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Panic Attack

Please read the Drugs Forum Disclaimer. This information wiki on panic attacks has not necessarily been been verified by a medical professional, and the information may be inaccurate. Large amounts of the information presented are based on anecdotal evidence.

Read This First!

In most cases panic attacks will not be a serious health concern for healthy individuals. For healthy people that are cardiovascularly healthy the best cure for a panic attack is time, hugs, reassurance and monitoring by friends until they calm down. However, Below is a list of symptoms that, if severe enough, should receive immediate attention by EMS personnel. If any of these are present, it may be necessary to call 911.

Emergency numbers in Europe:
Universal GSM/GPRS number (mobile/cellphone) in Europe is 1-1-2
Emergency number in the UK is 9-9-9
In Australia the number is 000, however it is 106 for teletype (TTY) phones and devices and 112 redirects there automatically from all GSM phones.

Symptoms

  • Shortness of breath and rapid breathing that cannot be brought under control through conventional methods such as calming down and trying to breathe slower
  • The inability to breathe without great struggle for a considerable period of time.
  • Elevated heart rate over 150 bpm, that doesn't subside after a short period of time
  • Profuse sweating or violent shaking accompanying any of the above symptoms
  • Dizziness that leads to the inability to stand or walk
  • Nausea or vomiting as a result of an attack
  • Induced by an overdose or an adverse reaction to a drug you have no previous knowledge of


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, seek immediate medical attention. If you feel that you suffer from an anxiety disorder, meet with your physician and tell him your symptoms and he will provide you with a diagnosis.

Note on calling an Ambulance - [NB: this mostly applies to US residents]

Calling an ambulance should be done if the subject is in medical danger, or if you don't have enough experience or knowledge of what the subject is experiencing to be certain of their lack of need of treatment. If the subject is wild and attempts to hurt himself or herself, they should be restrained. Sending authorities into the picture has an extremely high risk of legal trouble for everyone involved. A scary night of babysitting someone off their rocker is certainly no laughing matter, but it is always preferable to years in jail and a permanent criminal record. Not to mention the gigantic, monstrous hospital bill that someone is going to have to pay. Also, a hospital is rarely knowledgeable when it comes do dealing with psychedelic drugs in the first place.

This only applies when one knows for certain what drugs the subject is on. When that situation is unknown and a potentially dangerous drug interaction is taking place, then getting medical personnel involved is a better idea. Still, it should only be done when there is a clear medical emergency and not just someone freaking out in hyperspace. So, it is a good idea to monitor someone's vital signs throughout the experience.

In regards to psychedelics:


Instant transfer of the individual to a psychiatric facility in the middle of the LSD experience is not only unnecessary, but represents a dangerous and harmful practice. It disregards the fact that the LSD state is self-limiting; in most instances, a dramatic negative experience if properly handled will result in a beneficial resolution and the subject will not need any further treatment. The "emergency transfer" to a psychiatric facility, particularly if it involves an ambulance, creates an atmosphere of danger and urgency that contributes considerable additional trauma for a person who is already extremely sensitized by the psychedelic state and the painful emotional crisis. The same is true of the admission procedure in the psychiatric facility and the atmosphere of the locked ward which is the final destination of many psychedelic casualties. ref. 1
Introduction to Panic Attacks

Panic Attack. Noun.
The sudden onset of intense anxiety characterized by feelings of intense fear and apprehension and accompanied by palpitations, shortness of breath, sweating, and trembling. Also called anxiety attack.


It appears that the majority of users who experience a panic attack fit into a certain category. Victims of the panic attack tend to be younger, either in high school or in college. Their inexperience in the use of drugs is a contributing factor to their perceived fears, which result in the classical panic attack. Often times consuming more of a certain substance than usual, or a more potent form than usual, can trigger a panic attack. The setting is also a huge psychological factor and depending on where you are, it can allow your mind—in combination with your personality—to distort what you see. Users typically think the drug is to blame, yet people often forget the power of their own mind to distort reality and make a fuss out of something that is just a perception. At the end of the day though, it is all in your mind.

