Q. I wish to have some advice, if possible? I have been to the emergency room twice in the past two weeks. The first trip to the hospital, I was diagnosed with a bladder infection and sent home with antibiotics, which I took till they were gone and that was fine, I thought.

About 2 days after all of the antibiotics were gone, I had another weird physical thing (attack) that took me back to the emergency room. After spending a couple of hours at the hospital, they told me that my infection was gone and I was probably just having a panic attack. WHAT, ME? NO WAY! I'm just not like that. So, I went home and tried to relax, but it continues to happen. I decided to try an acupuncturist, and herbal meds she gave me, and I think they are helping but today I felt it's starting to happen again. WHAT is WRONG WITH ME?

SO, I went to Doctors on Duty and explained the whole thing to a doctor there. He gave me Xanax and said to go see a neurologist. Here's what happens to me: I start having a feeling of a total body rush and soon after I feel this I also feel scared that I might pass out. I tend to get extremely cold and sometimes shake and jerk uncontrollably while yawning through the whole ordeal. All of the people I've talked to experience panic attacks differently and I just want to know if you have heard of these symptoms? I really think it's something physical and think I will just die suddenly. I'm most afraid of this when my husband leaves and I'm home with my 3-yr old alone. Can you tell me what you think?
A. We are unable to diagnose. This does need to be done by your doctor as panic attacks can mimic a number of physical illness. From what you have written, your symptoms are typical of a spontaneous panic attack. If you go into our research pages on our web site and check the research, 'An analysis of an uncued panic attack,' you will see the symptoms you describe, including the fear that we will die from the attack.

It is important for you to have a full medical exam to rule out any physical cause, but if no physical cause is found it is very important that you:

* Accept the diagnosis. If not, you will only increase your anxiety and the frequency of the attacks may increase. When you can accept the diagnosis, you can move forward and break the cycle before it actually begins. Having panic attacks/Panic Disorder is not a life sentence, nor is it any reflection on you or your abilities. In fact, so many creative people, some of them quite famous within the Arts, have these attacks.
* Learn as much as you can about the attacks, which will, in turn, lessen your fears.
* Consider seeing a Cognitive Behavioral Therapist. They can help you reduce your fear of your experience.
* Be mindful that Xanax, and all of the other tranquilizers, are addictive and the addiction can begin within 2 - 4 weeks of taking any of these drugs. Withdrawal from these drugs include increased panic attacks and anxiety.

When you say "NO WAY, I'm just not like that" you probably don't realise we all say this or a variation of it, 'This is not me, I'm not like this'! It is difficult to imagine that we could have this type of problem. There is a genetic predisposition for this type of attack, and if one person in the family has them, there will also be others. In our parents and grandparents generation, it was never diagnosed and in these generations it can be very hidden and not talked about. The attacks were possibly triggered by your infection. Many of us develop the attacks following an illness.

You are in an ideal position to prevent the fear, anxiety, panic attack cycle from developing. Don't hesitate to contact us if we can assist you further.

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Q. HELP! I am only 23-years old and have had panic attacks for about 3 years and it is destroying my self-esteem, my confidence level---well, practically it is taking over my life.

I am an extrovert, by nature, and have always been a leader, very outgoing, outspoken, etc. I had no problem getting in front of people and giving speeches, talks, etc. I used to love to be the center of attention and give feedback to anyone on any subject. But now, because of my anxiety disorder, I can not do any of those things anymore.

I am married and have children and I am in school pursuing a degree. I did see a psychiatrist and he put me on Paxil (Aropax), but the Dr. left the hospital I was seeing him at (for free, I am on a very low budget) and I never got to follow up with him about my problem. I stayed on the Paxil for about 2-months, but got off of it because of the side affects and I had to take medication. I am now on Xanax, but I only take it as needed-sometimes once every two weeks, sometimes once a week; but lately I have been taking one a day .5mg everyday-when I get a panic attack.

