Building a Panic Attack Help Page

[Richi]

I'm planning to build a helpful resource page on quick and important information on what to do in the event of a panic attack.

It can also include a more in depth explanation of what exactly is a panic attack, physiological responses, what causes a panic attack, and what can be done to prevent one.

I'd like this to be relevant to all drug OD's in a comprehensive step-by-step way. I imagine this is a resource someone could use in the event of any panic attack that another person may have. For example, panic attacks are common to marijuana, and some hallucinogens of the dissociative, psychedelic, and deliritant classes. Many of these are not life-threatening, but some may be. Panic attacks resulting from stimulant use such as cocaine are much more dangerous.

Thus this resource page would first distinguish a life threatening OD from a non-life threatening OD, and direct the user further as to what to do to help the individual.

What is required:

I have come across many sources for help in the event of a panic attack related to marijuana, several for S. divinorum, and one for magic mushrooms. (I'll try to dig them up) However, more would be helpful, along with some for other drugs.

I particularly need one for ketamine.

I also need someone with a certification in first aid to write what should be done in the event of breathing problems, heart problems, etc. This relates specifically to cocaine - i.e., a stinging pain starting in the hand and moving up the arm towards the chest.

Any other help or opinion would be very appreciated. If someone wants to help tackle this task, please post what you can do.

Reputation Comments on this post:

good .. for swiy

[Richi]

I've created the wiki. Any help or input is appreciated.

[~lostgurl~]

You might want to google Supra-Ventricular Tachycardia as the symptoms of a panic attack are very similar, but SVT is often caused by a stimulant. This girl I know used to get SVT occasionally after partying on multiple drugs, she thought it was a panic attack but her Dr told her it was SVT. One time her heart was racing so fast it felt like she had run a marathon and she couldn't even walk accross the room, she then fell asleep out of exhaustion only to wake up 45 mins later with NO change. Now that was scary. Her Dr said she should have gone to the hospital. But with a panic attack this is not usually necessary, so she thought at the time that there was no need to go as it was "Just a panic attack".

Reputation Comments on this post:

very good safety point

[~lostgurl~]

This is for fast heart rate associated with SVT, so if this is something you are also experiencing you could try one of these techniques.. Be sure to talk to your Dr before trying these.

Vagal maneuvers for a fast heart rate

Vagal maneuvers are used to try to slow an episode of fast heart rate. These simple maneuvers stimulate the vagus nerve, sometimes resulting in slowed conduction of electrical impulses through the atrioventricular (AV) node of the heart. Be sure to talk to your health professional before trying these.
Vagal maneuvers that you can try to slow your fast heart rate include:

• Gagging.
• Holding your breath and bearing down (Valsalva maneuver).
• Immersing your face in ice-cold water (diving reflex).
• Coughing.
• Putting pressure on your eyelids.

It is important to have your health professional show you how to do these procedures correctly.
In addition to these, your health professional may sometimes try another vagal maneuver (called carotid sinus massage) in the emergency room to help slow your heart rate. This technique should only be performed by a health professional.

http://www.webmd.com/hw/health_guide...?navbar=ps1687

Reputation Comments on this post:

Very informative!

[TommyRowe]

Here is a rough draft of a article I threw together in 10 minutes after not being able to sleep at 4 AM... I will refine it later but feel free to use any of it in the Wiki. Ill add more drugs after I get some sleep and Ill add more depth it it...

--

INTRODUCTION


A panic attack, which is also known as a anxiety attack, is a condition that can cause intense symptoms that are both physical and psychological. Panic attacks can be brought on by many different factors and tend to vary among the individuals. Although panic attacks can be random, there are anxiety disorders that have panic attacks as a symptom such as Panic Disorder.


DISORDERS ASSOCIATED WITH


Panic attacks are associated with a number of specific disorders. Some of the more common are Panic Disorder and the more rare are disorders such as Agoraphobia. Agoraphobia can vary in levels of intensity but it is without more detailed information the fear of being in public or crowds. Agoraphobia can exhibit extreme panic attacks when the patient is in settings that they find uncomfortable. There have been studies in the past that have revealed that the Panic Attacks associated with Agoraphobia, combined with the fear the disorder produces, has lead to patients going as far as committing suicide. Although it is more common than you would think for someone to have Agoraphobia, severe and much more rare cases can produce extreme symptoms and reactions.


SYMPTOMS


Symptoms for Panic Attacks vary but more commonly include the following:


-Heart Palpitations that usually result in a quicker heart rate
-Increased sweating
-Severe shaking
-Hyperventilation or breathing harder than normal and shortness of breath
-Nausea and abdominal pains
-Dizziness
-Feelings of extreme distress
-Obscured vision


Though the symptoms of a Panic Attack themselves are not that serious, they can lead to issues that can be fatal. Increased heart rate in patients who have sensitive hearts can cause cardiac arrest and kill the patient. It can also lead to shock and stroke. Combinations of symptoms with medications patients are taking can also lead to complications.