A panic attack as a result of drug use has some unique symptoms to it that you should be aware of. A racing heartbeat, or the feeling that you are going to have a heart attack, is one of the most commonly reported effects. Another heart related symptom is being able to feel your heart beat throughout your entire body, like a pounding almost. Palpitations might accompany this feeling too, as your anxiety might focus on your heart skipping beats. Hot and cold flashes as well as sweating have been reported. Another common symptom is tingling in the body and numbness of the limbs. Trembling or uncontrollable shaking has been reported, especially if you go from one altitude to another, smoke cigarettes, consume lots of caffeine, or take medications like Ritalin. Some users report visual and auditory hallucinations. Just remember, this is a psychoactive drug, but it is also commonly a drug that has been used for thousands of years and many have been able to do so in a calm and controlled matter.
ref. 2
What to do

For the Victim

If you do experience a panic attack, there are a couple of things you can do to help cope with it. First off, relax! Try to lie or sit down and just close your eyes. One of the main things that people do mid panick is to tense up every muslce in their body, which further increases heart rate, try and lower your shoulders and slowly relax each muscle one by one. While you are doing this, take a big, deep breath through your nose and hold it for a couple of seconds. Then exhale slowly through your mouth. Do this for a good minute. Keep reminding yourself that this “feeling” is all in your mind, that you are going to be okay. Breathing is the most important part of this, it really helps calm you down. Try stepping outside to get a breath of fresh air if you can do so safely. Often times being surrounded by a large group of loud people and music can further increase your panic attack, so just get away. Find an escape somewhere and just breathe! Get a glass of cold water and maybe some bread or crackers. Try to divert your attention away from your panic attack by watching the television, eating food, or taking a cold shower. Anything that can take your mind away from what is going on is going to help, which is another reason why breathing is very important.
For the Trip Sitter

The first thing to remember is the importance of this role. The trip sitter stays sober and calm during the entire trip. Study the substances that will be taken, and it is preferable to be 'straight'... the sitter must measure the risks and consult whatever source for advice if in any doubt. Additionally, it is very helpful if the sitter has a good understanding of the substance being taken, or experience with it in the past. At all times, maintain the safety of the tripper, but this will vary from substance to substance. Here are some points to consider:

1) Get the subject to recognize that they're under the influence of a drug, and that the experience will end. If you do this they will almost always be able to get control of themselves. It's OK to be miserable on drugs, as long as the subject recognizes that these feelings are drug-influenced and that they will end.

2) If the subject cannot recognize that they're under the influence of a drug (i.e. they've "lost insight") and they are panicking they should be calmed and restrained if calming fails. Calming someone completely off their rocker is easily done by taking advantage of how easily distracted someone in a massively zonked-out state is. Change their environment - music, going outside if there is nobody around, turning the lights on and off, isolating them from others, etc. Give them something for their trip to latch onto that's something other than what's sending them off the edge. But if all of that fails, then restrain them, but don't ever get violent. The drugs will wear off in time.

3) Monitor their vital signs, and only call in medical aid when the subject has serious medical problems - severely elevated pulse, hypertension, seizures, difficulty breathing, etc. Off the wall behavior is not a medical emergency and is only needlessly going to get someone in trouble. Possibly everyone around them too. The US health care industry is not there to help you but to make money off you, and incidentally so is the drug enforcement industry, both of which you will be calling in to "help."

4) Don't administer even more drugs unless you know what you're doing.

5) The most important aspect of handling a bad trip is the re-integration period afterwards. They have to understand that a) their feelings were the result of a drug experience only and b) figure out how and why this experience went wrong, and if it did in the first place. A lot of so-called "bad trips" are simply people confronting things about themselves that they are in denial about. There is no denial with psychedelic drugs. All self-delusion barriers come down and the subject sees only the bitter truth.

6) Better yet, don't let SWIY give psychedelic drugs to someone that's not likely to handle them!

