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How To Handle Panick Attacks Or Adrenal Surges


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I wrote here before how emotions effect me.

It only takes a tiny amound of stress (it doesnt matter if it is positive or negative)

for my body to go into adrenalin rushes or panic modus with all the POTS symptoms

playing up big time.

Most of the times i can watch these surges come and go without really getting anxious or panicky about it.

But sometimes (especially at work) i start to panick and i get very hectic and anxious because i guess iam afraid

of dying or getting a fit at work?!?!?!?!?As soon as i feel that way i get the thought, i need to go home, but i usually stay there and try to get over it somehow without anybody noticing it.

Before i got diagnosed with POTS i saw a therapist because for over 10 years doctors couldnt find anything

wrong with me and decided that i might suffer from anxiety or panic attacks. They had no clue when i described

them the symptoms i get mostly upon standing and the rest of it. (even though i showed them how my pulse doubled up from sitting into standing).

Thats why i decided to see a therapist to try to work on the adrenalin rushes (then so called panic attacks). I learned a lot and it was really reasuring to hear, that a panic attack wouldnt kill me. I practised to just breath through these surges and wait them out.I also learned that i shouldnt avoid situations that would cause a panic attack. I was told that people who get diagnosed with panic attacks are usually healthy and that a critera of the diagnosis of a panc disorder is, that there is no confirmation of an illness that could cause these kind of symptoms, they must be purely psychological.

With this knowledge i lived for many years prior to my POTS diagnosis.

Whenever one of these surges appeared i stayed quiet calm because the doctors told me that there is nothing wrong with my body and a panic attack wont kill anybody.

Now after i got diagnosed with POTS i notice, that iam not so calm during them episodes anymore. I wonder if people with POTS can stick to the same advice concerning panic attacks like people without POTS.

I heard a million times that POTS is not going to kill us but i also notice, that whenever i get one of these surges for example at work i get insecure and i ask myself if its really safe for me to sit and wait it out without leaving the office.

Every day i get confronted with many situations that touch me emotionaly and that for set me into a hire wire state

like for example:

Today at work i got excited because a coworker visited to show off her newborn baby.

It was also the birthday of my boss and i wished him a happy birthday

I got involved in a discussion for only a few minutes...

and many more situations....

My therapist from a few years ago (prior to the POTS diagnosis) told me to stay in them sort of situations and dont run away and leave them.

Am i still safe doing this??? Even though i have POTS and because i have these symptoms due to an ANS dysfunction?

My BP gets really high in during these situations but doctors told me that i shouldnt worry about it. My Heart is ok. I have just a tiny MVP

How do you alle handle these, can you realte somehow?

Can i really expose myself without risking big damage like a heart attack or stroke? Because these are the thoughts that come into my mind as soon as i get into such a situation.

Should i just sit at home and never do anything to wake up any emotions that set me off in order to not provoke my ANS?

I dont want to die only because i watch an exciting movie or because i say good bye to a friend who moves away. All these situations set me off big time

Thank you all so much for your help.


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Wow you've lived with this for a long time I'd say you've done a great job!

I'm experiencing the same thing you are. I am trying to ride out as much as I can with this but I do have Xanax that I keep on hand at all times. I take a very tiny dose if I feel like I am too wired or the situation is too much for me and it works wonders, takes all of those weird feelings away. For that reason it makes me feel that that's all it is are feelings and gives me a bit of security.

I am trying as hard as I can to temper any excitement. To stay very calm in situations because like you say instead of squeezing out just a little adrenaline we do it to a point that it is debilitating.

I have also noticed when I am calm so is my heart. It doesn't do any of the flipping around skipped beats etc etc. It is my panic and anxiety that send my body haywire at this point for the most part so if I can control the anxiety hopefully my heart will relax too.

I live with the same fears you do that what if I just get in a bad situation and it becomes the end for me, I just go down? I guess I have no answer for that only what I have happen over and over that I feel so incredibly bad-it's like they can't get me to ER fast enough only to within a 20 minute time period feel okay again. I have to tell my self that's not heart failure. Heart failure does not go away that fast or come and go like I experience.

So my goal is upright and calm as much as possible.

I would be happy to travel this road with you. To check in periodically and see how we're doing with our anxiety-you seem like a pro.

The Xanax if you get a script might give you that little bit of extra confidence you need.

