Panic Attacks and Phobias

Panic Attacks and Phobias go hand in hand. But people who suffer from panic attacks do not always have phobias and vice versa.

Often phobias are caused when we link a specific object or situation to an unpleasant feeling. But a phobia can also develop because we have a panic attack in a certain situation and then subconsciously link the situation and the panic attack because that is how we make sense of it – even though the two weren’t linked.  For example it is quite common to have a panic attack due to hypoglycaemia (low blood sugar). And if it so happens that you are in a supermarket when your blood sugar drops and you have those panicky symptoms (cold sweat, feeling disconnected, dizziness, hype-real colours, palpitations) then you might become fearful of supermarkets.

So a panic attack is not just a symptom of a phobia, it is also a cause. If the object of a phobia is quite specific, such as a spider or an elevator then the best approach is probably exposure therapy. That is assuming that anxiety and panic attacks don’t effect the rest of your life. Please see here for best panic attack therapies.

If however your life is blighted by more general phobias, such as agoraphobia, then you should look for the cause of the panic attacks and then also challenge the phobia through exposure and CBT. There are many potential causes of panic attacks, which, when remedied, can make the whole process of exposure and overcoming the phobias you have developed much easier.

I have mentioned Hypoglycaemia, but there are many other possible causes of panic attacks:

  • Food allergies
  • Vestibular Disorders
  • Mineral Deficiencies.

To name just three.

There has long been a tendency to link Panic Attacks with psychological or emotional problems. I believe that this is erroneous. While they may have emotional symptoms and be exacerbated by stress and emotional events, that does not mean they are an emotional problem.

If you are interested in exploring the physical causes of anxiety, I recommend Killing Anxiety From The Roots.

Drugs For Panic Attacks

There are now a whole range of drugs for panic attacks on the market. For all of these drugs you will need a doctor’s prescription; none of them are available over the counter. All of these drugs have pros and cons, and some have serious side-effects.


The most effective Panic Attack Drug I have ever come across is Xanax (generic name: alprazolam). It works super-fast (in as little as twenty minutes if it is taken sub-lingually, or under the tongue). It is a benzodiazepine class drug, but unlike the others I have tried it doesn’t make you feel spacey, drunk, “out of it” or lethargic and sleepy. On Xanax I feel fairly normal, although I did once fall asleep on a large dose.

Xanax does have its drawbacks though. If you take it when you are having the occasional panic attack then that will probably be fine. But if you are a regular sufferer then Xanax might not be wise. While it’s side-effect profile is good, any prolonged use (more than a week or two of even small doses such as 0.5mg a day) can become habit forming. Being hooked on Xanax is not fun. It can lead to severe rebound anxiety and a host of other problems. Xanax carries a greater risk of rebound anxiety than other tranquillisers and benzodiazepines because it has a short half-life. The other drugs with their longer half-life are in a way “self tapering”.

Other Benzodiazepines

Clonazepam, Diazepam (Valium), Lorazepam (Ativan) all have significantly longer half-lives than Xanax and therefore are less habit-forming (but that does not mean that they are totally safe – addiction is still common!)

Side-effects include drowsiness and amnesia. Some people get paradoxical effects, in other words the opposite reaction to what they expected. In the case of someone taking these drugs for panic attacks that would be heightened excitement and possible anxiey and panic attacks! Therefore it is useful to start at a low dose and see how the drugs work for you. Some people don’t like using benzodiazepines because they feel out of control because they are so used to feeling anxious and panicky.

There are newer tranquillisers known as Nonbenzodiazepines, but their side-effect profile is no better and at the moment they are used chiefly for insomnia, not for panic attacks.

All in all, it’s important to remember that drugs don’t provide an overall solution to panic attacks but are fine for occasional use.

Chronic Hyperventilation Syndrome and Anxiety

Chronic Hyperventilation Syndrome (also called HVS) is a common cause of anxiety. The relationship between anxiety and breathing is complicated. When we feel anxious, our breathing tends to increase and become shallow, from the chest. If we live our lives in a slight state of anxiety and habitually breathe from the chest then our oxygen and carbon dioxide levels get out of balance. This habit of bad breathing is called Chronic Hyperventilation Syndrome.

Chronic Hyperventilation Syndrome has a long list of nasty symptoms but few people experience them all. In the emotional/mental health arena the most common symptoms are anxiety, panic attacks, fearfulness and phobias, depression and low mood, chronic fatigue and low sex drive or impotence.

Many more Chronic Hyperventilation symptoms are also linked to anxiety, such as IBS and migraines.