-It is preferable and recommended that the sitter is a good friend of the person being sat.
-Often in the case of a bad trip, physical touch is not a good idea, the offer of a hand to hold or a hug, but do neither until you are sure that the tripper is happy that this happens.
-Adding a nice thing or something the tripper likes is a positive... for example, adding a familiar face to a crowd, or another 'friendly' image.
-Pen and paper are good tools to have to hand, as often there is a point of non-vocalizing, and being able to convey thoughts, feelings etc can be a godsend to the tripper.
-An important thing to remember is that trips can go wrong, and to stay calm and focused on helping the tripper... now is NOT a time for the sitter to panic.
-Do not be afraid to call for help if necessary, and in some cases, if there is a serious risk of injury, an emergency call may be necessary.
-Be aware at all points of the trip, and be ready to help the tripper to distinguish why and how things are happening.
Extremely bad trips

What follows is based on swim's experience of two extremely bad trips which swim was the sitter for. These were of a level in total contrast to other “normal” bad trips which swim has seen and even experienced himself. The drug in question is LSD. This information is intended to inform future trip sitters. This is a work in progress which requires validation from more experiences so please share them if you have any (experiences from the perspective of a sitter preferred but not required). Remember though, this is about extremely bad trips only. One of these bad trips resulted in short-term psychosis and then PTSD, for example (in a normal sane person). The other miraculously snapped out of it and had no recollection of it whatsoever, even though it lasted 5 hours, and so wasn’t traumatised.

It should be noted that bad trips of such magnitude are extremely rare and you (the future trip sitter) will be very unlikely to encounter and have to deal with such a bad trip. Nonetheless, much of the information provided is relevant to less bad trips also and it never hurts to get more knowledge. Actually, if swiy suspects that learning just how bad trips can get will be bad food for thought when swiy is next tripping, it might indeed hurt to get more knowledge...

General pointers:
-The mind can only begin to relax once the body has relaxed
-If they appear to shrink away from physical contact or bat you away if you touch them, always back off. This applies unless you feel it is an emergency and you have to stop them harming themselves.
-Never crowd round them, never raise your voice: always speak with an extremely calming tone. Never shake them and never yell “calm down!” even if they start going berserk.
-If they are lying down, make sure it is on their side in case they vomit.

Signs that a bad trip is becoming a very bad trip:

-extreme short term memory loss. Eg, if you tell them they are having a bad trip in response to them asking "why am I feeling like this?" then they will ask exactly the same question 30 seconds later.
-confusion
-acting in uncharacteristic ways

Signs that someone is in an extremely bad trip:

-They start crying or whimpering
-They have their eyes closed
-They are unresponsive to any verbal and/or physical communication
-They are sitting or lying in a clenched position and have been doing so for a while. Clenched means that they are tensing a muscle group, such as crossing their legs and holding them to their chest with their arms.
-They sometimes murmur incoherent phrases
-If their eyes are open, they seem blank and they don’t seem to be aware of their surroundings
-they appear to be in one of the phases listed below
-They take their clothes off
Quote:
Instances of ... disrobing ... were described -S Cohen, Lysergic Acid Diethylamide: effects and complications p 32
Note that while these can be characteristic of a bad trip, just because a tripper is exhibiting one or more of these signs does not mean that they are in a very bad trip.

If they are responsive to verbal communication then that is a good sign. Talk to them, but be careful what you ask. Asking them their name can confuse them- Once I asked a person their name and date of birth over and over to try and keep them talking because they would not open their eyes and they started to think they had been in a car crash, were being questioned by a paramedic, and that they had killed people…

If they are unresponsive to verbal communication, they are very far gone and very possibly they will get a lot worse. Unresponsive means that either they don’t show any sign that they know where they are, what they are, or what is happening.

Different phases:
When on a very bad trip, the tripper may go through different “phrases” which can be very different. They are phases, not stages, because all bad trips are different and do not really follow a definable chronology.

"Looping" phase:
When in an extremely bad trip, people may perform a physical movement or action that they then repeat with increasing violence/intensity. The physical effort involved in each loop increases, and each movement is a more strenuous, more intense version of the prior movement. This continues until the entire body is strained to its maximum, and they collapse.