I would never encourage you to take it every day as it can be highly addictive. It's more the peace of mind it gives you knowing it is in your purse and then being able to take in the occasional times where you do feel like things are getting out of control.

For example for whatever reason one time I picked up fast food and ate a shredded chicken sandwich and a chocolate shake. Bad mistake. My heart rate instantly went up to 130 and would not come down. I was very uncomfortable. I took 1/2 my Xanax and within 20 minutes my heart rate came down to 90 and I felt much better. I'm all for waiting it out if that's at all possible but there is no reason to be in misery either. If you find something that works whether it is a palliative measure or a medication I am all for using it.


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I?ve got the same difficulty of being an overly sensitive person too. Any emotion ? either positive or negative ? other than calm and relaxed and it can send my nervous system into overdrive. Since my POTS dx however, it can send me into a full-blown panic attack. At work, it?s the worst because you want to appear professional, in control and not ?sick?. A couple of times I?ve had bad panic attacks at work and during and/or later when I confided in a co-worker, she had no idea I was going thru it while I was going thru it. So on the inside, I?m freaking out and falling apart but on the outside I still appeared calm.

At these times, I relied on every tip I learned from reading (tons and tons of reading) about anxiety and panic attacks (without the POTS). Mostly tips you already know like breathing techniques, not avoiding these situations, etc. In the beginning I had a prescription for Klonopin. When a panic attack would strike, I would take one (or half) and the attack would subside. Little by little, I realized that I could breathe thru it and not have to take the pill. Just knowing they were in my purse (just in case) was a big relief. And I ended up never taking them ? haven?t taken one in years. Have you ever tried medication for these attacks? I also make a cup of kava tea to relax when I feel really anxious. I used to think there was no way I?d have time to make a cup of tea because the panic comes on so fast but I?ve learned that the ritual of making the tea gives me time to breath, focus and relax and by the time I?m actually sipping the tea, the attack has mostly subsided.

I used to worry all the time that I might have a heart attack or was doing damage to my heart every time I had these attacks but I remember one of the techs who was giving me an echo once and my heart was going crazy and he was actually fascinated to see ?a young, healthy heart performing like the incredible machine that it is?. I felt like I was dying but he said confirmed that even though it was (mentally) uncomfortable, it wouldn?t kill me. I just have to trust that.

Having an over sensitive nervous system feels like a curse most times but I think it is also a blessing. I?ve read many posts where you speak about stimulating conversations, vacations, arts, work, friends and family. It sounds like you have a true zest for life and maybe that is the balance in all of this!

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No small surprise that I found myself spinning these same questions around in my head this morning ... then I came to the DINET boards and saw your post. Deep bow to you Carina for being such a pioneer and blazing this trail on your healing journey. I do believe that those of us with POTS who also have panicdisordered minds find ourselves in a unique situation. Unlike people with traditional phobias, irrational thoughts or unbased fears we have an organic component to our illness that sometimes can get caught up and intertwined with anxiety reactions.

From my experience (and dozens of years in therapy) things like "exposure therapy" in the traditional sense doesn't work for people with a chronic illness ... in that we may never feel "good" in a particular situation no matter how many times we face and accept our symptoms. At best what I have come to practice is how to feel REALLY REALLY BAD wherever I am. The "stay-where-you-are-approach" has alot of merrit in that it allows us to continue with as much amount of normalacy as we can within the confines of a life limiting illness. But whereas folks without POTS and only panic can look around and rationalize to themselves ... "Look at all of these other people standing in line, they aren't panicking I don't have any reason to feel anxious right now." ... that doesn't apply to someone with dysautonomia. OUR positive thinking has to be more along the lines of "I HAVE POTS" (its important to remind ourself of that because it lets us remember to be compassionate with our symptoms and our response) "My doctor assures me that my heart can handle these hyperadrenergic flares and I can do some things now that can help mitigate the symptoms." That when you decide that wherever you are you can SIT DOWN. It's ok to sit on the floor, prop yourself up against a wall, or lay down in your car in the parking lot until the flare passes. It's not running away when we take steps to soothe and comfort the symptoms of an autonomic storm.

