Panic attacks: can just thinking/talking about them be a trigger?

In My Humble Opinion
1

Something I’ve mentioned on the SDMB is that I have panic disorder. I’ve had multiple panic attacks (too many to count) since 2007. I’ve been in treatment for lifelong depression and now the panic attacks since 2011, with varying degrees of success. The attacks have greatly diminished since going on a course of Klonopin (1mg 3x a day, and yes I know it’s addictive, I don’t care) together with my antidepressant (Nortriptyline).

However, they haven’t stopped completely. And I never know when they’ll happen. The thing is, I haven’t had one in a very long time–until tonight. As usual nothing seemed to cause it. I was sitting and writing at my computer when I became aware of the symptoms I recognize all too well: a stretching, raw feeling in my nerves and muscles, like my muscles are trying to jump out of my body. My hands and legs started to tingle–so did my tongue. Generally I just had the feeling that I was in jeopardy. Unusually for me, my heart didn’t race, which 80% of the time is what actually triggers my panic attacks in the first place. (I am super heartbeat-sensitive, and once it starts getting higher than 85bpm I begin to get agitated, which of course only makes things worse.)

Anyway, tonight the panic was lessened through some methods I’ve learned to calm myself down – deep breathing, focusing on the fact that I’ve felt this exact feeling dozens of times before and it’s always been harmless if incredibly uncomfortable, and even distracting myself by watching something fun. When these things don’t work I have to pull out the big guns: my Xanax, which I only take in the throes of a panic attack. (I don’t abuse it at all – I’ve had the same prescription of 30 pills for a year now. These are strictly as-needed pills.)

Basically my rule of thumb is: if my heartrate is elevated or I’m having trouble breathing and if I’m feeling discomfort that lasts longer than a half hour, I go to the hospital. (This was just discussed in a thread elsewhere in IMHO, “What does a heart attack feel like?”) This time the heart wasn’t involved and I’d say this was one of the shortest duration attacks I’ve had; maybe 20 minutes or so. (Yeah, the Wikipedia and WebMD et al. articles that claim panic attacks only last 10 minutes can bite me–mine are usually at least two hours long.)

My point in all this is that there was nothing bringing this on. Usually heart awareness is the trigger, but today it wasn’t. All I can think of is that yesterday I had responded to that damn “What does a heart attack feel like?” thread – God knows why I even opened it, like I need more hypochondria? – and discussed some of my symptoms there. And today, in therapy, I was talking with my CSW about how I wanted to boost my antidepressant or change it, but was concerned that it might trigger anxiety. That’s the big problem with this kind of dual diagnosis. Stuff that helps depression is very often bad for anxiety, and vice versa.

I just don’t think it’s a coincidence that tonight, suddenly, I’m hit by panic that I haven’t felt in several weeks. But I don’t know.

Is it possible to subconsciously induce panic by just talking about it? By remembering the symptoms? Is my brain that ridiculously oversensitive that I can’t even discuss my panic disorder without triggering another attack?

The thing is, every time I have an attack, afterwards I feel miserable. Right now I’m teary because it feels… it feels as if I’m right back where I started. I keep thinking I’ve beaten it but then I have another attack and the terror returns.

I think of my panic as this stalking ex-husband whom I think I’ve evaded. I’ve moved away, started fresh, begin to feel safe again… and then he shows up at my doorstep. That’s when I realize that I’m not safe and I probably never will be.

I have to be coarse here: I fucking hate these motherfucking things. I hate them. I’ve been depressed all my life but it wasn’t until I started to have panic attacks that I actually felt like I was losing my grip on my sanity.

Guess my question is… as I said, could this have been caused by my talking about it a lot over the past couple of days? Has that ever happened to someone else with Panic Disorder, where you can trigger an attack just by calmly discussing it? It’s like I invoked it.

I’m rambling. I get that way after an attack. Sorry. TL;DR version: does this happen to anyone else with PD? Where you’re fine until you start thinking or talking about your symptoms, and then you actually have an attack?