Another thing that can lead to complications is smoking cigarettes. The lack of oxygen and rise in chemicals such as carbon monoxide can lead to shortness of breath or difficulty breathing which will cause psychological onsets and feelings of distress which will than bring on the panic attack.




TREATMENTS


Treatments for basic panic attacks are usually very low tech and simple. One of the easiest and most effective symptoms is breathing in and out of a paper bag. This slows the patients breathing rate and it also provides a psychological effect distracting the patient from the feelings of impending death and the fact that they are having a panic attack. Coping statements that reassure yourself that what you are going through is nothing serious can calm you down and slow your heart rate and bring down the panic attack.


Higher tech treatments include anti-anxiety medication. However, a lot of patients do not want to take these medications because they can have pretty adverse side effects. Anti-depressants are sometimes prescribed in lieu of anti-Anxiety medications.


If you feel that you may have a anxiety disorder, the best bet is to go see a medical doctor to rule out any other causes. He will diagnose you with the disorders and prescribe you with medications or refer you to a specialist, usually a psychiatrist.


REACTIONS TO DRUGS


Marijuana
Marijuana is sometimes a prescribed treatment for anxiety disorders. Marijuana slows down the heart rate, causes a sense of euphoria which distracts patients from the distressful feelings and can bring people off other potentially dangerous medications. Although the effectiveness is debated among the medical profession, there is evidence to support both sides.


Side effects that can lead to worsened symptoms are things such as coughing or difficulty breathing. When starting coughing, this can lead to difficulty breathing which can lead to the psychological symptoms that bring on a panic attack.


Meth
Meth is probably one of the worst drugs to combine with a anxiety disorder. Meth, by itself, can lead a otherwise healthy person to exhibit symptoms of psychological issues such as anxiety, paranoia and disorientation.


Things such as the shadow people, hallucinations of things such as shadows and sounds that onset at various times in taking meth, can lead to a anxiety attack through paranoia and other issues. The ability to focus and dwell on one thing on meth can lead to these issues also.


Cocaine
Cocaine's biggest interaction include a raised heart rate and higher ability to focus. The raised heart rate will make the user feel anxious as if a heart attack is coming which can lead to a attack. The higher ability to focus can lead to dwelling on things such as the higher heart rate leading to a panic attack.

Reputation Comments on this post:

good effort for the forum, and usefull information

[robin_himself]

Swim could write something about the psychological side of the panic attack. The post by Tommyrowe is really good as it concentrates mainly on body reactions. I'll concentrate on cognition.

[TommyRowe]

That would be cool as my psychological experience and education isnt anywhere near where I want it to be. Will be nice to have some insight on the issues from a pro...

Im thinking this could be the first article in a nice series of medical articles. Maybe we should all have a conference and see whats about it.

[Richi]

lostgurl, that is an important piece of information that is quite essential to a reliable panic attack help page.

Tommy, great rough draft. That is an excellent start to a useful resource for this matter.

robin, that's good that you mention the psychological aspects of a panic attack. We must not disregard the after-math as well, as inidividuals who experience a panic attack commonly are afraid of trying the substance again, since is can re-evoke the same mental state and this trigger another panic attack. Perhaps you could do some research on that as well.

I really like the input I've seen thus far. Here are my thoughts on the outline and content format that I envision.

1. Most important first step in the event of a panic attack - is EMS required? The very first section should outline sign and symptoms endangering one's health. Such as what lostgurl mentioned in her post (number 3).
2. If EMS is NOT required after a quick assessment of the individual, what next? This section would quickly outline steps to take if someone is hyperventilating, scared, etc. and what to do in such an event.
3. This section would go into more depth and detain about panic attacks, their causes, preventions, etc.
4.1, 4.2, 4.3, etc. These sections would give more detain on panic attacks due to specific drugs, which are life threatening and which are not, how long to expect them to last, etc.
5. This section would detail the after-math on the panic attack, possibly including information about post traumatic stress disorder (PTSD) and hopefully include remedies and other ways to help deal with and prevent future panic attacks.


On a final note, here is the group I've created on the subject.

Reputation Comments on this post:

Great harm reduction work Richi

[TommyRowe]

WHEN IS MEDICAL INTERVENTION REQUIRED

Roughly 5% of Americans suffer from a persistent anxiety disorder. These are disorders that need to be treated with medication and other treatments such as therapy. A much larger percentage of the population however suffers from non-persistent anxiety.

