Pots And Severe 'panic Attacks'

[Freaked]

This has been driving me bananas lately. I've been very unwell, and along with it I'm getting these monster panic attacks basically every day. As in they last for hours, my BP spikes, I'm in a cold sweat shaking on the floor and the whole time I feel like I really might die. Terrifying. The sort of panic attacks normally reserved for people with mania. They tend to ease if I manage to eat something big. I never had panic before POTS, and I know it's a symptom, but how does everyone cope with them without benzodiazepines (docs in my country aren't supposed to prescribe them)?

[blueskies]

Have you discussed this with your doctor? If it was me I would check this out with my doctor. You mentioned that they last for hours. I get some nasty ones too and they can last longer than the average 10-20 minutes that I read about on Panic forums but I haven't experienced one that last for hours. I do get extreme anxiety either side of a panic attack and severe anxiety can be almost as bad as panic. I was told by a psychiatrist once that anxiety can be so strong that there's nothing much between severe anxiety and panic . Do you find the attacks 'peak' - stay at their peak a while and then come down a bit?

If was panicking for hours I'd be checking with my doctor. I'd think it was my sympathetic nervous system is giving me a hammering, that's for sure. Thinking back, I did have a panic attack once that lasted what felt like about an hour. It was literally driving me up the wall - just a little bit. I was sitting in bed and pushing my legs hard into the bed and pressing my back hard against the wall which meant I was sort of pushing myself up the wall a bit. It was then I learnt that the old saying, 'driving me up the wall,' is based in reality.

I take benzos but if I could do it all over again I probably wouldn't. But who knows? Benzodiazepams are getting a very bad name. I do know that. They are highly addictive. Easy to abuse. Although I've never abused them. I do know they help keep my autonomic nervous system a bit calmer and did from day one. My allergist also told me they usually help with anxiety that accompanies frequent histamine release.

[Katybug]

I find it curious that eating a substantial mealncan help these attacks. Have you been thoroughly evaluated for hypoglycemia? What you are describing can also be symptoms of low blood sugar including feelings of anxiety and without doing something to acutely reverse the hypoglycemia like eating or taking a glucose tablet, the episodes can last a long time.

[gjensen]

Freaked, I think that Katy made an interesting observation.

If that is not what it is, I would be interested in seeing what you come up with.

I suspect anxiety/panic as part of my spells. My wife and some friends say no. They know me, and some have seen me go from good spirits to on the floor. And it is no fun. I know there is some anxiety that comes with it, who wouldn't? What I keep thinking to is am I getting a chemical flood in response to the symptoms? Mine are irrespective of mood, that I am sure of. Rarely are my spells preceded by any thought process. I tend to stay rational through the episodes.

I just want to make that separation. I tend to get these spells in the morning. They have almost always been early. I wake up feeling shaky sometimes and tend to know when I am most likely to get them. Not always.

I am not trying to connect what you experience to what I experience. I see some similarities, so I am sharing some thoughts that I have had. I do not have any answers, or even know how to get answers.

I would like to learn how to manage these, because they have become a game changer. I do not want to go the Benzo route if it is not necessary.

Regardless, it is something that has to be discussed with a doctor.

I really hope that you get some relief soon.

[IceLizard]

Hi Freaked,

I was given Clonidine to help with this type of attack. Clonidine reduces blood pressure and in general is calming, but it is not a Benzodiazepine. It is usually prescribed for high blood pressure. Short acting beta blockers may also help. They are not addictive and they help prevent the action of adrenaline on certain receptors, thus relieving panic and anxiety and reducing blood pressure and heart rate. This type of attack reminds me of pheochromocytoma. See here: http://en.wikipedia.org/wiki/Pheochromocytoma

I was tested for this and found to be negative.

I have found that sometimes I will feel over simulated and anxious before eating, then relaxed after eating. I am not sure why, though. I do know that skipping meals is a trigger and that I should never allow myself to become too hungry, so I eat throughout the day.

[Freaked]

Thanks for the replies everyone. I have a home blood sugar monitor, and my sugar would go towards low at times, but I never saw it actually hypoglycemic. I have been tested for a pheo too (though I was very asymptomatic that day, if that makes a difference). The BP spikes with the attacks are actually new, and the rest of the time my BP can be low or lowish, so I can't really try beta-blockers again according to my doc. Bit at a loss as to what to do. Benzos used to help cos it's definitely an adrenaline issue, but as I say, docs here only really prescribe SSRIs now and the ones i got said on the label not to take them if you had orthostatic tachycardia. Hopefully seeing a psychologist on Friday, but I'm not sure how psychological these attacks are; I don't think my body would even have been capable of this before POTS.

Gjensen, your episodes sound kind of similar to mine.

[andybonse]

I get this, I am having one now, but mines not to that extent.

I was feeling really good today, then suddenly I got a huge anxiety and fear and felt really weird, its a horrible feeling like your going to die for no reason at all, thing is my vitals are perfect during this lol resting hr 66, bp 120/70 etc,

I think it might be a sudden release of too much adrenalin from pooling blood or something, it lasts about an hour or two then its like a different person. I get it quite often, just no idea what to do when it happens, I also urinate more when it happens so all points to adrenalin to me.

Hate it!!!!

[dkd]

My blood pressure is on the lowish side also (100s/60s), and after three different beta blockers, I found one that didn't lower it even more. Maybe you could try a beta (or several different ones) if you could get your doc to agree?

