relapse a little bit into your old state.  Try to use this knowledge to your advantage and practice the skills that you have learned.  What has happened to me in the past is that I will be stressed out about work or relationships or what have you and have a couple of days where I am experiencing a few panic attacks per day (which I ride out fine).  But when your body goes through a bunch of attacks like that it can start to take a physical toll.  Suddenly you are hyper-aware of every little sensation in your body and your muscles are probably really tight and sore - this can create anxiety.  Recognize this series of events so you do not think something is wrong with you.  Yes, you might feel out of sorts for a few days after the fact.  Don't let this turn into a cycle of thinking something is wrong, having a panic attack and then feeling worse and then worrying and then having another attack etc etc.  Remember that during a stressful time, a relapse may occur.  That is okay.  Deal with it the best that you can.  Remember that your body might not be quite right for a little while after that but that is normal and nothing is wrong with you.  You are not spiraling out of control, you are not going back to the beginning.  You might have a few "off" days, but everyone does right?  With our disorder you have to make sure to recognize that this is normal, it is part of being a human being and you will feel better shortly.  Keep a positive attitude about your condition.  Attitude is everything with panic disorder.

A word about medication...

Okay so I thought I would say a few words about medications for panic disorder.  The typical medication prescribed for panic disorder are benzodiazepines (xanax, klonopin, etc) and SSRI/SNRIs (prozac, zoloft, etc).  Benzos act on your brain and basically calm down your brain if it is overexcited and your neurons are firing way too much.  They act pretty quickly, within minutes, and so people like to take these when they feel a panic attack coming on because it will lessen or stop the attack.  When I have taken these in the past I could almost feel them slowing my brain down.  SSRIs are pretty complicated so I won't get into the mechanism of action but these are antidepressants and keep you in a "happier" basal state, I guess, so that you aren't as prone to feeling anxiety on a daily basis.  You take them regularly every day.  SSRIs would be considered more of a long term, in-the-background sort of thing whereas a benzo is short-acting and would be taken at the onset of a panic attack to achieve instant results. 

I think both of these medications are great, and they have their purposes with other medical problems.  But not ours.  Our problem is essentially a fear of the fear response.  To get over this you need to prove to your brain that this fight-or-flight response is NOT something to be scared of.  But if you are someone that pops a xanax every time you have an attack you are telling your brain "Yes, amygdala, this is a VERY scary and dangerous situation, so I am going to take this pill and make it go away".  You are confirming to your amygdala that there was in fact a dangerous or scary event going on.  This is the opposite of what you want to do.    

Think about it: what is so scary about a panic attack?  It is the fear of death, of going crazy, of having something terribly wrong with you, of passing out.  If you are having an attack and you take a xanax and then your attack goes away....guess what - you just confirmed that you were having a panic attack and it is not some life threatening illness.  It means that you are not going to die, you are not going crazy, you do not have anything terribly wrong with you and you are not going to pass out.  This, if anything, should give you all of the confidence in the world to go out there and power through a panic attack and start to retrain your amygdala.

If you have been on medication for a while I know it will be very scary to get off of it.  But if you want to get rid of this disorder for good, you have to show your amygdala that a panic attack is nothing to be afraid of.  And unfortunately you can't do that with medication as a security blanket.   

Don't Leave

Okay so I think the single most difficult thing for me during my panic disorder treatment was staying put during an attack.  Your mind is telling you to leave whatever situation you are in - to run away, to go home.  And it is extremely hard not to listen to it.  You just feel this intense need to escape.  This is all part of the fight-or-flight response: your body is responding as if you were faced with a bear.  Of course it is going to tell you to run away!!  But to overcome panic disorder you need to show your amygdala that there is actually no real danger.  You are not faced with a bear and your life is not threatened in any way.  In order for your amygdala to understand this, you can't give into this need to escape.  If you have an attack at your desk at work and then you go into the bathroom to calm down, you are indirectly telling your amygdala that yes, there was danger at your desk, it was very scary so you "escaped" from your desk.  Your amygdala will then recognize your desk as dangerous and you will continue to have anxiety and/or panic associated with being at your desk at work.  

