What to Do for a Panic Attack

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This survival-medicine website provides general information, not individual advice. Most scenarios assume the victim cannot get expert medical help. Please see the disclaimer.

Panic Attacks: What to Do for Your Worst Nightmare

Artist Brad Siskin’s representation of a panic attack.

by James Hubbard, MD, MPH

Anyone preparing for a disaster needs to know what to do for a panic attack. We’re all susceptible during extreme stress. No matter how stoic or brave you are, it could happen, and for that period of time, you’re totally disabled. You can’t think straight or physically do much of anything.

Those of you who have experienced a panic attack (anxiety attack) know what I mean. If you haven’t, try to think of a time when you were most afraid, maybe it was just for a second, but you thought you were going to die. Now, imagine having that feeling for ten, fifteen minutes or more.

We’re not really sure what all goes into having a panic attack, but we think it has to do with your body going into its flight-or-fight mode, sometimes for no specific reason. And it seems some people’s bodies have lower trigger point than others.

Adrenaline and other hormones are released and increase your energy levels and heart rate. Your muscles tense, you sweat, you breathe fast, your thinking gets fuzzy. Now that’s great if you need to every iota of your energy focused on running away from or fighting a charging tiger, but for the average folks nowadays, it just wreaks havoc on your body.

Medical Treatment for Panic Attacks

If you’re having panic attacks now, there is good medical treatment available in addition to the paper-bag technique. A sedative like Xanax or Valium will provide immediate, short-term relief. Certain types of antidepressants can prevent attacks in the long-term.

Always try to rule out lung and heart problems by getting an oxygen level, EKG, chest X-ray, etc.

Your muscles may cramp, your chest ache; your feet, hands, and around your mouth may tingle, and you are just scared out of your wits. Many times, the fear is overwhelming. It’s often called a feeling of “impending doom.” You feel like you’re going to die and there’s nothing you can do about it. As a treating doctor, it’s often a difficult task to convince a person otherwise.

And if you’ve had one panic attack, you often live in fear you might have another because you never want to have that feeling again.

How Do You Know If It’s a Panic Attack?

Unless you’ve had one before and know the symptoms, you’re going to have to rule out other problems. This is important because the treatments are different, and one of the ways to relieve a panic attack (breathing into a paper bag) can make lung or heart problems worse.

You often can’t make the diagnosis with certainty without the proper diagnostic tests done in a medical clinic. One thing I’m going to start suggesting to add to your emergency kit is a pulse oximeter. You just slip it on the finger, and it measures the oxygen level in your blood. With a panic attack, your blood is getting plenty of oxygen, so if your oxygen level is, say, 94 or below, something else is going on. (Don’t use a paper bag.)

To see how much oxygen you’re getting, you can clip a pulse oximeter to your finger. (No needles, no blood.) If it reads about 94 or below, you’re not just dealing with a panic attack. There’s a heart or lung problem afoot. DON’T use that paper bag. (The picture is just an example, not a product recommendation.)

Here are some other tips to try to make an educated decision if there is no expert help available.

Think heart problems (heart attack, perhaps a sudden worsening of congestive heart failure) if:

    • The person is over forty-five years old.
    • The person has risk factors, like obesity, smoking, high blood pressure, high cholesterol, or a known history or family history of heart disease.
    • The heart rate is 150 or over (SVT).
    • The blood pressure is low.
Why That Paper Bag?

With a panic attack, you’re not breathing fast because you need more oxygen. You’re doing it because your fight-or-flight hormones have gone haywire.

With each breath, you blow out carbon dioxide. Usually that works out just right. But when you’re breathing too quickly, it messes up your body’s chemicals and the acid/base balance. That’s why your muscles cramp and sometimes spasm. That’s why your fingers and toes tingle, why you get dizzy. All those symptoms tend to make you more anxious and want to breathe more.

When you breathe into a bag, the carbon dioxide collects, and you breathe it back in. This can relieve your symptoms.

Some docs don’t think much of this CO2 theory. They think breathing in a bag works because you’re concentrating on doing that one thing. It takes your mind off your other symptoms, and you start relaxing. Whatever. If it works, it works.

Tips it could be the lungs (blood clot or spontaneous collapsed lung):

    • The person is wheezing.
    • The lips or area around them turn bluish.
    • The pulse oximeter shows an oxygen saturation below 95.
What to Do for a Panic Attack
  1. Try, try, try your best to calm down.
  2. Slow your breathing. Concentrate on slow, deep breaths.
  3. Breathe into a bag. Find a bag (I think a paper one works better), seal the opening around your mouth, and breathe. This replenishes your carbon dioxide balance. Don’t do this for more than a minute or two without taking some fresh-air breaths to make sure you’re getting enough oxygen. HOWEVER, if the diagnosis is wrong and you’re having lung or heart problems, carbon dioxide is not your issue. You need as much oxygen as fresh air can deliver. In those cases, breathing in a bag could make your condition worse. So how do you know? I’d follow my tips above.
  4. Or, better yet, learn breathing and relaxation techniques. Psychologists and respiratory therapist are good at teaching these. Use your stomach muscles to help you take in a deep breath, hold it for a few seconds, and blow it out with your mouth closed or through pursed lips. There are some techniques that require a certain instrument to help you train—best done by pulmonary therapists. Integrative-medicine doctor Andrew Weil describes some simpler ones here.