This is better described by an example: A very scary version of this is when they start yelling. It starts with a moderately loud growling noise accompanied by a tensing of the arm muscles, it sounds quite like a motorcycle revving. Then, they pause for breath and relax their muscles and then they begin the second loop in which they growl louder and tense their muscles even more. After a few loops, they jump to their feat clenching their arms in front of them, roaring as hard as they can. After this peak, they instantly forget how to stand, and fall over again. Make sure you catch them and lower them down safely. Another horrific one to watch is when they get stuck on a loop of breathing through their nose with ever increasing violence. At the peak of this, they are forcing the air in and then out of their nose with incredible force, throwing their shoulders and head back and forth like a piston creating such a loud noise it seems likely their sinuses will rupture, although that did not happen. Do not try to hold or cover their nose, as they will probably just rupture their eardrums instead.

Once they have finished one loop and collapsed back on the floor, they will instantly pick up on whatever physical movement they happen to make next, and turn it into a loop. Dangerous loops for example, are things like smashing their teeth together with ever increasing force. If you see them do this, force a towel in their mouth. They are likely to carry on and not notice at all, but their teeth will be saved.

It should be noted that they will not have any recollection of performing these “loops”. (in swim's experiences)

In situations like this, getting them to calm and rest their physical body is needed if they are to get out of the looping stage. They will not be conscious so you will have to physically move them into a relaxed position. Hopefully, after being relaxed for a while, they will stop looping. Later on, they may give a sign that they are going to start looping such as beginning a loop movement. Swim found that saying "no, don't do that" in a very calm relaxed tone stopped them re-entering the looping phase every time.

When they are in this stage, they will be totlly oblivious to the external world, and all you can really do is stop them harming themselves, and try to keep them comfortable. There may be times when they come out of it a bit and try to communicate saying things like "how do I get out of it?"- tell them to relax their body and think about nice things. They will not be able to stand or sit up, so put some cushions under them. The looping stage does not last for very long- 45 mins at most- (more experience reports needed to validate this) but a tripper can re-enter it again.

In addition to physical loops, mental looping is described by many and seem to be more common than physical looping. I have condensed an experience report I found on the internet which described this:

Quote:
Talking Someone Down from a Thought Loop

We were watching some trippy graphics on a screen, and they looked 3d to me and my two mates, but my girlfriend said that they were splilling out onto the floor... I should have noticed at this point, that she was tripping more than us, but I was tripping too, and thought nothing of it.

After about 1hr, we put on some music, and my two friends went to our grow room to trip off the plants (highly reccommended, by the way). My girl and I were downstairs talking about the universe and wormholes, and I put forward the thought that we might be caught in a time-loop, and everything was repeating itself... after a while this became true, and our conversation seemed to be going in circles (I thought this was hilarious, and remembered we had taken the acid, so it was ok). I left the room briefly to call down my friends, as they were missing some great music. When I came back into the living room (about 2 hours in...) my girlfriend started the same conversation we had been having before I left, but she seemed to be more adamant about it, seemed to believe it. I thought she was just playing with our heads, but as time went on, she started getting worked up about the things that we had been talking about (eating oranges, smoking spliffs, and being stuck in the centre of the universe, and how we had to join hands to break out!). I kept reassuring her that what she was saying was not happening. She would then say 'Oh, yeah yeah yeah. OOOOOKKKKK. So who is smoking the spliff?'

It was as if the last few sentences we had said to each other had gotten stuck in her brain, and all she could say or think about was these things.

I tried to roll up a joint, thinking that this would calm her, but she started to grab at me and the other people, trying to get us to join hands and 'break the loop'.
Now I was worried. Nothing I could say would get through to the real her... It seemed like she had gone to sleep, and left a recording of herself in charge of her body.
I decided that a change of environment may help, so I got her to my bedroom (practically had to drag her out of the living room) and tried to talk her down.
Unfortunately, at this point, she got quite worked up, and started screaming at me, for our friends, and hitting out at people. This was killing me. The love of my life was thrashing around on the floor, and I had to put my hand over her mouth (making sure she could breath through her nose) to stifle the screaming.

About 4 hrs in, I finally was able communicate with her. She would say one of her 'loop thoughts', and I would try and reassure her by saying an appropriate response. For example, she would say 'Oh God, where is C and V?' And I would say 'Oh look, here they come. They are here'. I had to convince her that what she wanted to happen, was happening.