<<Should i just sit at home and never do anything to wake up any emotions that set me off in order to not provoke my ANS?>>

Let me put your mind to ease with this question .... coming from someone who had to stop working in 07 and has been homebound for much of the time since .... SITTING AT HOME DOES NOT KEEP YOU IMMUNE FROM THE FLARES. No matter how much meditation I do, breathing exercises I practice or combination of inactivity or ANS retraining ... I STILL go through the daily surges associated with hyperadrenergic POTS.

<<I dont want to die only because i watch an exciting movie or because i say good bye to a friend who moves away.>>

I had to smile when I read this thought, because it is one that I have had for years .... it's as if I worry that when I get up to the pearly gates they are going to tell me "I'm sorry EM, you did something stupid and we can't let you in. If only you had heeded the warning signs sooner." Having said that, I do know what things I can handle and what things are simply too activating to be able to "stand and deliver" .... so for me, I will most likely miss my daughter's graduation this May as well as a very important event in April. Both of these bring a tear to my eye. But in my old age, I am coming to realize there is no "easy path", no "safe script" for how to manauver through this dis-ease. At best we do what we are inspired to do in the moment ... nothing more .. nothing less.

Be gentle with yourself. You are doing an amazing job.


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My cardiac ablation was quite stressful as any of the members here who have had one could tell you. Adrenaline ended up being the means to induce me into afibb I was going at over 200 beats per minute I think it was something like 240 and they were getting ready to put me to sleep to convert me when I converted on my own. Very scary. Next they may have done the mapping. Next the actual ablation those two parts were not bad. Next comes the uncomfortable part. They try to trigger you again. They were pumping me full of adrenaline and after about 10 minutes of it I was begging them to quit it was so uncomfortable. Well little did I know they do this for 30 minutes to make sure they fixed the problem. I was in misery. Finally the 30 minutes had passed. You are awake for the whole cardiac ablation and I was lucky mine only lasted 6 hours that I was laying there on that table. So at the end the nurse gets so excited practically jumping up and down and says-Wow you are in such great physical health! Your blood pressure only got up to 120/70 that entire time. She said with what you have just been through we expect to see bp's all over the map but you hung in there like a trooper. I was in la la land not from any of the drugs they had given me but just overall weakness and fatigue and just feeling I couldn't take another moment and was just thankful it was all over. Her words did not do much to comfort me at that point.

What I am finding though is I think that the sensations that I get are very overblown and that much of what they are just exaggerated. I still fear steps and normal activity.

The thought of trying to make it through Walmart right now sends me into deep concern but I think I need to try to stay positive and work with my body. Not let the feelings overwhelm me.

I had mentioned in another post so many times when I'd feel like crap and take my bp I'd get 92/50 and think what? How can I feel so bad but my body seems to be functioning just fine?

I don't really understand it and while I am still experiencing the panic and anxiety I won't deny that I am also trying to work to build my own confidence back up.


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I will be missing my daughter's graduation this May, also. Besides it being way too "busy" of a situation, it is outdoors and, living in the deep South, the temp will be above what is comfortable for me. I am even going as far as having my mother in law to have the after-grad small party(whe loves doing that kind of stuff!). I even missed my daughter being on the homecoming court due to the same reasons.

I have come to a point in this disease that, yes I am missing some of these events, but I still see my daughter everyday in normal life, so these events don't represent what we mean to each other. I am always excited for her to experience these events because they are about her, not me.

The first year of this, missing all these things would have crushed me! But, I have come along way in accepting what life has thrown at me. I would like to add, though, that I am not just sitting back and accepting that this is the way the rest of my life will be. I still actively research possibilities and see new doctors if my current one gives up. I even run some of my own labs when I get an idea that a doctor never checked some odd thing.

The panic/anxiety is a whole monster of it's own. It is life-restricting, to say the least!

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Thanks Sue! Somehow in my disordered mind it felt like I was the ONLY person not attending her daughter's graduation. I also get to see her all the time and I know she understands. We often joke about hiring a celebrity look-alike who can stand in for me at these special moments. And of course I'm a whiz with Photoshop! I can BE anywhere I want to be in hindsight. ;-)

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I can sympathize with you. Every time I go to doctor or dentist, I get myself worked up into such a state that my heart is racing and pounding out of me and my blood pressure goes up. Then the dr. says, "Is your heart rate always this high? How do you function?" and I say, "No, it will come down as soon as I walk out this door."