>> Got a wound but no doctor? Don’t panic! Pull up your handy The Survival Doctor’s Guide—ready when you are. <<

How to Prevent Panic Attacks
  1. If you can, go to a doctor to rule out medical causes such as thyroid disease, lung disease, and heart disease.
  2. There’s some evidence that supplemental zinc and magnesium can help.
  3. Treat underlying anxiety. More on that in the next post.

 

Painting and its photo by Brad Siskin, via Flickr.

Full disclosure: The picture of the pulse oximeter includes an affiliate link to Amazon.com. If you buy anything through that link, someone who works on this site—not myself—gets a commission. As noted, the link is not meant as an endorsement, just an informational example.

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  • Lois Timms

    hi im 49 yrs old & I had a panic attack a last month October 2013 I just let mine run its course bc I don’t know really what to do bc I was very scared I was at my sisters house in rome ga I guess that it was when I hear some one talk about me I get kind of upset & it stays in my mind of what I heard about me & my son but mine lasted about half the night I was scared to go to sleep it was hard for me I guess its where I have been around drama to much people want to talk about me and put me down a lot I have tried to srug it off but it was hard to do so I was trying to calm myself down by breathing slowly in my nose & out my mouth I was still shaking & nerveous & I was rocking myself sitting on my bed but I didn’t really know what to do I have had this since I was a very young girl at the age of 10 yrs old it still is difficult on me but if it happens again what shall I do to help myself ,,,,, oh I also heard that if you have this problem that you maybe able to get some finance help from the social security for s s I , is this true or does any one knows sometimes I get nerveous to easy

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      You could see your regular doctor or, in most towns, there are psychological and counseling services at a low price. It’s usually called Behavioral Health or Mental Health services. They might can give you advice and counseling that would help a great deal in preventing these attack. If you don’t know about them, your regular doctor or your local hospital could help you locate them.

  • Manda

    I had terrible panic attacks in my early twenties- to the point that I couldn’t leave my house on my own. I had to have an escort of some form. I was terrified that if I started having an attack in public, whoever found me wouldn’t understand what was going on and I’d end up in the ER (again).

    For me, simply coming to understand that the attack itself wouldn’t kill me (I wasn’t dying.) was a huge breakthrough. I learned to ride out my attacks. Over time I also learned other coping techniques such as reciting favorite Bible verses (at one point, I wrote them on my arm.), deep-breathing, and meditative prayer. I also took up yoga, which helped to ease my stress levels in a way that no other form of exercise has even come close to. Over the past decade, I’ve been able to reduce my panic attacks (sans medication) to the point that they really aren’t even a blip on my radar, anymore. They still happen, but they’re very rare and I’m able to squash them nearly as quickly as they pop up.

    I’m not an anti-drug freak. For many people, they do great things. Unfortunately, I wasn’t one of them. The medications just left me in this awful, zombified state. I’m always grateful that I’ve been able to control my anxiety and still keep my emotions intact.

    • Marie

      Manda, I am right there with you. My panic attacks were brought on suddenly from my body attempting to pass a gallstone 1/3 of the size of my gallbladder. To this day whenever I get nauseous or stomach pain, I have a panic attack. I had no clue what was going on, only that I couldn’t function. It took days to figure out the panic part and they put me on Xanax. I hated that drug. I would find myself staring at a wall and no clue when or how I got there or how long I’d been out of touch with reality. With 4 kids, one still at home, I knew I needed to find a better way to cope with the panic attacks. As of this time, my gallbladder issues still were unknown. They would be for a year of visits to the ER over and over. It took passing out in the triage and vomiting while passed out to be diagnosed by a PA. Anyway, I researched and researched better ways to deal with panic attacks. Drugs, meditation, you name it. I finally found someone who related that they talked themselves out of it. They believed for some, if not all, panic attacks are triggered by something else, not actual fear. For me that made sense because I never had them outside of being sick or feeling sick. So I started playing a game with my own brain. At this time I was still feeling sick all the time. Mostly because I was still eating wrong for someone with gallstones as well as gastroparesis which I was later diagnosed with as well. So I was nauseous, a lot! And because of that, I was having panic attacks, a lot! So I decided that when one started I would focus on it, and only it. I would breathe through them like I did when I was in labor. All the while I would tell myself over and over and over that I was okay. Nothing was going to happen. I was not going to die. My kids would still have their mother. Calm down. It’s okay. Again and again and again. They would last for hours in the beginning. Now, 6 years later, I forget I even had them. I might get the occasional attempt when sick but I can squash it within seconds. It took a long time to get them under control and a couple months to wean off Xanax. I am so glad I took the time to research and even more importantly, I got off that horrendous drug that turned me into a zombie.
      I know some are not strong enough to do this, but it’s always worth a try.

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Manda, thanks for sharing. It’s great you have found relief and what works best for you.

