Being too cheap to pay bus fare for four kiddos, every day I have to camp out at the bottom of the grand staircase of their school and try to collect them as they scamper down in the crush of students. It’s like playing Plinko crossed with Whack-a-Mole. But this particular day it was all that plus Operation, complete with weird buzzing alarms because apparently a student had gotten a case of the vapors and swooned at the top of the staircase. Elementary school kids are hyper anyhow at the end of the day so this only ignited the powder keg as I tried to make sense of all the kids yelling.
“He can’t breathe!”
“He’s having an asthma attack!
“He’s having a heart attack!”
I knew it was legit when the sweet 3rd grade teacher snowplowed up the stairs literally chucking kids out of her way. Soon there was a crowd and once I was reassured that the school nurse was there and an ambulance had been called – the general consensus was the poor kid was having a really bad asthma attack – I decided the best way I could help would just be to herd kids out the doors and give the boy some room. (Seriously I swear the universe is telling me I need to become an EMT.) As I pushed kids towards their buses one little boy ran up to his mom and, caught up in the zeitgeist of emergency, yelled “MOM! A BOY JUST DIED!!!”
You should have seen all the panicked parents on that sidewalk. This is, after all, the state of Columbine. “No, no!” I yelled in my loudest Mom Voice (which, if you’ve met me, is on par with a bottle of pop opening. I have a very quiet voice). “He’s not dead! Nobody died! It’s just an asthma attack and the ambulance has already been called!”
I gave up the game of Telephone (playing Bingo yet with the number of kiddie games I’ve managed to work in here??) and got my kids to our van. At which point I discovered that I’d dropped my car keys in all the hustle and bustle inside the school. So I left my kids with a friend and ran back to the school. I found my keys… at the feet of the paramedics. The boy was crying so I figured that was a good sign. (Crying = breathing and breathing = living! That little life lesson is basically the only thing that got me through the 9 months of colic with Son #2.) All the paramedics seemed chill and unhurried so I asked if he was okay. (I swear I would not normally bother a working paramedic! They were just standing around.)
“Yeah,” he answered me. “It was just a panic attack.”
Yo. Medical pros. THERE IS NO SUCH THING AS “JUST” A PANIC ATTACK.
As a girl who’s had panic attacks her whole life – the first I remember was in 5th grade but by now I’m sure I’ve had hundreds – I can tell you with total assurance that a panic attack feels as much like you’re dying as if you’re, well, dying. Except maybe worse because you don’t actually die and then you have to do a repeat performance at random, inconvenient moments. And put up with people – including some medical professionals, sadly – mocking you, calling you crazy or telling you that you just need to think happy thoughts.
Truly though. Panic attacks are terrifying. Even I as an adult still get overwhelmed by them to the point where I vomit, get diarrhea, feel faint etc. And I know what’s happening to me! (Which is 80% of the battle, by the way. Being able to ID a panic attack for what it is is perhaps the best skill I’ve ever learned.) I can’t imagine how scared that poor kid must have been.
When I relayed this story to another mom she asked, “Well what set it off?” Meaning, I assume, “What was he so panicked about?”
I shrugged. “It’s the first week of school – who knows? It could be anything. Or it could have been nothing.”
“Well it had to have been SOMETHING,” she answered. “Who freaks out over nothing??”
Turns out lots of do, actually.
Here’s another interesting tidbit about panic attacks: There are actually two different kinds. Sometimes you know what sets them off – generally a fear of something bad happening or a phobia of a specific thing, like spiders or public speaking. These are called “triggered (or phobic) panic attacks”. But sometimes you have no idea. The attack comes out of the clear blue. These are “non-phobic spontaneous panic attacks.” (And then sometimes you can combine the two by triggering a panic attack simply by the fear of having one. Fun times ten!) The weird thing is we only ever talk about the phobic kind.
The first question people always ask me when I have a panic attack is “What are you so worried about?” And 90% of the time I answer truthfully, “Nothing!” (At least nothing more than usual. I’m a consummate worrier.) Often people try to figure it out anyhow and try to solve it for me. It’s well intentioned but often meaningless to me because more often than not, my panic attacks start first – they feel like they have a biological root inside me – and then I start worrying about crap. But I’ve never understood why that is. So the other night while I was laying on the bathroom floor trying to stave off the nausea and waiting for my heart to stop going at rabbit speed, I decided to look it up. (Intellectualizing my panic attacks is my primary coping technique. You gotta do something right?) What I found was super interesting:
According to Dr. Jay Hedaya, “Nonphobic panic attacks are thought to be the result of abnormal, over- sensitivity of a brain alarm system whose function is to detect early signs of suffocation. This theory is called the suffocation alarm theory.”