My panic attacks are brought upon by being the focus or center of attention in a room, talking (in length) with someone face-to-face, being in a situation I feel I can't get out of- like sitting in the Barber's chair, sitting the middle of the classroom with the doors shut, etc, etc. The moment I get in any of those situations, I start thinking "what if" I have a panic attack right here and pass out and off my body goes and I have to immediately get out of whatever situation I am in.

The first symptoms I get are sweaty palms, then I get shaky ("weak in the knees"), then I feel myself turning real pale, then I get a rapid heart beat and/or I go straight to feeling like I am going to pass out. Either I literally run out from the situation or I feel like I am fixing to hit the floor. I know that there is nothing to fear and that what I am having anxiety over is totally irrational, BUT I can't control the panic attacks, no matter how hard I try. I am so frustrated- I JUST WANT TO BE THE SAME PERSON I USED TO BE!!!!!!!!!

What is really bothering me is that lately I will be sitting in class, taking notes, and I think to myself: what if I was to have an attack right here, right now. WHAM! I start to have an attack and I either have to pop a Xanax in my mouth or leave the room. I can't do anything in public without the fear of having an attack and I am at my wit's end and I NEED HELP, PLEASE.

I have tried to contact professionals to get therapy, but they are all too expensive. Although, it would be worth a million dollars to cure my ailment, I just don't have any money to spare. I did get one place to offer me sessions at $7 a session, but it was and hour drive from my house and my vehicle is not in the best condition and I didn't have the money for gas back and forth. I would really appreciate some advice on my problem and is my problem 100% curable and is there qualified help for someone who can't afford the private sector.

A. The secret of recovery is in your email! The harder we fight it, the worse we become, and the more we 'what if,' the worse we get. In both cases, we turn on the fight-and-flight response and it is the fight-and-flight response which creates many of our symptoms. The fight-and-flight response is a natural response which is activated in times of danger to prepare the us either to stay and fight the dangerous situation or to run away from it.

It is the way we think which causes 99% of the problem. The way we think ..'what if'... signals the body that we are in danger and the fight-and-flight response is activated. But the only danger we are in is being created by the way we think. Recovery means we need to learn to manage our thoughts. Not positive thinking, this usually doesn't work in the early stages of recovery as we don't believe what we are saying to ourselves. We need to see the damage our thoughts are creating and we need to learn to neutralize our thoughts. We also need to learn to let the panic attack and the anxiety happen. And it doesn't matter where you are or what you are doing or for that matter what other people think. Once we can let go of our thoughts and let it happen we turn off the fight and flight response. Easier said than done, at first, but many of us do learn to do it. And once we do, we have our life back.

Re: the Xnanx. Here in Australia the guidelines for the prescribing of any of the tranquillizers is for 2 - 4 weeks only. The tranquillizers, including Xanax can be addictive and some people may become addicted within four weeks. Xanax is one of the short-acting tranquillizers. With the short-acting ones, if people do become addicted, they may have withdrawal symptoms every 4-to-6 hours. Withdrawal includes anxiety and panic.

Our federal government recommends people on the short-acting tranquillizers transfer over to the equivalent dose of valium and once stabilized slowly withdraw the valium. Valium in a longer-acting drug and prevents the 4 - 6 hour withdrawal. You MUST NOT simply stop taking these drugs. This can be very dangerous. You need to speak with your doctor and slowly withdraw the drug under medical supervision. This also applies to any transfer and withdrawal from valium.

We are not sure where you live, but have you spoken to your local university. Many universities around the world do run Cognitive Behavioral Therapy clinics through their Dept. of Psychology either at no or minimal charge. If you live in Australia, we can refer you onto a therapist in your area.

You can recover once you have learned the appropriate skills.

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next: Questions and Answers

Q.I'm a 48 y.o. female just diagnosed with Multiple Sclerosis eight months ago. My diagnosis started with waking up in the middle of the night with body tremors and a feeling like I was going to die. The doctor thought I was having an anxiety attack except for the body tremors, which therefore sent me to have a brain MRI. That is when the beginning of the MS diagnosis started.