  • alexjonesradio1

    My husband and both have anxiety attacks, though his are more mild and have different triggers. Meditation and relaxation techniques help us both. It also helps so very very much that we’ve talked about it and each of us know the best ways to help each other when one of us experiences one. I had one a few months ago while riding a public bus and called him–just talking to him helped me through it since I was basically trapped for 5 minutes until the next stop. Brisk walking or even pacing can help. We’ve also learned that MSG consumption is a trigger. We’ve stopped eating everything that contains it (it’s in much more than we ever realized, including soups) and both of us have had a large decrease in the number of “out of the blue” ones that we experience. Once those were out of the way, it’s been much easier to figure out the “triggers” and work on those. The information in this post is extremely important to know so that you can help someone else through one, even if you don’t experience them yourself.

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Thanks for sharing. As you allude to, it’s important to find what works best for you.

  • August Arkham

    and when I say “great” Rob Black, I’m talking a great big scumbag that needs to be given life and executed.

  • August Arkham

    His “artwork” is about the same as his porn directing. Truly garbage. What a lowlife disgusting human being running on the mental capacity of a disturbed 8 year old. Of course leave it up to the great Rob Black to give the nutcase money to make “movies”.

  • August Arkham

    Brad Sisken (your “artist” image) is better known by the name August Arkham. A psychotic porn addict and failed “director” who made movies such as “1,001 Ways To Eat My Jizz”. He now draws terrible looking and often sick pictures in Crayola crayons and calls himself an artist.

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  • JeanieB

    Hi, good info but I have disabling panic attacks and take 2 different prescription meds to make them bearable. I have been prepping for about 6 months because I live in a earthquake zone, not out of a paranoid the world is ending thing. I must say I do spend more time than I care to admit thinking about what I would do in a shtf scenerio if I ran out of meds, a slight anxiety/panic episode that most are talking about here is way different from a full on curl up in a ball panic attack, any suggestions ???

    • Justineeey

      Six years ago, I went through the two most traumatic events of my life (so far) 29 days apart, which started a horrible, debilitating TWO YEAR long panic attack. Twenty-four/ seven, there was no relief. I couldn’t sleep, I couldn’t eat, I couldn’t breathe, I couldn’t function around people. I would cry at least three times a day. I had no idea what was wrong with me. I literally felt like I was going crazy. The only way I survived was by figuring out what the triggers were. For me, I figured out it was from suppressing my emotions. I can’t go through any life experience without learning every lesson and facing every emotional aspect of it before I’m able to move on from it. Studying the attack as it went through waves ranging from horrible, to “kill me now and end my suffering”, learning what was going on in my body, isolating the different sensations- feeling like my lungs are suffocating, my throat is choking me, my arms and legs and tongue going numb, mind racing out of control, heart simultaneously fluttering and pounding- helped me in some way feel more in control of it. Some panic attacks were led by sighing, others were led by yawning. Knowing that those sensations were not my impending doom, but just an anxiety attack, enabled me to remind myself that it would be over as soon as I regained control of myself. One day about 4 years after it all started, I realized that the sigh-started attacks had a sad emotional root, where the yawn-led attacks were from angry emotional roots.

      I don’t know if you’ll see this so many months after you originally posted this, but if you do, I strongly urge you to try to study your attacks objectively, rather than subjectively. Try to see them from the outside looking in. When you’re feeling really bad, try to force yourself to look at the positive things in life, even if it’s far reaching. Try to figure out the root of the anxiety, and remind yourself when you’re curled up in a ball, that you won’t die. You will overcome, you will survive. You are strong, and you got this. And most importantly, remember you are not alone in your fight. One of the worst parts of mental illnesses are that they make you feel like you are the only person who has ever felt so horrible and no one understands your pain. Not everyone will understand; in fact, most people won’t. But that doesn’t mean that you are alone in your battle. Hopefully this helps you a little bit. :)

      • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

        Thanks so much for sharing. And yes, people still these older posts. You did for one. But also I link back to them in other posts and comments.

    • alexjonesradio1

      Jeanie—I know what you are talking about. When I first started having anxiety attacks and didn’t know what was going on, mine were very severe. I actually stopped leaving the house for days at a time and lost my job! Once I learned what was wrong and realized that I was, for the most part, physically healthy, they became less and less severe. Cognitive therapy has helped a lot of people–and though it might be costly, it can definitely be worth it because it should lesson dependency on meds in many cases. What worked for me was less thinking and more doing—in your case you could maybe stop thinking about disasters as much and put more energy into your preparations maybe? I had to completely re-work my thoughts and make myself be more positive. My mental health has been much better since! I did have a relapse to the debilitating panic attacks when my father-in-law was dying of cancer and I went back on meds to get through it so that my husband didn’t have to deal with me having attacks when he was already distraught from the loss of his father. But I was able to “bounce back” after 6 months because I already had the resources I needed from the first time I suffered from the attacks. Believe it or not, it gets easier once you get the structures you need in place. If you can’t get therapy, I know there are books people have written that have been through it that could also help:) Lots of well wishes to you!

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Sorry, Jeannie. I don’t know of anything else.

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