It became clearer to me that she was still in there by looking at her eyes. When she was in her own world, her pupils were so large, nearly all black. But every so often, when I got through to her, they would close to a point, and I could tell she could see me, then she would lose it, and the pupils would dilate again. The only way I could get her actual conciousness to surface, was to trick her mind. She kept on with the 'loop thoughts', but every so often I would throw in a new response, referring to our real lives. for example, I at one point I asked her what she thought of the music at the club the other night, and she replied 'Oh, it was quite good', and I said 'I thought it was shit', and then she would go back into the loop.

She kept scratching at my arms, and putting her hands in my mouth (she said afterwards, that this was to try and communicate with me by 'putting her thoughts into my mouth!')

About eight hours in, she began to calm down, although she was still thinking in loops occasionally. When she did come back, she felt so bad, she was convinced that she was going to die, for about 2 hours. I knew that this was not going to be the case, but I had to keep on reassuring her, because she would believe me for a second, and then think that she was going to die again. After about 11 hours after taking the acid, she was down (but still mildy tripping visually). she had no idea about what had happened, and we both cried and comforted each other for many hours. From her point of view, she had resigned to dying, there in my bedroom, and this had had a huge emotional impact on her. From my point of view, I had watched the one I love most in the world, nearly dying (mentally), and since I was tripping, this had had a huge impact on my psyche. All the fucked-up thoughts will stay with me forever.

I am writing this, in the hope that other trippers will read it, and if they are with someone that gets stuck in a bad trip in the form of a though 'loop', will know how to talk them down. Reassure them, that whatever their delusions are, they are happening (if good, safe ones), or not happening (if they are bad). My girls thoughts were mainly about oranges (as we had been eating them at the start of the trip). She would shout 'we must eat the orange... who is eating the orange?' and I would say 'Its OK sweetheart, I am eating the orange now (chomp chomp, munch munch).' She would then sigh in relief, before coming out with another thought, or maybe the same one again.

I just kept talking to her, trying to say things to 'trick' her mind back to reality, refer to events in life, outside of the trip. I looked at her eyes to see when the mind had surfaced, and try to get through to it before it went back down under.
Above all, I gave love and hugs to her, because she was in a bad place, and only I could help her back out.
The advise given is debatable, especially about the part where 'tricking' the trippers mind is recommended. It seems a danger that important trust might be lost if the tripper believes they are being tricked by the sitter. If it alleviated anxiety, however, then perhaps it was a good strategy. As I said before, it is debatable and should be debated. The state of consciousness described is clearly extremely fragile.

Seizure phase:
People on a very bad trip may start shaking their body, with their eyes rolling back into their head. DO NOT crowd around them yelling “whats wrong?!” and shaking them. Try to remain calm and support their head, saying calming things.

Catatonic phase:
When they sit or lie down with their eyes open or closed and don’t really move or say anything, often in a clenched position. Put a blanket over them and hold their hand if they don’t object. If they have their eyes closed and are in a clenched position and appear to be getting anxious then gently lift their eyelids for them and say “hi, X, it’s me Z”. If this makes them more anxious, then you can either choose to carry on holding them open and try to soothe them, or you can close them again and try to soothe them- (more experience reports are required for this advise). They may ask for water. When asked things like “how are you feeling?” they might reply with things like “you should just be yourself…” Try not to laugh at them even if you are in need of some humor as it can confuse them although they will probably simply not register your response.

S Cohen describes this as a defencive mechanism against the painful emotions encountered in a bad trip:
Quote:
Those subjects whose major defensive response is somatization have been able to fight off the psychic effects of the drug at the cost of suffering a variety of aches and pains for six hours. Osmond warns of the occasional appearance of a severe catatonic state. We have reported one which was impressive to observe -S Cohen, Lysergic Acid Diethylamide: effects and complications p 32
Traumatised phase:
Consists of sitting or lying down and just crying and being really upset, usually straining arm muscles, often pausing for a second in total confusion to look around, and then crying again. This can last for hours. They will likely be semi aware of surroundings in the sense that they will be able to "see" the room they are in and the people they are with, but they will not really take in the information properly, and will be very confused, upset and worried. For example, if you offer them water, they might recognise it but will not likely take it. In this state, it is best to help them calm down by looking cheerful if they look around them, and saying calming soothing things.

