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Suggest treatment for panic attacks

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Psychiatrist
Practicing since : 2005
Answered : 947 Questions
Question
Hi Dr. XXXXXXX
I am 41 year old who has always led an active, creative and fairly adventurous life. Then a few years ago, my father acquired Alzheimer's and died of old age related complications. He used to be an intellectual giant, highly educated and erudite, but was reduced to a horrifically helpless state when he forgot how to speak, could not recognise anyone and so on. Around the same time, my relationship with my partner of 7 years fell apart. After she left, my father passed away shortly, and I decided to quit my fairly high stress job to try my hand at freelancing. My first three months in my new life was quite blissful but then one evening out of the blue I had a horrible episode. I thought I was having a stroke or a heart attack. I was driving through heavy traffic then, and somehow managed to not crash my car and get home. I felt better in a few hours, but those episodes kept coming back. My doctor ran all sorts of checks and the diagnosis was panic disorder. It was debilitating for a year. I stopped going out, stopped interacting with people, stopped driving. I used to be super-fit, but I put on weight, I looked older, I got shifty eyed, couldn't look people in the eye anymore. I was a wreck. I used to be a prolific traveller and did high altitude trekking in the Himalayas regularly. All that became unthinkable. I became a hypochondriac, compulsively checking my own pulse and blood pressure. A psychiatrist advised me to get on Xanax but I didn't want to do anything that might impair my cognitive abilities, even temporarily. Instead I gritted my teeth and forced myself to do the things I was afraid of. I started working out, I went out and met people, I also started driving. I am much better now. On a scale of 1 to 10, I would give myself 7. I was 10 before i started getting the panic attacks. I was about 2 immediately after. Now this is my question. I think I am now a functional member of society again, but I do have my bad days, say once a fortnight or so, when I have to consciously tell myself that this is just a panic attack and it will go away in a bit. The possibility of an episode clouds my existence. I miss the carefree, fearless, adventurous old me. Is that gone forever? Can I ever be the person I used to be? Lastly, you should know that I was a regular marijuana user for over a decade and a half prior to getting the disorder. I stopped immediately afterwards and it has been 4 years since I had my last use. Thank you very much for your patience.
Posted Fri, 8 Aug 2014 in Mental Health
 
 
Answered by Dr. Manisha Gopal 6 hours later
Brief Answer:
try JPMR/ pramayaam; if no help, take medicine

Detailed Answer:
Hello,
I have read your question carefully and I must say that it described all my queries quite well about your health and drugs taken.

You have indeed done a very good (though tough!) job by facing panic attacks and anxiety. You tried almost all lifestyle changes that I usually recommend..I think you must have altered your diet too, though you forgot to mention.

Now, the main part which is bothering you..is that you still have bad days every fortnight and face the regular apprehension of getting them.. For this, I would suggest that you may try: relaxation exercises-e.g., JPMR (which you may get from internet). It is a 40-45 min procedure & very effective.
OR
You may also learn the right technique of pranayaam from someone who is properly trained in it and practice it.

This I would hope will take care of anxiety and might just stop panic attacks.
You may try this for some weeks and see the results.
If you still would feel panic attacks, then I would prefer giving an anti anxiety medicine- paroxetine, in a lowest dose 12.5mg. With this, Im almost sure that you will never be bothered by any attacks. This medicine is not a sedative like xanax..but a proper suuplenent of a chemical whose deficieny lead to such attacks. So, it is not an addiction but a very needed substance for proper functioning.
You may continue all the lifestyle changes and include relaxation exercise along with this medicine for few months. This will stabilize your nerves and later we may try to stop the drug.

The cause behind all this is probably related to your father's illness, followed by his demise, breaking of a long relationship in a background of marijuana use.

It was very wise of you to quit both your high stress job and marijuana.

Hope the reply is useful for you.
Please feel free to ask more questions for clarification.

wish you good health
Dr. Manisha Gopal
MD Neuropsychiatry
Above answer was peer-reviewed by
 
Follow-up: Suggest treatment for panic attacks 37 hours later
Thank you for your detailed answer. I will try JPMR and pranayam. I would also like to know if you have any dietary recommendations. Because I am physically active, I try to maintain a regular and balanced diet. But I am not aware of any specific dietary changes I should do. Are there foods I should avoid/eat more regularly?
Thanks.
 
 
Answered by Dr. Manisha Gopal 3 hours later
Brief Answer:
more green food, sprouts;good sleep & early dinner

Detailed Answer:
Hello,
The dietary pattern that I have found to be effective and suitable in similar patients in long run are:

1. restrict/ avoid-
-tea, coffee, and any such product which can increase the brain neurons..i.e.avoid stimulants.
-avoid cold drinks (even red bull, it has high taurine content) and junk food which have preservatives, that is avoid artificial flavoured substances. These are not good for anyone, so, not even for you.
-donot take wine, beer or any kind of liquor..These may again stimulate and increase panic attacks.
-avoid sleeping late at night on a regular basis. Maintain sleep hygiene so that nerves get enough rest. Disturbed sleep can be a significant trigger for any psychiatric illness relapse.

2. Try to include-
- more liquid, water in your diet. Take sips of water every 10-15 minutes, instead of full glass at a time.
-include more salad and green veggies in daily diet
-nuts, especially walnuts are considered good for brain functioning. so, taking one daily can help in long run
-sprouts: have high nutrient value among all food items, so please make them a regular part of your diet. Take them in raw or cooked form; thrice a week or daily. They can be made from pulses, beans, etc.
-if possible, try to eat dinner by/before sunset and get up early (I feel you do have this schedule as you were into trekking)..keeping the body fit is another way to keep mind in control...this was one of the main reasons that you could face these attacks and could control them on your own without meds.

P.S. You may learn meditation under someone who is properly trained. Avoid doing it on your own if there is no XXXXXXX available( as this may do more harm than good).

I hope the reply helps you.
please ask if there are more concerns/doubts. I will be pleased to help you.

Thank you,
Dr. Manisha Gopal
MD Neuropsychiatry

Above answer was peer-reviewed by
 
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