The chest tightness and difficulty breathing that often accompanies anxiety and panic attacks are signs of hyperventilation. When we over-breathe we tend to gasp for breath and then feel like we can’t breathe and so try to breathe more. This vicious circle needs to be broken.

The best way to overcome Chronic Hyperventilation Syndrome is to go through a process of breath retraining. To do that, I recommend reading the seminal work on the subject:Hyperventilation Syndrome: Breathing Pattern Disorders and How to Overcome Them USA version Hyperventilation Syndrome: Breathing Pattern Disorder UK / Europe version and  Self-Help for Hyperventilation Syndrome: Recognizing and Correcting Your Breathing Pattern Disorder USA version. The author of these books, Dinah Bradley, is a worldwide authority on Chronic Hyperventilation Syndrome.

I have added a post on special breathing techniques for anxiety that you might well find useful. Also this post is dedicated to Anxiety Symptoms: Breathing.

Some doctors don’t really accept the existence of Chronic Hyperventilation Syndrome, but many people have found that changing their breathing habits make a huge difference to their lives, and their anxiety.

Xanax Rebound Anxiety

Xanax (alprazolam), like other benzodiazepines, is famous for its rebound anxiety – the anxiety that you can get after you stop taking a drug or as the effects of the drug wear off.

With Xanax you can get a rebound effect just from taking the drug once. It is in essence a bit like a hangover. People have reported different symptoms and plenty of people don’t get any rebound anxiety from just taking xanax once or only occasionally. Some of the symptoms people have reported from Xanax come-down are:

  • Feeling Groggy/Spacey
  • Lacking Motivation
  • Feeling Lazy
  • Feeling Anxious
  • Having a Headache

This straight-forward Xanax hangover tends to be mild and pass over the course of the day.

Much more unpleasant and persistent is the rebound anxiety that you can get after you have been taking Xanax for some time (normally at least 2 weeks but less for some people). For an explanation of why rebound anxiety happens please click here.

Some common symptoms of rebound anxiety from Xanax:

  • Anxiety
  • Palpitations (racing heart)
  • Panic Attacks
  • Intense feeling of fear
  • Tight chest and difficulty breathing
  • Upset stomach
  • Aching Muscles

Rebound anxiety is often described as much much worse than the anxiety that lead the patient to take Xanax in the first place. It can be very serious and that is why you should never stop Xanax abruptly and always follow the doctor’s advice!

If you are suffering from rebound anxiety then speak to a doctor and talk about tapering your dose. Else you can be in for a miserable few weeks or months, as rebound anxiety can really go on (length of rebound anxiety seems to depend on amount of time you were taking Xanax, size of dose and personal differences).

Remember, drugs are not the answer to anxiety. If you are interested in permanent solutions to anxiety I recommend reading Killing Anxiety From The Roots, which is all about the underlying physical causes of anxiety.

You might also consider reading our Panic Away Review.

Dizziness Vertigo Anxiety

A while back I blogged about the links between anxiety and dizziness and how more often than not the two seem to go together: people experiencing dizziness as part of an anxiety attack or a panic attack.

Today I want to look at dizziness and vertigo as potential causes of anxiety and panic disorder – things like agoraphobia. It has often been said that stress and anxiety can bring on what is often referred to as giddiness, dizziness, light-headedness and vertigo. The reason being that blood is diverted to the muscles, the oxygen balance in the blood changes. This is perhaps true however it doesn’t tell the whole story.

The fight or flight response is meant to save us, but why did we evolve to disable our balance mechanism when poise and stability is needed most, when we are in danger? That begs a question along the lines of the chicken and the egg: what comes first dizziness or anxiety/panic?

For sure anxiety or a big shock can bring on balance problems like vertigo, often very short sharp bouts. However I think, and there is a certain amount of scientific evidence to back this up, that there are a lot of people with panic disorder who actually have an underlying balance problem.

If you into a supermarket and feel funny, maybe get derealization or feel dizzy or lightheaded the doctor will no doubt send you to a psychologist that will tell you that your subconscious doesn’t like being out of control and in a supermarket there is no easy way of escape. Maybe this is rubbish. Maybe the lighting and long aisles of a supermarket make it such a strange environment that the signal from ear and eye get somewhat out of sync in people with a slightly defective vestibular system. Maybe that is what causes the panic like symptoms and leads for the desire for an easy escape route.

If you think about it, the agoraphobics’ worst nightmares are all places that tend to be unnatural and odd and somewhat disorientating: supermarkets, shopping malls, motorways and highways: all places that could cause strange feelings in a person with a vestibular balance problems.

Also read Does Anxiety Cause Dizziness?