If you are suffering from a anxiety attack more than once a month, there is a good chance you could be suffering from a anxiety disorder. It is not uncommon for most people to feel anxious at any given time throughout the day. It is even common for the average population to suffer a panic attack. But recurring attacks and frequent attacks are a good indicator of a disorder.

There are times when immediate medical intervention, such as that from Paramedics, are required. Below are a list of symptoms that, if severe enough, should get immediate attention by EMS personnel:

-Shortness of breath and rapid breathing that cannot be brought under control through conventional methods such as calming down and trying to breath slower
-The inability to breath without great struggle
-Elevated heart rate that doesnt subside after a short period of time
-Sweating profusely accompanying any of the above symptoms
-Dizziness that leads to the inability to stand or walk
-Nausea or vomiting as a result of a attack

The above symptoms, accompanying a attack, can be different issues that are caused by the attacks that can lead to everything from brain damage to death. If you feel a attack is out of control for any reason, seem immediate medical attention. If you feel that you suffer a anxiety disorder, meet with your physician and tell him your symptoms and he will provide you with a diagnosis.

---

Another rough draft. Please give input on what should be edited.

Reputation Comments on this post:

great input, keep it up

[~lostgurl~]

You need to provide links to back up all information in a wiki.

[Richi]

Links, or of course books, manuals, and other resources.

[TommyRowe]

Can I use myself as a reference? I mean, my knowledge is stemmed from field experience and book knowledge that I learned in Paramedic school quite awhile ago. I dont even think I have the books anymore.

And if we provide links to websites that already store the information, doesnt that sorta defeat the purpose of creating a new article? Ill be honest, I cant cite specific sources other than myself and I dont feel like Googling for hours finding a source reputable enough to stake my knowledge on. Ive seen many wiki's that cite experts in the issues as sources. And Im 99% sure the information I state is right (1% because there is always a margin of error in medicine) so yeah...

Not trying to sound like a dick here. Its just that would be a lot of work on my part to back up everything from outside sources online when the knowledge came from the head that is attached to these hands.... Ill do my best though.

Reputation Comments on this post:

thanks for your trouble

[Alfa]

You can use yourself as a reference, but that means it is empirical data in contrast to referenced information. It should be clear to the reader that it is your personal experience and not scientific fact.

Providing links to data, documents or webpages that backup your claim does not defeat the purpose of creating a new article. It is not a replication of other pages that we are after. We should always strive to provide better and more useful information.

[Richi]

Would you be willing to use your name as a reputable resource?

Would it be possible to find out the titles of textbooks you studied from in school? My university has a website that lists all textbooks currently used by students for sale.

[TommyRowe]

I found one of my old Paramedic texts. Its a Mosby book. Aptly named Mosbys Paramedic Textbook as far as I can tell. That was the standard book. All the other ones I did a book return on because, well I was a starving college student at the time. But I have about 3 boxes of paper work from college here. Ill go through it and find my old syllabuses. Maybe Ill just email my teacher or something. We are getting closer to finding a reference cure.

As far as my name goes, Tommy Rowe can be used as its my psuedoname. However, my real name would probably cause complications for me. Because of the fact I work for a government agency, and because of some of the stuff I have said on here, Im pretty sure I would lose my job which would make me cry. And I dont think you all want to see me cry. Its not pretty...

EDITED

Below is a list of books that I have read/read from in the past from various courses both in the basic and advance courses I have taken. Its not all the books I have read but Im not going through another box tonight

-Basic and Advance Arrythmia Concepts
-Advanced Life Support
-The only EKG book you will ever need
-Clinical Medical Calculations
-Basic Dysrhytmias
-Drug Dosage Calculation for Emergency Care
-Essential Drugs Dosages and Calculations
-Pracare Principles and Pracice w/workbook
-Merck Manual
-Introduction to Oncology
-Mosbys Immunology
-Textbook of Medical Physiology
-Atlas of Human Anatomy
-Basic and Clinical Pharmachology
-Medical Microbiology
-Intro Textbook of Psychiatry
-Harrisons Principles of Internal Medicine

[Richi]

That's great. It will be quite a lot of work to actually cite each one of them, but that's a good start.

Does anyone know how to cite an individual, in this case, Tommy Rowe? Would his [unverified] credentials be listed as well?

[lostmente]

thought this might be interesting

http://www.hypoglycemia.asn.au/artic...g_anxiety.html

its about excess adrenaline (among other neurotransmitter imbalances) being a symptom of insulin resistance...and talks about a diet to readjust the bodies response to sugars through what they call a hypoglycemic diet that includes

no refined carbohydrates
high protein intake
essential fatty acids
b vitamins
minerals (particularly zinc, chromium, magnesium)

[Richi]

Would someone be able to compile a brief piece of writing that would outline if someone required medical attention? Tommy, could you expand on yours? What are some treatments of anxiety disorder?