To break this cycle, it is absolutely imperative not to give into the need to flee the situation.  You just have to sit there and breathe through the attack.  It actually helps to talk yourself (or as I prefer, your amygdala) through the situation.  If you are having a panic attack at your desk at work, you can say something like "Oh so I see that my fight-or-flight response must have gotten triggered by some set of cue at my desk.  Interesting.  Well I am just going to sit here and continue to work on this document.  There is nothing dangerous about the situation I am in so there is no reason for me to get up and leave."  The trick here is that you cannot be angry with yourself because anger actually comes from a very similar emotional place as fear so you don't want this to trigger further attacks.  You just have to be matter-of-factly with it.  Just observe your emotional and physical response with curiosity.  And don't get up.  I know how hard it is to stay put with all of the adrenaline coursing through you - you might squirm a little and that is okay.  But try really hard not to get up and leave. 

Another mistake that I have made in the past is to try to figure out what the cues were that triggered the attack.  I became almost obsessed with figuring it out.  The problem is that when I didn't find a "satisfying" answer I had a lot more trouble coming out of my anxious state.  The best thing to do is try not to overanalyze the situation.  Just say "Yep, something here must have triggered my panic attack.  Okay.  Well that's fine.  Doesn't matter what it was.  I'm just going to continue what I was doing".  (this is very hard, just to warn you!!).  The good news is that if you can manage to do all of this, to stay put and talk to yourself without anger and to not overanalyze what trigger may have caused your panic, your attack will probably last about 90 seconds (this is how long it takes your body to break down the adrenaline that has been released).  

I don't know about you, but I can handle 90 seconds of discomfort every once in a while.

Handling a fear of passing out

Okay so just a quick side note for anyone that is worried about riding out a panic attack with a fear of passing out / fainting / becoming unconscious.  First of all, it is extremely extremely unlikely that someone would lose consciousness during a panic attack.  Why?  As you are now aware, a panic attack is your body going into fight-or-flight mode and this involves, among everything else that is explained below, an increase in your blood pressure to deliver oxygen to your muscles so you are ready to fight or run.  Fainting, or passing out, involves low blood pressure - your brain doesn't have enough oxygen and since it is all the way up there at the top of your head, the easiest thing for it to do is cause you to lose consciousness, thus ending up on the ground where your blood doesn't have to fight against all of that gravity to deliver oxygen to your brain (again, a defense mechanism, this isn't going to harm your body at all).  So anyway with your high blood pressure during the attack it is HIGHLY unlikely that you will ever pass out.  I know it feels like you might, trust me!!!  But it just won't happen.  You might feel lightheaded, yes, and that is probably due to you hyperventilating without realizing it which is why the breathing exercises are so important.  And you don't have to breathe in super super deep - just a natural, slow pace like in....1....2....3....out...1...2...3.  Focus on filling your lungs with oxygen and then emptying them completely.  It is also easier while sitting or lying down because that way you will breathe with your diaphragm (lower chest) instead of your upper chest, which helps even more.  

The one thing I have noticed with my panic attacks is that since you feel like you aren't getting enough air (sometimes called "air hunger"), you tend to do a lot of inhaling but then sort of forget about the exhaling, or don't exhale completely.  The exhale is really important and I can get into all of the details about blood oxygenation levels if necessary but just trust me that you want to inhale completely and also exhale completely - focus on your exhale during the attack if you realize that it is a problem for you as well.  You don't want to be taking huge breathes and then not exhaling because this might lead you to feel more lightheaded or dizzy (which isn't dangerous so don't worry but it is just unnecessarily uncomfortable).  Okay good luck!!!!  Email me if you need help or advice!

First Step to Remission

Okay so the first thing you need to do, although I'm sure most of you have already, is go to the doctor and just make sure that everything checks out.  Let the doctor listen to your heart and lungs and really listen to them when they tell you that everything sounds good.  And I think it is really important to find a doctor who understands your condition and doesn't make you feel bad, or disregard what you are saying.  You will need to be honest with them and tell him that you have been struggling with anxiety.  Depending on how the doctor reacts, you should be able to tell if you have found the right person for you or not.  It needs to be someone that feels comforting.  Someone who understands what panic attacks actually are and does not blame you for your condition.  So let this person give you a full physical and try as hard as you can to believe them when they tell you that you are okay. 