I'm dealing with the MS fine, but last night the tremor came back, also a very rapid pulse of about 100 to 110. It was the exact feeling I had 8 months ago when this all started. My question is, can a panic attack start in the middle of the night and wake you up from a deep sleep or should I be looking more to an MS problem.

A. Although we can't diagnose, yes, people can be woken from sleep with a nocturnal panic attack. The research on the nocturnal attacks show they happen during the change of consciousness as we are going to sleep, or from REM to deep sleep, or deep sleep back to REM, or as we wake up. The research also shows they have nothing to do with dreams or nightmares, but is an effect of the change of consciousness.

Increased heart rate, breathing difficulties, feelings of an electric shock, or burning heat or an ice cold sensation, or 'surge,' or intense 'whoosh' can be part of the overall symptoms presentation.

People can develop nocturnal attacks and/or uncued daytime attacks as a result of illness. It can be difficult initially in sorting out the symptoms of the illness vs the panic attacks and we do advise people to work closely with their treating doctor/specialist to isolate the symptoms of both.

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Q. I have what you have said are spontaneous panic attacks. They just happen any time any where and they can also wake me up at night. But my therapist tells me that 'spontaneous' panic attacks is just one particular theory amongst others. He believes this theory is wrong and thinks that I must have some sort of phobia that I am not recognizing. He also says my night attacks are a result of having a nightmare. I know what I experience, but now I am beginning to become confused and I am beginning to doubt my own experience. After all my therapist is an expert.

A. There was definitely some opposition to the three 'Panic Attack' categories in the Diagnostic and Statistical Manual Number Four (DSM 4)when it was released in 1994. This manual, is as it says, is the diagnostic manual for diagnosis of Mental Disorders which is used by the American Psychiatric Association. Some therapists did question the validity of these categories, primarily because it appeared to be at odds with their own particular schools of thought and the therapies they provide. Irrespective of the other varying theories about Panic Attacks, the DSM 4 is correct. My own experience of Panic Disorder and the thousands of people I have spoken with over the years show that this type of attack is very real and without doubt does happen. Not only is there the personal experience of so many of us who have this type of attack, the research and the subsequent release of the DSM 4 confirms the scientific validity of these attacks.

The sleep research also confirms that this type of attack is not a result of dreams or nightmares but occurs at the change of consciousness from dreaming sleep to deep sleep or from deep sleep back to dreaming sleep. Many people also report it occurs as they begin to enter the first stages sleep or as they begin to wake up.

Even though the attacks do occur for no apparent external reason, Cognitive Behavioral Therapy is the one therapy that has been proven Internationally to be the most successful long term therapy. I would suggest you discuss your concerns in detail with your therapist. If your therapist does not agree with your experience and is not prepared to work with you on that basis then you may wish to consider changing therapists. Your recovery must be your number one priority. Trying to fit your experience into a model that does not recognize the latest scientific research and diagnostic criteria is going to mean an unnecessary and costly uphill battle in your recovery.

The 1994 edition of the DSM 4 (Diagnostic & Statistical Manual, American Psychiatric Association) now shows that Panic Disorder is not a Phobic Response and people are not afraid of situations or places but are frightened of having a spontaneous panic attack. A conclusion we agree with without reservation.

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Q:Hi, My wife is a Chinese migrant, 45 years old and has anxiety and "scared" for no reason. She started it when she was engaged in a process work and long drive from home 5 years ago. Then it cured after a few month with good sleep. Then she got pregnant and give birth to our son in 1994. Last year she started it again while I was away. She took some Aropax 20 for 2 months and stopped due to dizziness.