I had 4 of these 'anxiety attacks' before I went on a beta blocker and have not had one since (knock on wood). I hesitate to call them anxiety attacks because I wasn't doing anything at the time that I felt anxious about. I do think it's an adrenaline flood or something.

(FWIW, I tried an SSRI (Lexapro) and it made me feel worse--visible hand shaking, increased urination, increased startle. )

[IceLizard]

Hi Freaked,

What you may need is a med that reduces your adrenaline response only temporarily, since you have low bp at other times. Clonidine or a short-acting beta blocker have helped me in the past during these attacks, but, yes you need to bring it up with your doctor. Just something to think about. I am seeing a Psychiatrist, too because I am on Librium, Cymbalta, and Paxil and I need help managing these psychoactive meds. Nothing to be ashamed of. Too bad the autonomic nervous system doesn't have its own specialist.

[gjensen]

Freaked, do you have shaking spells afterwards? Other than the shaking you might have during? I always conclude with shaking spells that are as dramatic as the spell was. Also when I have settled, my orthostatic tachycardia is much lower than my usual. This can last for an hour or so, before I go back to my typical.

I have tried to identify a trigger, but there is no consistency. It comes out of no where, or I can be symptomatic for something else prior. Mine are most often in the morning. Almost exclusively. I have grown to be weary in the morning.

My BP gets very high, very fast. The highest HR was 220. The highest BP was in the 190/140- 180/140 range. The former by my monitor, and the later one in the ER.

My logic with no proof says that it is a neurologically instigated chemical surge. A severe panic attack that I have no control over, no matter how rational my thinking, and instigated by a variety of triggers.

[gjensen]

Ice Lizard, I gave credit to Clonidine for settling these spells for me. Now they have come on stronger than ever while on Clonidine. I am still convinced that Clonidine was helping, but I may need a larger dose.

[Freaked]

Yeah gjensen, I get the shaking afterwards too. And once that passes, I also seem to be less symptomatic for the evening. Basically what's happening atm is I start feeling short of breath, nauseous and cold sweaty in the morning and my pulse pressure narrows (higher diastolic, lower systolic). Then comes a full on attack where my blood pressure goes up, I feel very scared, dizzy, etc. Then shivering and shaking with my BP slowly normalising (once I've drank a lot of water and eaten something large and low in sugar). Then I'm okay for the evening usually (touch wood). This all happens just sitting up, but lying down seems to help.

[gjensen]

They sound more and more similar to my own. When I hit the shaking stage, I know that I am coming out of it.

I have been having bad chest pains constantly for some time, and I have had some severe spells set it off. Sometimes just sitting up, putting on clothes etc. will get me. It does not take much. I can be laughing one minute, and feeling like I will die the next. LOL.

In the mornings when I feel unstable, I tend to take it easy, because it does not take much to set one off.

Clonidine did seam to help me. I may need to up my dose. I have a Mayo referral, so I was hoping to hold out until then. I do not know what they will end up recommending.

[IceLizard]

I have had these so badly that they conclude with what looks like seizures with a heart rate near 200 bpm. I have to avoid stress that can bring them on, like for example, trying to about a normal life instead of resting all day (only half-joking). I am shaky in the mornings especially, so I take Librium, which seems to be helping. Clonidine helped too but I had side effects from it. I am concerned about being on the Librium because it is a benzodiazepine, so I am seeing my doc to look for alternatives. I have reactions to non-selective beta blockers so I can't really use them. Sometimes Metoprolol (a selective beta blocker) can help with my heart rate. I think there is another medication called alpha-methyldopa that is supposed to help hyper-POTS patients. Hyper in this case referring to the hyperadrenergic state. (Hyperadrengeric = panic, high heart rate, high bp, and other symptoms of sympathetic nervous system over activation.) This site has more info on Hyper-POTS if you are interested. http://stoppotsvirginia.blogspot.com/2012/02/decoding-hyperadrenergic-pots-how-to.html#.UzCKeIWf0dV

I am currently investigating mast-cell disorders, because they are associated with Hyper-POTS and low blood pressure symptoms.

I hope you find something that will work for you.

[gjensen]

That may prove helpful for me to. I would have been thrown off the hyper trail because I have Orthostatic Hypotension on a TTT.

I really think that I would test differently on different days.

[Gemma]

Hi icelizard. Can I ask, so hyper POTS can also have low orthostatic BP. This is what I have, but my NE is high upon standing, so doctor says I have hyper pots and also suspects MCAS. But I was always under impression that hyperpots needed high BP.

[lynnie22]

Freaked, it sounds so much like what I go through often. I was having a terrible time, with the surges in BP, despite it being normally low. I shake, feel terribly anxious, and could not seem to control it. I take a very tiny dose of propanalol, haven't found a beta blocker that doesn't lower my bp too much at other times. I am unfortunately on benzos, but at night to sleep. I don't think in the long run they are very helpful because you do get addicted and according to a sleep specialist, it may be causing some of the pots symptoms to get worse. I found it correlates for me with times of day -- late afternoon being problematic, late evening being low blood pressure and calmer. It's all about our overactive sympathetic nervous system I think, and obvious surges in adrenaline. I have tried meditating which has seemed to help over time. My blood pressure is now higher in the morning and that seems to help me feel better later. But I am a nervous wreck most of the time, and do experience these terrible panic attacks with all that you talked about. I have also heard about although not tried biofeedback.