Now you need to do something that will probably seem really scary.  But hopefully from what you have read in my previous posts and from what you hear from your doctor, there is absolutely no risk to doing this.  You need to ride out the panic attack.  You need to let the adrenaline wash over you and teach your amygdala that the fight-or-flight response is not dangerous.  Up until this point, your brain thinks that panic attack is a dangerous and potentially deadly experience.  In reality, it is not.  But you will need to teach your amygdala that.  In order to prepare for this you need to practice a few techniques.  One of these is the ability to separate yourself from your thoughts (it sounds really weird, okay, but just trust me on this one).  So just take 10 minutes per day and sit down in a quiet area and just notice what you are thinking.  Without any judgement about the thought.  Just be aware of what you are thinking.  So just say to yourself: "Okay I am now having the thought that I should be doing dishes.  Now I am having the thought that this is really boring.  Now I am having the thought that this exercise is incredibly stupid....etc" (and yes, until I realized the power of this exercise, a lot of my thoughts tended to be about how I thought this whole listening-to-your-thoughts thing was stupid - and that is perfectly fine but remember there is no judgement.  Just notice the thought, period).  One of the other benefits of this exercise is that, at least for me, I ended up feeling noticeably calmer after this 10 minute break.  Just sit or lie down, set a timer and close your eyes...  

Anyway this ability to separate yourself from your thoughts is really important because during a panic attack your mind will be flooded with thoughts of "I'm going to die" "I'm having a heart attack" "I can't breathe" "I hate this" "I need to go to the ER" etc etc.  and you need to be able to recognize that these thoughts are actually symptoms of the panic attack just like heart palpitations and dizziness are symptoms.  These thoughts are linked to your fight-or-flight response and will keep coming up with each panic attack but that doesn't mean they are correct and that you need to listen to them or believe them.  So if you can separate yourself from these thoughts, and just notice "okay, I'm having the thought that I can't breathe" it is actually super powerful.  Instead of thinking "I can't breathe!!!!!!!!" it is "I am having the thought that I can't breathe".  This reminds you that you are only having a thought that you can't breathe, not that you actually can't breathe.  And this shift in thinking is really critical for you to retrain your amygdala.

Now in the moment of a panic attack this takes a LOT of practice.  The fight-or-flight response is such a powerful response that it is very difficult to do the above exercise in the heat of the moment (especially if you are not at home) but if you keep practicing it becomes so natural that you can do this shift in thinking in any context.  But since it is so difficult, I want you to just have one goal in mind for the first few panic attacks that you ride out: just breathe.  Sit down and just focus on breathing in and out very slowly.  If you can start to recognize your thoughts as thoughts, that is awesome.  If not, just breathe.  Breathe and know that it will be over in about 10 minutes (and if you really are just breathing through it, it will be much shorter).  And importantly, NEVER feel bad about yourself if you fail, if you forget everything you are supposed to practice in the heat of the moment.  This stuff is SO HARD.  Even just to sit still is so difficult, I know it is.  You might be panicking for 20 minutes before you remember to focus on your breathing.  That is fine.  Do not get mad at yourself, do not judge yourself.  Recognize how hard it is to do this and celebrate every single baby step you make during this process.  I cannot emphasize this enough.  If you are constantly berating yourself every time you forget these exercises during a panic attack it will slow your progress.  Celebrate any possible positive change from the last time you had an attack.  And also recognize that there are good and bad days.  This is completely normal, and in no way does this mean that you are taking steps backwards (even though it might feel like it, try to be positive!!). The process of retraining your amygdala does not happen overnight.  It is a tough road but one that is so well worth it.  I know that you can do it.  Just start simple: Breathe.

 So the first steps towards getting over your panic attacks are the following:

1) Get checked out by a doctor and try as hard as you can to believe them when they tell you that you are fine.

2) Try to sit in a quiet place for 10 minutes per day and notice what you are thinking without judging your thoughts

3) Sit through a panic attack (don't run away, don't pace, just sit) and focus on breathing in and out.  Let the adrenaline surge through your body and just breathe.  The panic attack won't hurt you at all.  It SUCKS but it won't hurt you. 

4) Try to notice your thoughts during the panic attack, and recognize that they are symptoms of the panic attack itself.  They are only thoughts, they are probably not true.