Then in December, after taking some Sudafed to clear her nose she had a very high heart beat, 240/m and admitted to hospital by ambulance. (She had this fast heart beat problem since she was 18, often triggered by over work and stress. Inderal was very effective once it happened.) Since last December then her condition got bad and according to a local GP she took Aurorix, and then some Chinese medicine. A few weeks after taking the Aurorix she developed many side effects, including palpitation, extreme well haplite, sleepless (awaken with a shake during sleep) etc. She had a suicidal idea and admitted to hospital psychiatry ward in March for two weeks. She stopped the Aurorix before that, and some of the side effects gradually disappeared but some are still there.

Since being in the hospital she has been taken Xanax 1.5 mg/day and sometimes Inderal. Two weeks ago her liver function was found abnormal. She tried to reduce the dosage but had muscle twitching. She is now given 10mgX3/day of Thioridazine but not dare to take it, scared of muscle twitching and other side effects. At the meant time she remains scared for no reason (she make up non-exist reasons).

Apparently she is very sensitive to drugs, and has live abnormality. I wonder what alternative drug can she use and should she take some drug when the muscle twitching happens.

A: Has your wife been diagnosed as having an anxiety disorder? It does sound as if your wife is having a very difficult time. Unfortunately this can be the case for many people who have an anxiety disorder. It is also not unusual for people to be extremely sensitive to medication.
A couple of points about medication.

Has her doctor told her about Xanax? The guidelines for the prescribing of any of the tranquillizers, including Xanax is for 2 - 4 weeks only. The tranquillizers, can be addictive and some people may become addicted within four weeks. Xanax is one of the shorter acting tranquillizers. With the short acting ones, if people do become addicted they may have withdrawal symptoms every 4 to 6 hours. Withdrawal includes increased anxiety and panic. The Federal Government recommends people on the short acting tranquillizers transfer over to the equivalent dose of and once stabilized slowly withdraw the valium. is a longer acting drug and prevents the 4 - 6 hour withdrawal. Your wife MUST NOT stop taking these drugs. This can be very dangerous. She will need to speak with her doctor and slowly withdraw the drug under medical supervision. This also applies to any transfer and withdrawal from valium.

The one drug that is tolerated by many people is Prothiadon, an anti depressant. Your wife may wish to talk to her psychiatrist about trying this one. As we said earlier though there are a number of people who are sensitive to every drug and cannot take any at all.

The reaction your wife had to Sudafed again is a very common reaction. Many people cannot take any type of cold/flu medication because this reaction can happen with any of the cold/flu tablets which are available. She must never take them when she is taking anti depressants as the reaction can be worse.

If your wife has Panic Disorder she would have many symptoms, including muscle twitching and jerking and she would also have many different fears. This is what happens with this particular anxiety disorder. People with panic disorder do have a greater risk of suicide as no matter what they do and how hard they try by themselves, they can get worse not better. Of course suicide is not the answer. There is another form of treatment which is very successful called Cognitive Behavioral Therapy.

Once your wife has learnt to understand what is happening to her and once she has been shown how to learn to manage it she can make a full recovery. And as we have said TCM can also be very helpful.

Don't hesitate to either ring us or email us and we will refer you onto a CBT specialist.

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Q.Thank you for your web site. It has been very helpful to me. I am a 42-year old woman. I developed panic attacks one week after starting in September 1998. Although, over the past 6-months I've improved, I still do have "edgy" days occasionally. I'm not on any medication. My psychiatrist wants to put me on another SSRI, which makes no sense to me since it seems that the caused the panic attacks in the first place. My question to you is - In your experiences with patients experiencing panic attacks, have you noticed that SSRIs can, in fact, cause panic attacks? Thank you so much for your time in answering.

A. This is difficult to say. We usually see clients who are using one of the SSRIs for their pre existing panic attacks/anxiety/depression, etc. One of the side effects of some of the SSRIs in an increase in the pre-existing panic attacks/anxiety.

If you wish to know more about Zolft, you can visit the HealthyPlace.com Psychiatric Medications area . Or you can ring Pfizer, the manufacturer of Zoloft. They will be able to assist you with your enquiry.