Coming out of it phase:
They seem to be getting better and can get up, move around and talk almost normally. If they are completely normal, then great, they have “snapped” out of it- which is very possible, even snapping out of violent looping back to total normality is possible. If, however, they seem a bit weird and confused then it is VERY important that you keep them company and talk about really simple things, perhaps put on some calming music. Signs of confusion include not seeming to remember much if any of the experience, mixing up words and meanings, extreme short term memory loss, repeatedly saying they want something but they don’t know what, such as saying “come on guys!” “what do you want?” “I don’t know…” DO NOT suggest that they try to get some sleep. They may seem fine and even happy and will probably laugh at jokes but if they show signs of general confusion then there is still real danger that they may fall back into the catatonic or even the looping phase, EVEN if they are nearing the 12 hour mark. Bad trips of this magnitude can easily reach the 18 hour mark. They need to stay awake and happy until the effects have fully worn off AND they are EXTREMELY tired before going to sleep.
Quote:
A valuable point is illustrated by Merlis' three patients who were left alone after the interview period was completed. The drug effects were declining and it was assumed that they were recovering uneventfully. Instead, they became increasingly tense and confused and required further therapeutic support. This exemplifies the importance of constant attendance even during the waning phase of the psychotomimetic experience. - S Cohen, Lysergic Acid Diethylamide: effects and complications p 32-33
Violent, aggressive, self-destructive behavior This is not based on swim’s experience, but is based on a compilation of reports and articles he has read.

From an experience report I came across on the internet:
Quote:
According to friends, any time someone let go on my arm , I would grab anything I could and pull it to my mouth to bite it. If I couldn't grab anything I would bite my fingers, and it was no play bite. If no one pulled my hands out of my mouth, I would have no doubt bitten all of my fingers off.
Some quotes from Drugs-Forum:
Quote:
Originally Posted by VitaminK22 View Post
the guy was standing there with a knife screaming he was going to stab everyone
Quote:
Originally Posted by Charolastra View Post
He was running around screaming like a crazy person, trying to kill himself, running into cars, screaming out gibberish, etc. He ended up taking all of his clothes off and wanted to do really disturbing things to himself, like sticking his head through 2 sharp metal bars.
Quote:
Originally Posted by Charolastra View Post
He got to the point where he got really really violent towards me and to himself. The cops and ambulance showed up and he resisted so they had to cuff him.
Although extremely rare, such reports are always seen as very significant and therefore there are a large number of reports of a similar theme to these quotes. As the first quote demonstrates, constant vigilance is required to prevent self-harm as a person can hurt themselves in the blink of an eye. If possible, a person should be taken to a room/place which does not offer much opportunity for harm as soon as the bad trip initiates. Physical restraint may indeed be necessary for extremely hostile people.

A note on physical restraint:
This may be required if they are thrashing around near something very hard or sharp, or if they are displaying hostile or self-destructive behavior. Remember, physically retraining someone on a bad trip is likely to make them worse and holding someone in the wrong way can easily result in a dislocated shoulder or something similar. If you feel you are not physically strong enough to restrain the tripper, call for help. Also, try to keep contact time and force to a minimum. For example, steer someone gently but forcibly away from danger, rather than grabbing them and trying to hold them on the floor. Of course, only you can really judge what is necessary.
Quote:
Originally Posted by Third/Eye View Post
If you are to hold any part of their body it should be their head. Put a pillow under their head and support it, as you only have 2 hands. A broken or dislocated arm is much more preferred over a damaged brain. Turn them on their side so they don't choke on their tongue. You probably shouldn't move them at all, unless you are unable to move some things away from them. Like, a wall.
*Note: It also may or may not be legal to physically restrain someone in your country, because if you injure them, you could be at fault.[/B][/U]

The decision to administer Benzodiazepines:
Benzodiazepines will diminish anxiety and sedate people on very bad trips. They are the drugs most likely to be given to a bad tripper taken to hospital. Obviously, these drugs can not be forced in the mouths of people who are really freaking out as they will just choke, but in swim’s experience, however, there are brief “interludes” in very bad trips when people “come out of it” for a few seconds, usually to say “why is this happening to me?!” or something. Those are the occasions where you could offer them a benzodiazepine, sedative, or anything you think might help (research drug effects and interactions beforehand).