Good luck.  I am proud of you for taking this step forward.  I know how hard it is.  If you have questions or need help or support do not hesitate to contact me: panicremission@gmail.com

Fight or Flight response explained II

So you can probably start to see the difficulty with the situation that you are now faced with.  Every time your heart rate increases, or you feel a little lightheaded, your amygdala wakes up and senses "danger" and does the only thing it knows how to do to protect you: initiate the fight-or-flight response.  Giving you the exact same feelings that you have come to dread and hate.  And not only that, every time you are in that same restaurant, maybe at around the same time or with the same people -  if your amygdala decides that this situation seems an awful lot like that one other time where there was danger, it will press the ON button and initiate the fight-or-flight response.  You will probably leave the restaurant (after all, your mind is telling you to run away) and eventually the response will go away.  Then your amygdala will think, okay good I survived that dangerous situation.  And then it will catalog all of the new information about that experience.  What you were wearing, what you were thinking, what you ordered.

You know how it seems like you have panic attacks completely out of the blue?  I tend to think that that isn't exactly true.  Example: maybe you have a panic attack while you are at home eating some cheerios wearing a red shirt and thinking about the ninja turtles.  Cheerios, red shirt and ninja turtles are now cataloged as "dangerous".  So now lets say you are at a grocery store and you happen to be wearing that same shirt.  And then you walk past the cheerios in aisle 5 and the box is advertising a free ninja turtle action figure with every purchase.  Your amygdala recognizes cheerios + red shirt + ninja turtles = danger and presses the ON button.  To you, it feels like you are having a panic attack for no reason at a grocery store.  But actually it is your amygdala working incredibly hard to protect you from what it believes to be dangerous. 

So the amygdala starts to gather this enormous amount of material that it thinks is dangerous.  I mean seriously it is probably an unbelievable amount of material, especially if you have had panic attacks for a while now.  To the point where yes, the attacks do seem unpredictable because you can't possibly remember every detail about every situation in which you had a panic attack.

But armed with all of this knowledge, this understanding of what is actually going on - you can start to do something about it. 

Fight or Flight response explained

Like I described earlier, the purpose of the fight-or-flight response is to give you the best possible chance of survival when you encounter danger.  One of the first things that happens is an increase in your heart and breathing rate.  These are beneficial for either fighting or fleeing - your lungs take in more oxygen and your heart pumps faster to deliver that oxygen to your muscles so you can punch harder or run faster.  At the same time, your body doesn't want to waste energy on anything that isn't immediately important to your survival.  So it completely shuts down your digestive system, and not only that, it doesn't want you to have any extra weight while you are running away from your attacker.  So whatever food or liquid you have in there needs to leave ASAP.  It also redirects blood flow away from your limbs so that if your arm is ripped off there is less blood loss.  Your sweat glands are turned on so you are nice and slippery to make it harder for your attacker to grab you.  Your pupils dilate so that you can better see your attacker's next move.  Okay so that all makes sense if you are trying to run from a bear.  What if you are just sitting in a restaurant?  What does it feel like?

You notice that your heart is racing.  It is extremely uncomfortable and you wonder what is wrong.  Your breathing rate increases - which you might not notice but you do feel a side effect of your accidental hyperventilation: feeling lightheaded and dizzy.  Your body turns off your digestive system so now you feel nauseous and maybe like you need to throw up.  Your body redirects blood away from your limbs - so now your arms and legs start to feel tingly or numb.  You start to sweat heavily.  Your pupils dilate and this screws up your vision - either making your peripheral vision blurry or maybe blocking it out completely giving you tunnel vision.  Your senses also become extremely heightened.  Every noise seems louder, smell seems stronger.  And I don't know if I have read this anywhere but just from personal experience I also know that you lose the ability to think rationally.  Your body has just initiated this ancient animalistic program and there is not very much room for you to use your brain and think clearly during this fight-or-flight response.  The only objective is to survive by fighting or running away.

So suddenly you get really sweaty, your heart is racing, you feel lightheaded and nauseous, your vision is blurry, your legs are numb and at the same time your mind is screaming at you to "run".  The only problem is that you are not faced with an attacker.  You are not about to protect your child from a tiger.  You are sitting quietly at a restaurant minding your own business.