The basic gist of the theory is that some of us just have more sensitive “suffocation reflexes” and so when CO2 levels rise in our body, our body kicks into overdrive with hyperventilating, faster pulse etc. to get oxygen in. The interesting part is that our CO2 levels rise naturally at certain times: Primarily when we’re in a relaxed state, as in getting ready for sleep or meditating. Then they rise again during sleep. And lastly, any decrease in progesterone. Dr. Hedaya writes that women in particular are prone to these spontaneous attacks.
“Interestingly, women are more vulnerable to panic attacks premenstrually and just after childbirth. These are both times when the levels of progesterone drop suddenly. Since progesterone decreases the levels of CO2 in the brain by increasing respiratory rate, the loss of progesterone at these points in time would lead to increased CO2, and more vulnerability to panic.”
You know when my panic attacks are the worst? I’ve talked about my crippling post-partum anxiety before and now I think I finally have an explanation for it! Also, my husband and I joke I have “Sundowner’s syndrome” because if I’m going to have a panic attack it’s always right before I go to sleep. And while I’ve never looked at the correlation between my cycle and attacks, this last time it definitely corresponded. I’m guessing they probably go together a lot.
I don’t know why this info helps. But it does. I guess it’s because it makes me feel like I’m not nuts? It’s this biological thing my body does – I can’t help it! So why did it take having panic attacks for over 20 years for me to finally learn about this?? According to Dr. Hedaya, phobic or triggered attacks are far more common (and are the type most people think of when they think of panic attacks) so those are the only ones we talk about. In fact, most doctors think there’s only one kind! Yet the distinction is an important one because clearly there are different treatment modalities required.
For triggered attacks, dealing with the underlying phobia is critical and can “heal” the attacks but this approach does nothing for spontaneous attacks. Since spontaneous attacks are more biologically rooted, a more medical approach would be helpful. Who knows – perhaps a little progesterone cream could have saved me from the six weeks of absolute hell I went through after each of my kids were born. Oh, and the worst thing you can tell a person having a spontaneous panic attack is to meditate or slow their breathing as this raises CO2 even more in their already panicked brain. The effect is so immediate that one doctor said this is how he tests his patients to see which type they have: If their panic improves with learning focused meditation then it’s the former but if meditative relaxed breathing makes it worse then there you go.
And, not to get all conspiracy theory up in here, but perhaps spontaneous attacks are a lot more common than doctors realize. Maybe they’ve been written off for years as a “women’s problem” – just us ladeez being all up in hysterics in herrrre! – instead of recognized for what they really are: a medical condition.
Another treatment for panic attacks regardless of source, that’s getting attention of late is the almighty probiotics thanks to their newly recognized ability to help reduce cortisol! Several recent studies have found that giving people probiotics not only reduces anxiety and panic attacks but can have sweeping emotional effects:
“[Psychiatrist James] Greenblatt’s provocative idea — that psychiatric woes can be solved by targeting the digestive system — is increasingly reinforced by cutting-edge science. For decades, researchers have known of the connection between the brain and the gut. Anxiety often causes nausea and diarrhea, and depression can change appetite. The connection may have been established, but scientists thought communication was one way: it traveled from the brain to the gut, and not the other way around.
But now, a new understanding of the trillions of microbes living in our guts reveals that this communication process is more like a multi-lane superhighway than a one-way street. By showing that changing bacteria in the gut can change behavior, this new research might one day transform the way we understand — and treat — a variety of mental health disorders.”
The scientists tested mice with different traits (and different gut microbiomes) and compared them with mice bred to have no intestinal bacteria (don’t ask me who figured that trick out). Not only did the mice with healthy germs in their guts have less cortisol (evidence of stress) but when they took bacteria from the happy mice and fed it to the anxious mice, the anxious mice changed! Bad news for me though: The effect only lasted up to a point. Once the mice reached adulthood, the effects were much harder to alter, suggesting that our guts are more easily manipulated in childhood but eventually become “set.”
Also, a separate study (which I think I’ll do a whole post on, it was that fascinating!) found that all this gut populating doesn’t happen in a vacuum. To get the “good” microbes to take hold you need to be eating healthy food. The little mice that ate junk saw no benefit from the bacteria!
Now I suppose the trick is to figure out which bugs exactly are helpful for mood disorders. And also which flavor of yogurt to put them in. (You know us ladies and our yogurt!)
So, have you ever seen anyone have a panic attack? Have you ever had one? Anyone ever noticed a correlation between anxiety and hormone fluctuations? Anyone else want to go out and buy stock in probiotics now??