[Silentscream]

I wish I had the knowledge to make a useful contribution to this group! At the moment my good friend swim is dealing with a panic disorder (only present when under the influence of psychedelics)..

Swim has experienced severe panic attacks under the influence of LSD.. Twice resulting in hospitalisation.

Swims main problem is elevated heart rate, around 140-150 BPM, accompanied by a tightening of the muscles in his left arm and left side of his chest, and sharp chest pains.
Swim has experienced the same problem when predosing and LSD trip with propranolol, swims heart rate remained at a normal level, however the chest pains were present and walking up stairs became very difficult - feeling like his heart was straining to do the work.

Swim will be following this group closely for help in dealing with these attacks.
Thankyou to all involved )

[Richi]

If a good friend of yours is currently dealing with a panic disorder, I think it would be very beneficial for swiy to share their knowledge!

Would they be able to share their situation? Effects and experiences? How long, how often, since when? Progress? And in the future, outcome?

What helps? What doesn't? The questions go on.......

[Silentscream]

I will try to explain how swims anxiety was suddenly triggered, and the conditions/thoughts that brought him towards a full blown panic attack.

Swims panic attacks were triggered approximately 4 hours into a <100mic LSD trip, combined with amphetamine and ketamine.

The ball of thought that produced the physical effects was a loop of panic over the belief that swim had consumed a dangerous level of speed (in reality this was not possible as swim had only roughly a gram of relatively impure speed to use over the course of the night.

Swim finds panic attacks involve, in his mind;

-vivid imagination of possible negative outcomes of the situation (eg. being rushed to hospital, dying from reaction to drugs, becoming a story in a newspaper etc)

-it becomes impossible to lead ones train of thought away from the source of anxiety, or to distract ones self

-Even once it is known that swim suffers from panic attacks, future panic attacks are still under question in swims mind - are the symptoms swim is experiencing a panic attack, or are they real symptoms of a heart attack or overdose this time!

Physical symptoms;

- Racing heart

-Increase in awareness of heart rate and blood pressure

-Circulatory system feels under immense pressure, like a tyre being over-inflated, swim is worried that his arteries would burst from the pressure they are containing.

-Sharp chest pains

-Swim feels as though his heart is working at maximum rate just to keep him alive, walking or exerting energy in any way causes further increase and strain which further increases anxiety in swims mind.

Swims first panic attack was 12/09/08. Swim spent this night in a medical tent and passed out several times. Diazapam was administered which terminated the trip and swim was fine the next day.

Swims only began to experience anxiety later on when he next dosed on LSD. Again a <100mic trip was taken and at around 4 hours into the trip, a full blown attack came on with all the symptoms described above, and swim called an ambulance in fear that it was a heart attack (swim was unaware at this point that what he was experiencing was likely to be a panic attack). Doctors monitored swims heart rate on an ECG and swim was discharged a few hours later. It took 4 hours for swims heart rate to return to a normal level.

Since this day swim has become hypersensitive to all psychedelics.

He has not used LSD or mushrooms (which later produced another panic attack, although this time swim was aware of the condition) for the last 3 months.

Swim experienced what he considered moderate levels of anxiety for a month or two after the second attack.

Swims anxiety is now gone although does return occasionally during the come-up of 2cb trips, which swim fully enjoys once he is past the first half hour or so. Note that an effective dose for swim is now <5mg of 2cb, whereas before it would take >10mg to achieve desired effect. Swim only mentions this hypersensitivity to psychedelics as it seems to have been triggered at the same time as his panic disorder.

As for the experience of a panic attack its self, swim has not yet been able to control and stop one once it begins without the help of benzos.

Swim plans to use LSD again some day, and advice he has received from various sources all tell tales of other users who experienced the same problem and fought it by building up from tiny tiny doses until they could ride out a trip on a normal dose again without experiencing any form of panic attack.

I hope some of this information will be useful to you
Swim has tried his best to describe to me exactly how his mind was operating throughout this period!

Reputation Comments on this post:

great contribution

[Richi]

Some very good information, I will sort it out and update the wiki soon.

I wish said individual all the best in future endeavors...

[Richi]

I want a moderator's opinion on this.

I am staring to feel that the panic attack wiki requires a disclaimer. Certain sections seem like they are promoting drug use. As well, a lot of the content is not empirical data, since no such empirical data on the subject exists.

Should this be stated in the wiki?

[kerang]

Can this be useful? The bad trip guide is simple and so it does not require a lot of "processing power" from the user.
http://www.badtripguide.com/

[Richi]

Are you referring to the content of that link, or the panic attack 'button' link at the top?

I think the content is good and rational. It needs to be sorted and the most valuable information needs to be pulled out.