2

I don’t think there is anything unusual about it at all. Anyone can begin to recall the sensations created by a prior event by thinking about the event. In your case you have a response to some sensations that causes you to pursue them until they become a panic attack but that is just where your particular events end up. With other people they end up as depressive episodes or hitting the booze or getting in a fight or whatever.

For instance there is plenty of research that indicates that talking about traumatic events increases, rather than decreases, the suffering of the person talking about it. Despite this people are encouraged to talk about such things.

3

First of all, this doesn’t mean you’re right back where you started. This is the very nature of panic disorder: to leap upon you when you’re vulnerable, to make you doubt yourself, to make you afraid of doing whatever it was that might have set this one off. Don’t let it do that to you.

Sure, talking about panic can trigger it, but so can a baby’s cry, the smell of toast, or (as in the worst attack I ever had) tinnitus. I once had a major panic attack while I was describing an earlier attack to my therapist. She was fascinated! I had one triggered by a sharp, cold breeze as I turned the corner of a building. They can be provoked by anything, but they are just as frequently provoked by nothing.

The ultimate result of panic disorder is too often that people try to avoid things that could bring on an attack, but because virtually anything (or nothing) can do that they end up avoiding all potential instigators, and they end up locked away from life. Trust me; I know whereof I speak.

You’re right to remind yourself during an attack that you’ve survived them before without permanent damage. What works for me is to take it even further and revel in it. Pay attention to the sensations, experience them fully. I realized the first time I did this that a lot of people spent huge amounts of cash to experience the same things, and for some reason that made it a lot less frightening.

Panic itself cannot hurt you, and unless you have a serious health issue, the physical sensations are almost certainly not symptoms of a critical health problem. Above all, don’t try to figure out what caused it, because there is no way to find that out and it doesn’t matter anyway.

If you’re not seeing one already, a good cognitive therapist would be of immense help to you. CBT is very effective with panic disorder and it doesn’t do any harm with depression, either ;).

4

I am guessing as a result of your depression and panic attacks that you have been prescribed meds? I am also guessing that as part of your treatment plan you saw a therapist if not for your depression then your panic attacks. I am further guessing that your therapist and you developed tools to deal with your panic attacks? Do you find those tools useful? If so how have they helped you?

If your answer is no to the above. Yes you can talk yourself into heightened anxiety.

5

Thank you very much, don’t ask, Sudden Kestrel and stoplight.

I know talking about the symptoms/anxiety is likely to be a trigger, I just wonder why it doesn’t happen right away, while I’m talking about it. Instead it hits me hours later when I’m doing something else entirely and seemingly feel fine. Is the subconscious that… sub? It’s like a time bomb that doesn’t even give you the luxury of hearing it tick.

Yes, sadly I’m all too familiar with that behavior too. During my worst periods–and really, even now after an attack–I stopped being able to exercise (because the faster heartrate scared me) and hated leaving my house because I was so scared I’d have a panic attack and people would see me. I get really distant and claustrophobic, like anything can set me off. (I keep using the bomb metaphor…) Basically whenever I could I just hid in my bed and lay there.

My therapist isn’t CBT but she does have a lot of experience with panic disorders and between her and my psychiatrist (not that he’s much use except as a dispensary) and plenty of reading on tips to combat anxiety, I have reduced the incidences of the attacks. As I said, it’s just that whenever they strike again, my depression/nerves tell me “Aha! See, and you thought you were better? What hubris! You should know better. You’re always going to be in the clutches of fear.” (Okay, I guess my inner voices are a bit melodramatic.)

It’s interesting, Sudden Kestrel, that you mention reveling in the feelings. I listened to this audiobook called Pass Through Panic and it too mentioned letting myself really feel the manifestations of the fear instead of actively trying to get rid of them. I tried that for a bit but I found it hard to do. If… well, when… it happens again I’ll give that a try. Last night wasn’t a full-on attack as I was able to get rid of it in less than a half-hour, so for me that’s a relative success.

stoplight, yep, the answers to those questions are pretty much in my ridiculously long OP (I think in the first sentence, but it’s probably easy to skip over a wall of words like that).