This is potentially important because in such cases your psychologist or charlatan hypnoanalyst will be telling you your neighbor sexually abused you. In fact there are types of vestibular rehabilitation and other physio techniques, as well as drugs, that might well help.

If your anxiety seems heavily related to dizziness or vertigo, or you experience balance problems elsewhere in life it might well be worth looking into.

Depression Panic Attacks

Depression and Panic Attacks can often be linked. There is a simple reason for this and that is that low levels of the neurotransmitter Serotonin can lead to both depression and panic attacks.

What’s more, people who suffer from panic attacks often find themselves placing restrictions on their lives. For example someone who experiences panic attacks may become to a greater or lesser extent agoraphobic. Agoraphobia being basically a fear of panic attacks.  If you start to fear things that you used to do easily you may well become depressed and frustrated.

So depression and panic attacks might coexist because of the same cause, or because one leads to the other.

Certainly, the treatment you choose for one would most likely effect the other. For example SSRI anti-depressants like Celexa/Citalopram are often used to treat panic disorder, although the dose may need to be altered to be effective for panic.

Likewise, a course of CBT (Cognitive Behavioral Therapy) will teach you how to think more rationally and not be afraid of the symptoms of panic attacks. The same techniques can happily be applied to depression and the negative thought trains which surround it.

So basically establishing the link between panic attacks and depression is not really necessary for effective treatment.

Xanax Anxiety

Xanax, also known by the generic name Alprazolam, has been licensed in the USA to treat anxiety and panic attacks since 1981. It is used in the treatment of anxiety disorders, panic disorder and, in some cases, depression. It is a member of a family of drugs known as Benzodiazepines. It is a mild tranquilizer.

Many people who have experienced drugs like Valium may be aware of how Benzodiazepines can make you feel doped and sleepy. Xanax is not like this for many people. In my own personal experience Xanax didn’t make me feel very different at all, just much much calmer. I didn’t get any of the side effects listed, and in an ad hoc experiment to see how my reaction times were effected I actually found my reactions to be almost exactly as good as when I wasn’t on Xanax.

Some people do suffer from side effects, sleepiness, dizziness and vertigo, nausea. But these drugs are rather well-tolerated.

In terms of dose, it is important to follow your doctor’s instructions. I personally worked my way up from the 0.25mg dose which is the lowest available and now take 1.5mg on an as needed basis.

Initially I took a tiny amount of one Xanax tablet to see how I tolerated it. As I was fine I took the rest. Some people who suffer from anxiety may have a psychosomatic side effect of feeling a sudden onset of anxiety or panic whenever they try something new. This can mean that at first a Benzodiazepine has a paradoxical effect. If I were you I would persevere, as for the short term relief of temporary anxiety and panic attacks this drug is very useful and very effective.

A word of caution. Like all Benzodiazepines, Xanax can be habit forming. If you take it for too long you may need to taper off slowly to avoid withdrawal effects. Also, if you take it often you may find you need to take more to get the same effect. Your doctor will be able to advise you on this.

I don’t recommend you buy from online pharmacies without prescription, you don’t know what you are getting or how safe it is, or even if it will arrive or not!

See also:

Xanax for travel anxiety.

Panic Attack Symptoms

Panic Attack Symptoms can be similar to anxiety# symptoms but usually feel much more intense. Often people say things like “I feel like I’m losing it” or “It felt like I was going mad”. In fact neither of those things are true, but as Panic Attacks cause such a rush of adrenaline and your body is so tense some quite bizarre symptoms can develop.

The typical symptoms are:

Racing heart (palpitations)

Feeling like you are going to have a heart attack

Increased breathing (hyperventilation)

Dizziness or vertigo

A feeling of unreality or depersonalization.

Sweating or feeling hot or sometimes cold

The great news is that all of these symptoms are harmless. They have been specifically designed by nature to feel as unpleasant as possible to encourage you to take action, but they are designed to protect you not harm you.

Many people find the feeling of unreality the hardest to cope with. Some people report that colors become more vivid, like when the sun is low at the end of summer. Or that sound is out of sync or doesn’t sound real, and that people don’t seem real. Some people think that this is a symptom of fainting, but in the case of panic attacks fainting is very rare, as blood pressure is raised somewhat and people normally faint from low blood pressure. I have never known anyone faint from panic.

Other people  feel like they are having a heart attack, and if you have experienced an elevated heart rate you should have this checked out by a doctor just to be safe. Many people who are admitted to emergency rooms feel they are having a coronary but are in fact just panicking.

There are lots of treatments for panic attacks.

Also read more on feelings of unreality.

And a little more on feelings of unreality!