It is so aggravating because I can try to reason with myself and calm myself down but the powerful combination of my anxiety and the adrenaline surges from POTS make me totally miserable. Distraction seems to help some. The last time I went to the dr. I took my son's MP3 play with my favorite movie downloaded on it. That helped some.

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As I read these posts and write this one, I am struggling to breathe, my hands are shaking, I don't feel like I'm thinking clearly and I am afraid that I'm really going to not be able to breathe. I'm doing deep breathing techniques and telling myself,"This will pass, it always does." I'm watching the clock because I know within 30 to 40 minutes of panic I will start to feel better. And what caused this adrenaline rush? I had too much FUN! It seems like TOO mich of anything is too much for my body to handle. Too much fun, too much noise, too much laughter, too much(fill in the blank) and I'm shooting off adrenaline like it's a fourth of July fireworks show.

Oh to live in a Goldilock's world where everything is JUST RIGHT-not too hot, not too cold..........

Hugs and panic free days to everyone!


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Thank you all so much for your replies.


a few years ago a cardiologist prescribed me a medication called lexotanil its a tranquelizer (Bromazepam). Back then my cardiologist figured that my sympathetic nervous system is far to sensitive. He used to tell me that my sympathetic nervous system is as tall as the eifel tower and that he tries to bring it down to its normal size with the help of this medication. I took a tiny amount of it over the period of a few years and at first i experienced that it helped a bit. After i got diagnosed with POTS in 2007 they told me to stop taking it and i stopped. And you know what? I did feel better not taking it. I remember that they told me that i could take a tiny dose whenever i need it. Therefor i always have a pill with me in my handback but up until today, i never took one. I always tried to go without it and forgot about it i guess. Iam a little worried about the side effects because iam very sensitive to medications and like i said, i havent taken it for years. But you are right. This is at least another option i can look into.


I can so relate to your work situation. With me its the worst at work as well because of the same reason like it is for you, i want to appear professional and not sick. Whenever i get so sick at work i cover it so well that nobody ever notices it. Even during the worst adrenaline/panic attacks i appear relativly calm on the outside but on the inside my body is going craaaaaaaaaaaazy and at some point my mind follows. Thats when i can feel the pressure i put on myself by trying to hide how i really feel. Thats mostly when i start thinking about running home because there i can be and act according to how i feel like laying down even crying sometimes. I know that i will feel better afterwards. But at work i cant do that. Sometimes i fantasize about how it would be if i would let it all out at work as well, it would surely take a lot of pressure away from me knowing that i can be myself no matter where i am. But in reality that is not easy. All i know is, that i want a safe little place when i get like that until its over.


like you, i spend dozens of years in therapy i also always wanted to become a therapist myself and therefore i took every oportunatey i could get to learn as much as i can. I share the same opinion you do when you say that ?exposure therapy? doesnt work for us potsies. Long before i got diagnosed i tried all kinds of therapies including exposure therapy. I was told that i should put myself into as many situations as possible that normally cause my body to go into a panic state.

These situations happened mostly when i went into a sauna, or when i was standing in line in the supermarket. For months i exposed myself to them situations. I went to the sauna every week and i felt so sick almost all the time. My therapist didnt believe me when i told him that it gets worse and worse. Can you imagine how relieved i was when i found out i had POTS and read what provokes the symptoms. All i read about what to avoid ,i knew already but i always put it down to being to sensitive because thats what i was told for many years.

I also practise to feel really really bad wherever i am and thats a good thing to do in my book.

The only place i dont want to feel that way though, is at work :-(

I also practise to connect myself with my inner body like our friend E. Tolle says. It helps me to

realize and feel that iam not what i think, i know you understand what i mean:-)


I agree with you, that distraction seems to help some. When it gets really bad and iam not at work, it helps me to get my cell phone out and play a bubble game. This helps me to focus on something else.


when i was hospitalized due to extreme POTS symptoms (this was about 1 month before i was diagnosed) i had a very very bad episode in the hospital. Like you described i was struggling to breath. My Heart Rate trippled up when i was trying to stand up and i was shaking all over the place. I felt so sick and adrenaline kept shooting out of every cell in my body when finally the panic kicked in on top of all of this i thought that i was going to die. This was one of my worsed episodes ever. The nurses kept running around me and the doctors put an ECG on me. They were all very interested to see what was going on. After my system settled down again the doctor told me, that i was never at risk of something bad happening. He reasured me that my heart was fine and healthy.

