When Panic Attacks

Bring Out the Dread continued...

Other than being convinced that I had boarded a one-way train to Reaperville, what scared me most about my panic attack was that I wasn't doing anything strenuous or out of the ordinary when it hit. There was no obvious trigger--I was just lying in bed. That's common during what's called a spontaneous panic attack--one that isn't clearly connected to any fear-­inducing situation, says Jordan W. Smoller, M.D., Sc.D., associate professor of psychiatry at Harvard Medical School. Though it's true I had been under a fair amount of pressure in the months leading up to the attack, because it didn't arise as an immediate reaction to my stress, I didn't make the link until later on.

In other cases, it's easier to connect the dots. A panic attack may strike when a person encounters something that trips a specific phobia, as when a claustrophobe enters a confined space. Asthmatics--who, researchers have found, are about twice as likely as people without asthma to have panic attacks--may experience one at the first sign of shortness of breath. Or a chemical trip could shove you over the edge: Substances such as caffeine, nicotine, and other drugs can spark a panic attack because they induce arousing symptoms (like the jitters you get after a few rounds of espresso) that people who are vulnerable to attacks interpret as dangerous. "About a third to half of my patients report that their first panic attack occurred while they were taking a drug like marijuana," Kiriakos says.

Your Panic Plan

If stress usually precedes a panic attack, then the obvious prescription, you'd think, would be to double up on yoga classes or try some head-calming meditation. Unfortunately, more "om" isn't the answer. There's no scientific proof that stress-reducing techniques will stifle future panic attacks. Because there's often no predicting when or whether another attack will strike, doctors usually don't recommend therapy or taking meds regularly unless your attacks are frequent and debilitating. But if a panic attack does occur, how you respond can steer you clear of uncontrollable hysterics. Here's how to wage your own war on terror:

Before It Happens Know that a panic attack will not harm you "In therapy, we teach patients that although panic attacks are uncomfortable, there's nothing physically dangerous about them," says Kimberly Wilson, Ph.D., a cognitive-behavioral therapist in the San Francisco Bay area and a psychiatry instructor at Stanford University.

Open up about your attacks If you know you're susceptible to panic attacks, let friends, family, or even a trusted coworker know the symptoms, so they can recognize one when it's happening and reassure you that you'll get through it, Kiriakos says.

Pack a pill If you've had a panic attack before, you can talk to your doc about getting a prescription for a small amount of a benzodiazepine, such as Xanax or Valium, to have on hand in case another one strikes. A benzodiazepine takes only a few minutes to increase the activity of a neurotransmitter called gamma-aminobutyric acid (GABA), which has a calming effect in the brain. "They're not recommended for chronic panic sufferers [because they can be addictive], but they can be effective against isolated attacks," says Alexander Neumeister, M.D., an associate professor of psychiatry at Yale University. "Sometimes just having the pill in her purse can prevent a patient from having an attack in the first place," he says.

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