So how did this happen?  Maybe you were in my position, where you skipped lunch and had really low blood sugar.  So you start to feel lightheaded - your brain needs sugar,  and it is politely suggesting that you eat something relatively quickly.  And you accidentally misinterpret this suggestion.  You instead start to worry: "What is happening to me?  Something is wrong" and with that fear, your amygdala wakes up and says "Oh there must be danger here!" and presses the ON button, initiating the fight-or-flight response.  As you are wondering what is wrong with you, you start to get more "symptoms".  Sweaty, heart palpitations and tunnel vision.  And you start to worry even MORE: "What is happening to me?!"  Your amygdala sees that wow, there is a LOT of danger here, obviously it did not give you quite enough adrenaline so it presses the ON button again.  Now you feel dizzy and nauseous and your legs are numb.  And now you are completely distraught and think you are about to die because your whole body is in chaos.

The good news is that you are not about to die.  As awful as it feels, your body is actually trying to protect you.  Your body was designed for exactly this type of response.  Think back to the days of our ancestors living on the plains.  They probably had to watch out for lions and other predators every single night.  They probably had this fight-or-flight response go off several times a day for their entire life.  It will not hurt you.  Your amygdala sensed danger and it is doing the best job it can to prepare you to survive. 

So you are sitting at a restaurant and you feel all of these symptoms.  And you don't realize that it is your amygdala trying to protect you.  You think that something is seriously wrong and your body is falling apart.  You think that you might pass out and die.  You are scared of the increased heart rate, at the dizziness and numbness.  You are scared because your vision is blurry and you feel like you can't breathe.  And your amygdala, wanting to always protect you from danger, remembers all of the details about this event.  It remembers that increased heart rate = danger.  It remembers that dizziness = danger.  It remembers the name of the restaurant, the position you were sitting in when you started to feel dizzy, who you were with, what you were wearing and what you were thinking.  It is trying to do a good job of remembering all of this information so that next time you are faced with this same "danger" it can press the ON button and protect you. 

There is one problem.

This "danger" that the amygdala has now cataloged and stored is the very same physiological response that it uses to protect you.  Your amygdala now thinks that the fight-or-flight response = danger.  And what is literally the ONLY thing that it can do?  Press the ON button again. 

What is a panic attack?

A panic attack is actually a completely normal physiological response.  It is otherwise known as the "fight-or-flight" response or an adrenaline rush.  This same biological response occurs if you are in a near-car accident or are hiking in the woods and run into a bear and her cubs.  This response has evolved to protect you by either preparing you to fight, or preparing you to run away from the danger.  The key to a panic attack is that this response comes at an inappropriate time.  You have this huge adrenaline rush and a feeling of intense fear....but maybe you are just sitting on your couch.  Or at a grocery store.  There is no bear, there is no car accident.  And so you can only assume that something terrible is happening to your body.  You must be having a heart attack or brain aneurysm.

Your first panic attack was probably a combination of a variety of biological and psychological factors that happened to all peak at the same time.  For me, 1)  I have always been a bit of a hypochondriac.  Growing up, if I had any physical symptoms I would immediately look them up on the internet and worry until they went away.  In this way, I probably just happen to have some personality characteristics that make me more prone to anxiety and panic attacks.   2)  The weeks leading up to my first attack I had a variety of life changes: I graduated from college, I left all of my friends and moved back home, I was about to start a new job, my boyfriend and I broke up, I was about to take the GREs, my grandpa had just passed away.  And although I didn't consciously feel any stress about this, looking back I know that I was probably more vulnerable to anxiety because of this combination of events.  3)  At the same time, the day of my attack I had a huge breakfast and then knowing that I would be having an early dinner, I skipped lunch.  Well the dinner kept getting pushed back and back and so I probably had incredibly low blood sugar at the time of my attack.  Taking all of these factors into account when I felt myself becoming lightheaded from the low blood sugar, combined with the anxiety I probably felt about everything that was happening in my life and my predisposition to health anxiety, I misinterpreted the signals that my body was giving me.  Instead of thinking "Oh, I probably should eat something I'm not feeling too well" I responded with fear: "What is happening to me?!" and thought that I was about to die. 