Ever since then, i tried to think, that if my heart goes that crazy it might be a good thing because my heart is training without me moving around. I was told that the heart makes no difference between racing due to sports or due to a dysfunction of the ANS.

I feel that i do know a lot of things about handling those kind of situations as long as i feel ok and my body is in some kind of balance. But as soon as my body goes crazy my thoughts start to

race and i seem to forget all that i know.... Most of the time i feel as if i can handle the fast HR quiet ok but what scares me more are the kind of symptoms i get in my head. I get vision problems and i cant focuse anymore. I also feel a pressure in my head and get very very light sensitive. My ears start to ring and i feel so dizzy and lightheaded. I dont even want to know how high my BP gets in these sort of situation. When i get all these symptoms it feels as if my lights would go out any second wich lead me to the thought what if i get a stroke now... I try all the technics under the sun to stay calm and sometimes it works but sometimes it doesnt. Its just so problematic if i get these kind of symptoms at work. I wrote before in another post, that iam lucky because my sister works in the same company i do which means that i can contact her so she can back me up. But she is on holiday soon and i can feel that this makes me very nervous......


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hi there im new here but def not new to dysautonomia!!!

i usto suffer from these attacks every time i went out of the house. i was stuck in home and barly able to complete home school.

it wasnt untill i met a wonderful chardiologest that changed my life by one simple thing to do daily.

after he did a blood volume test and a tilt table test his results showed him that i had low blood volume. not enough blood in my body. he then explaned to me why i would have these attacks. he told me that my blood pressure would drop, and my heart rate would compinsate for it, but the heart rate wasnt enough to get blood flowing so my body used its adrenilen to fix its problem. which in return looked like an anxiety attack.

he then went on to tell me one simple thing i would have to do.... GATORADE!!!!

i was to drink gatorade untill my urin was clear. and maintain this untill my body started to achieve normality, which took about 2 years for my system to maintain its own electrolytes. roughly about 12-24 ounces a day. powder form is ideal, has no high fructose corn syrup

i no longer suffer form these attacks so long as i stay hydrated and eat well. i do however have blood pressure crashes making me not feel so well for abotu 20 min, but almost never do i get the adrenalin any more.

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I am new to this board as well. I have been struggling with the pots/panic attacks that you described. My cardiologist and neurologist said that it is really important to stay hydrated because of low blood volume too. I'm also on florinef which helps to raise my blood pressure because mine tends to run very low taking that medicine helps too. I also have ativan which I take as soon as I start feeling a panic attack coming on. I used to have to take a pill everyday but now I'm down to taking a forth of a pill every couple of days so I promise it will get better and there are meds that can help also try deep breathing and sometimes changing the position your in can help a lot.

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There's not much to add to the wonderful, kind supportive thoughts already posted, but, I wanted to add, do not underestimate the amount of energy you use "hiding". Living with this as a secret, hiding your problems at work, is sheer torture. I've been there. God bless you! And, may the Gatoraid be just the thing you've needed.

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I am not sure I know about the powdered form of gatorade. I had a physician tell me to drink mega amounts probably a dozen years ago. I did that for perhaps a year or more drinking 32-64 ounces a day as I was able. I ended up with systemic candida -- my guess was because of the high sugar content of gatorade.

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I am not sure I know about the powdered form of gatorade. I had a physician tell me to drink mega amounts probably a dozen years ago. I did that for perhaps a year or more drinking 32-64 ounces a day as I was able. I ended up with systemic candida -- my guess was because of the high sugar content of gatorade.

poweraid, i think if you look at the back doesnt have as much essential ingredients as Gatorade.

gatorade is proven to replenish electrolytes. idk if poweraid is qualified to do that. next time im at the grocery store i'll pick up a bottle to read the back.

gatorade does have a high sugar content. my doctor recommended only using the powder form, the powered gatorade apparently has something else instead of high fructose corn syrup. also with the powder form you can add or remove according to how you feel :)

i personally like G2, it has way less sugar and calories.

to much of one thing is defiantly not a good thing as i found out from the constant hunger that i was taking in to much sodium. over hydrating is as dangerous as being dehydrated too...

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