Dosage for extremely bad trips (assuming no other depressant type drugs have been taken):
Diazepam (Vallium): 20-30mg
Alprazolam (Xanax): 2-3mg

Some people argue that forcibly interrupting bad trips can have a negative psychological impact and that therefore people should be left to work their way out of it and the experience will be ultimately rewarding. I am not going to presume to have the answers, but I will note that from swim's experience that extremely bad trips are better ended sooner rather than later. In swim's experience, an extremely bad trip can go on for 18 hours+ and can be the most horrible experience of a persons life. Swim's friend also lost several months of their life to short-term psychosis which was also awful, and nothing was gained from the experience. I believe that if the trip had been halted earlier- when he was not actually “conscious”- still in the looping phase- then he would not have remembered any of it or at least remembered less of it and therefore been less traumatized. The other experience swim had of an extremely bad trip involved the tripper suddenly snapping out of the trip having been in the looping phase just minutes before and he remembered nothing of it and so was totally normal despite the incredible intensity of his bad trip. Judging from swim's experiences, if someone is in the looping phase it is better to try and get them to take a Benzodiazepine. If they are in a catatonic or traumatized stage then it is less clear if they would benefit; but swim believes they will.

Quote:
Just a quick note on the use of benzos - this should be avoided until you are sure it is a very bad trip as (in the case of swim and the others that he knows) it reduces the ability to differentiate between hallucination and reality and does not give any mood lift. This can lead to a long uncomfortable 'mashed' trip which removes any chance of salcaging and enjoying it. I have to agree though that it is probably necessary for very very bad trips to prevent harm to the tripper or those around him/her.
*Note: It also may or may not be legal to administer medication to another person in your country. If they happen to have an allergic reaction to the medication, then you will be responsible for injuring them and this may result in a law suit against you.
More information about Panic Attacks

What they are

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.

This section needs to be expanded. More information about panic attacks.
Prevention

1. Know your substance, know your source. - It is crucial that any individual who partakes in drug use know what they are getting, how pure it is, how strong it is, how much to take, and who they are getting it from. Stories that begin with "My buddy X got 3 little yellow pills from Y who bought them from Z, and I took them..." are usually bad news. Do your research, ask questions, read books, before you do drugs!

2. Don't trip alone. - If all goes aloof, having a friend help you through a difficult situation may only be possible if that friend is there. If by any chance you need further medical attention, having a friend ready to help you may save your life. Make sure this friend knows what you are taking, what you expect, and who to call first depending on the nature of the situation.

3. Have a game plan. - It's early Sunday afternoon, you fed your pet fish, and you have no further obligations for the day. Good. But if you just got home from work on Monday night, have dinner plans with your in laws in 2 hours and have to complete an architectural assignment that your boss wants Tuesday morning, bad time to do drugs. Make sure there is an adequate amount of time, and you know what you want to do with your time, ahead of time. Plan in advance.

4. Mind your Set, mind your Setting. - Set refers to the mindset of the user who is about to change their brain chemistry. Is it stable? Are they happy, sad, angry? Are they looking forward to the experience, or scared of it? Are they a well-grounded individual, or are they susceptible to radical thinking? These are things to consider.
Setting refers to the surroundings that the user finds themselves in. Is it comfortable? Is the environment drug friendly? Are the people present close friends? Is everyone on the same page, same verse, same level? These are also some things to consider.
Specific drug reactions

These sections need to be written.
Cocaine

Marijuana

Quote:
For swim, these mainly consist of the body high becoming very intense, and then worrying that it is going to get too intense. The fear and panic kind of washes over you and manifests in a very physical intense feeling like your nerves are on fire. This further intensifies the "trip" which then that fuels the anxiety about feeling too stoned- a viscous cycle. Sweating, fast heart rate and fast breathing rate and nausea accompany all of this.