It’s not so much talking myself into it, it’s… okay, staying away from the bomb metaphor, I guess it’s more like planting the seeds of an attack. It can be a day or hours after whatever the discussion is, and then, I’m watching Parks and Rec and suddenly there it is, that stretchy, rubber band-like feeling in my muscles, or my heart’s racing, or I just otherwise feel it coming on.

(One other, unrelated possibility of a trigger could be my being really really bad at staying hydrated. I am probably in a perpetual state of low-to-middling dehydration and I believe that’s actually a known cause of anxiety too. So I suck at even doing the basic things that could keep some of the symptoms away.)

Anyway thanks very much for letting me vent and for giving me your experiences/support. I really appreciate it.

6

Sorry that you’ve had to endure panic attacks. I’ve had them, and they are a helluva thing!

I had one in high school and didn’t again until 2010. I think I started getting them because of irritation to my stomach (mine always start in the stomach, and I actually control them by taking an antihistamine [chlorpheniramine] that seems to help my stomach and the attacks. Works incredibly well, and it’s something I lucked into: I started taking for other reasons and just happened to notice that it knocked attacks on their ass).

But to your point: I find my attacks were triggered by stress, but not immediately after experiencing the stress. Often it was days later–but still there was a clear connection.

It could be you were reading the heart attack post, that dumped some stress hormones into your bloodstream, and then the attack happened because of that the next day (seemingly for no reason).

Hope this helps, and good luck!

7

When i was married I used to have panic attacks when driving with the family. Some friends of ours were on vacation and they had an accident, the parents survived but all three children were killed. This seem to be the original trigger. It first started when we were on long trips and then started happening on shorter trips of about 40 miles or so. The only symptom I had was I felt like I had to control my breathing or I wouldn’t breath. It would go on for hours, I had to count every breath and still try to look normal to the family.

8

The more self-awareness you have, the better…in general. But, yeah, being aware of the proximity of a panic attack can set off a panic attack. Weird and unpleasant.

The ideal is to use this self-awareness as an early-detection-system, so you can see the attack coming before it actually hits. That allows you to take counter-measures, such as breath control, or defensive measures, such as leaving the room and being alone for a few minutes.

I have learned how to induce leg cramps voluntarily. Damn foolish thing, right? But the advantage is that I’m familiar with the earliest, non-voluntary pre-cramp symptoms – the tightening of the muscles, etc. – and this sometimes allows me to prevent the cramp from occurring, or, at very least, to sit down so I don’t cramp while standing or walking. Self-knowledge can be (somewhat) useful for both diagnosis and therapy.

9

There is a great book entitled “Hope and Help for Your Nerves” written by Dr. Claire Weekes. It was written quite a few years ago, and the author has since passed away. It is a brilliant book, and I highly recommend it. It is the best self-help book I have ever read. She has other books and CD’s, and I am in the process of purchasing them as well.

10

What’s the expiration date on your Xanax? Friday night, my acid reflux flared up for the first time in over a year, and to my dismay, my usual meds were entirely ineffective (my aim wasn’t so great, either. :frowning: ) The next morning, I looked at the blister pack the pill had been in, and noticed that it had expired in 2007.

11

Yes. Sometimes if I’m really bored my mind will start to wander, and sometimes it wanders into the realm of “what if I had a panic attack right now?” So I’ll keep thinking about it even though my mind is screaming at me “STOP THINKING ABOUT IT!”, and if I don’t find a distraction I’ll eventually be launched into a panic attack. Sometimes I’ll win the fight and will find a suitable distraction, but other times I realize that there’s no going back and that whether I like it or not I’m going to have a full-on attack, and that I might as well stop fighting and get it over with sooner than later.