Have you seen a Cognitive Behavioural Therapist? CBT is the most effective therapy in the long-term for panic disorder.

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Q. I noticed that there was something wrong with me for awhile, and I was told that it could be anxiety. I read some of the symptoms for it, and I think I do have anxiety disorder. I'm pretty sure it started after I tried some drugs like marijuana. If I stop using the drugs, should it go away?

A. We do advise you to speak to your doctor and have a physical check up to ensure there is no physical cause for your symptoms, as the anxiety symptoms can mimic a number of physical problems.

Unfortunately, many people are developing panic disorder as a result of using marijuana and even though they stop using it, the Disorder can be ongoing until they receive appropriate treatment. We do advise people not to use this, or any other 'recreational' drug, including LSD, cocaine or ecstasy, etc. because they can add to and increase the problem.

If your doctor confirms anxiety and/or an anxiety disorder, then you may need to see an Anxiety Disorder CBT Therapist who will be able to assist you. We notice from your email you are at a University. Many universities run Cognitive Behavioral Programs through their Dept. of Psychology. You may wish to check with your local dept. If they don't the psychologists on staff, they would be able to refer you to someone.

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Q.I am a 46-year old female who has been having anxiety/panic attacks for 2 years now. I have had all of the medical check-ups, and there is nothing physically wrong with me. I am also seeing a psychiatrist who has put me on Prozac and I am also on Oestrogen, a very low dose.

Is it possible for the attacks to be hormone related? My attacks seem to be cyclical, but I cannot correlate them to my periods because I have had a hysterectomy. I wonder if I should be taking more oestrogen, I am on .5mg at this point. Also, how do I know if my Prozac should be increased-I am on .5mg of that also. This past week, I have had 2 panic attacks and many hot flashes. This affects my entire family-how goes Mom, so goes the family. This has also affected my intimacy with my husband. He has been very patient, but we need to get over this hurdle. Thanks for a great website-I have learned a lot in the last 2 hours!!!

A. Although we don't normally do this, I am going to relate my experience as it is similar to yours. I developed Panic Disorder as a result of a physical illness which ultimately led to me having a hysterectomy and surgically induced menopause.

I went onto hormone replacement therapy, but while it helped with the menopause, it did absolutely nothing for my panic attacks and anxiety. I have now spoken with thousands of women in similar situations and their experience is the same. Hormone therapy doesn't help to any great degree.

It can be cyclic, as many women do experience increased panic attacks & anxiety in the week before their period, and it does aggravate any PMS, but again the pill, etc. doesn't help. I saw a recent research article which said researchers were now beginning to investigate this, but they say any definitive answer is 10 years away.

We are not able to advise you in regards to your Prozac dose, but we can suggest you see an Anxiety Disorder Cognitive Behavioral therapist. CBT is the only therapy which has been demonstrated internationally to be the most effective therapy in the long-term for Panic Disorder. This is how I, and so many of our clients, have recovered and are medication free.

We do have a list of therapists worldwide. If you would like us to check our list, please advise us in which Country/State/City/Town you live in.

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Q.I've just been checking out your Anxiety web pages. My Girlfriend suffers from Anxiety and Panic attacks regularly. I am trying to help with her disorder. She wants to help herself - The natural way- self relaxation and overcoming her fear. Do you know of any herbal, or non-medical, natural remedies which may help in the control of her condition.

A. The most important thing your girlfriend can do is to learn Cognitive Behavioral Therapy (CBT) This will assist her in managing the thoughts which create so much of what is happening to her. CBT is not positive thinking. Positive thinking doesn't work for many people in the early stages of recovery. Once she learns to manage her thoughts she will recover.

We don't usually recommend herbal medications, simply because they can work for some people, but not for others. The current trend is to use St. John's Wort and while some people are saying it is great, we have also had other people telling us of quite severe side effects. Can you arrange for your girlfriend to see a Naturopath? They may be able to help, but learning to manage the thought process is the most important.

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