To calm down: Swim finds that getting very warm and lying down, drinking water if not to nauseous and doing controlled breathing and meditative exercises work very well. Also, the peak of a cannabis experience does not last long, which is a comforting thought, and after the anxiety has been dealt with swim can usually enjoy himself again.

To avoid: Swim notes that to avoid panic attacks on cannabis, he finds that smoking very slowly and waiting until you have felt some effects before smoking more eases him into the experience much more gently. And of course, set and setting apply.
Ketamine

Salvia Divinorum

Quote:
Smoking Saliva divinorum creates a very uncomfortable experience for swim. He immediately feels as though he is losing control and something is taking over. Then a feeling creeps over his head and forces him to feel as though he should lean forward and huddle over. He feels gravity pull him down and he begins to get cold sweats, he shrinks in size compared to the rest of the world. He always has a rush of severe anxiety, that something will happen that will be out of his control.

He knows it will end soon. It is always a relief when it does. It would help if someone reminded him that it is temporary, and that they will deal with any external problem that arises. Swim needs to maintain the mindset that it is time to enjoy this, not worry about other things.
LSD

Quote:
For swim, psychedelics like LSD are the worst substance to have a panic attack on, but he still feels that it is manageable. What the panic attacks consist of for swim is a horrible wave of fear and anxiety washing over him which makes him feel he is going to faint and his vision goes black around the edges.

Dealing with this first stage of the bad trip: Swim tells himself that he can get through it, that the worst that could happen is that he freaks out and then gets better. Breathing exercises, meditation and convincing himself that he is actually enjoying these feelings all work to alleviate these first symptoms but only to a lesser intensity: for swim the panic, once begun, will not go completely away until he manages to sleep.

After this initial panic has been overcome, swim finds that the fear and anxiety becomes a lot more emotional than physical. Essentially, the fear tries to attach itself to something to "feed" off, or make itself "stronger". This mainly includes swim's imagination; he finds himself thinking horrible things such as he is somehow mentally working himself into a corner from which he will not be able to escape- or the image of himself locked in a pitch black room forever keeps forcing itself into his mind. Swim deals with such fears by ignoring them as irrationalities. Swim tries to listen to relaxing music and just waits until he is tired enough to sleep. This can take many hours and it is hard to deal with the fear. Never at any point does swim allow himself to cry or be upset as doing so could let the fear take hold. Don't try and think about the situation, your mind will only create some horrible fear and you will just get scared. Just sit and wait.
The Aftermath

What happened?

This section needs to be written. It will include PTSD, and effects of having a panic attack on the mental state of the individual.
What now?

First, remove the source of the problem. The individual must stop consuming the drugs, or possible several drugs that may be part of the problem.

Second, reassess the situation. The panic attack was initially caused by an unknown or alien substance where the individual did not expect what they got. It probably could have been done in a safer way. List some things that could have prevented the panic attack. Think about why the panic attack happened, and what could be done to stop it from happening.

Third, reaffirm positive beliefs. Many people have previously enjoyed an altered state of mind without having a panic attack. They were able to enjoy the experience, so swiy probably can too. Understand that some drugs carry health risks, while others are more safe and less toxic.

Finally, reintroduce the substance. Start small, very small: one toke, one hit, one bite, one bump, but just one. Wait 10 minutes. Wait an hour. Wait a day, whatever need be. Then take a little more. Wait again, and go on from there.

Overall, remember to know positive. One must know they will be okay, not think that they will be okay. Be safe!


This wiki needs expansion. See this thread.

Acute Anxiety Management group
- discuss and contribute to this wiki here.
References

1. Crisis Intervention in Situations Related to Unsupervised Use of Psychedelics; Stanislav Grof, M.D.
2. Higher Logic. Marijuana.com. Accessed January 14th, 2009. http://www.marijuana.com/medicinal-m...y-attacks.html


Contributors: Richi, bananaskin, TommyRowe,
Third/Eye, Durd1e


Created by NeuroChi , 14-01-2009 at 05:39
Last edited by Beenthere2Hippie, 19-01-2014 at 03:09
Last comment by bhonkers on 28-07-2013 at 00:19
6 Comments, 34,541 Views

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