There is a region in your brain called the amygdala.  It is a very primitive part of your brain and one of its important jobs is to press the "on" button to turn on your fight-or-flight response.  It has evolved to protect you from danger, and importantly it has the ability to learn what is dangerous.  Just say you are hiking and you encounter a bear and its cubs.  You are not an experienced hiker so you don't understand the danger of approaching the trio.  So you go ahead and try to pet one of the cubs.  The momma bear rears up on her hindlegs and roars ferociously.  Your brain then decides the best thing to do is to run away.  The amygdala does its job and presses the "on" button, turning on the fight-or-flight response and you are luckily able to flee your attacker.  The amygdala then stores all of the important information from this event so that next time you see a bear, you will feel fear and remember the danger involved.  It is a response designed to protect your life.  Unfortunately, the amygdala is pretty stupid so it doesn't really know what counts as "important" information.  So it will store information related to the bears but also related to the weather, to what you are wearing, what you were thinking at that moment and who you were with. 

Coming back to my panic attack, I became very afraid because I did not know what was happening to me.  In response to this, my amygdala immediately woke up and turned my fight-or-flight response on.  Unfortunately this made matters much worse.  To understand why, lets look at the details of a fight-or-flight response....

What is panic disorder?

Panic disorder is somewhat like an allergic reaction:  Just say you are allergic to peanuts.  You actually do not have an allergic reaction the first time you have a peanut.  It is only with the second and subsequent times that you are exposed to peanuts that you experience a bad reaction.  Panic disorder (in its typical form, I guess) follows this same pattern.  The first time you have a panic attack you are absolutely terrified for your life and don't know what is happening to you...but then it ends.  You survived.  You do not have panic disorder.  It is the next time, or next few times when you realize that this horrible experience, this feeling of being out of control, not knowing what is happening to you comes at you again and again.  And the timing is completely unpredictable.  And you are worried about when the next attack is going to come and how bad it is going to be.  That is panic disorder.

I had my first panic attack at a restaurant.  I had this horrible sense of impending doom, I started shaking and felt really dizzy.  My vision started to go out and I thought I was going to die.  I had no idea what was happening to me but it was unbelievably scary and confusing and terrible.  I somehow made it home and laid on the couch where I went between periods of extreme cold and extreme heat while visibly shaking uncontrollably.  My heart was racing.  I felt like I was going to pass out cold at any second.  That night I could not sleep at all.  Every time I would start to feel tired, I think my body interpreted it as passing out – a bad thing rather than just normal sleep - and I would have another wave of intense fear and heart palpitations and shaking.  But over the course of the next few weeks I went to the doctor, got checked out and found out that what I most likely experienced was a panic attack.  After a while I was able to get back to complete normal.  I'm talking absolutely completely normal.  

That lasted for about 3 months.

My second panic attack was in a theater.  I was sitting in almost the exact middle, with at least 5 people on either side of me.  I had the same wave of intense fear, my head hurt, my vision was blurry and I left the theater and went home.  After some time I realized that no, I was not having a medical emergency, this was actually another panic attack.  I could not believe that this was happening to me again.  I thought that little panic attack episode was way behind me.  I did NOT want to feel like that ever again.  I would therefore avoid any place or activity that would make me feel that horrible and that scared.  That is panic disorder.

Purpose

I started this blog because I know how it feels.
I know how it feels to be utterly consumed by anxiety.
To suffer from daily panic attacks.
To feel like no one understands what I am going through.
To feel angry, ashamed, alone.

When I got to a point where I was barely functioning in my daily life, I knew that I needed help.  And I was lucky enough to have the capability to get myself help in the form of cognitive behavioral therapy with a psychologist that specialized in treating panic disorder.  I know that many others are not this fortunate.  Treatment costs a lot of money and there are only a few good experts in the field.  I want to share my experience and the skills I have learned with other sufferers of anxiety and panic disorder.  I know what it is like to search the internet for treatment answers, and to read through a website that sounds really promising, only to get to the bottom of the page and be expected to pay $500 for help.  I don't want to make money off of someone's suffering.  I know how bad it can feel and I don't think anyone should have to feel like that.  Hopefully I can show you how to move in the right direction and realize that anxiety and panic does not control you.  This disorder does not have to ruin your life.