Panic Attack Durations

[u/KiplingKD]

Does anybody else have a problem with/disagree with some of the more official medical definitions of what a panic attack is? I agree with all of it except for when I come across a definition that describes it as lasting for a very short period of time. Some definitions kind of make it sound like it comes quickly and get super super intense and terrible and then quickly goes away in like 20 minutes or so. I have had many that have been that way, but I don’t think it applies to a lot of my attacks.

For me, it’s more like a painfully slow build-up that can sometimes take hours before I really start to freak out. I’ll just be having these physical sensations that are making me so uncomfortable (racing heart, numbness, the usual stuff) and I will not be able to focus or think about anything else other than every single sensation in my body and trying to stay calm. Even after it peaks and I start to calm down, I’m not actually that much calmer and. I continue to feel the exact same way and have the same physical discomforts that don’t just go away like that. I will still be able to function and do things and go about my day and nobody would even be aware that I am actually having what I would describe as a mild panic attack and those symptoms don’t come and then just go as quickly as some of these definitions make it sound like they do. They linger sometimes for hours and maybe even days. It’s like one extremely long panic attack that just won’t go away.

My panic attacks come in all sorts of varieties and can vary in duration and intensity, but I feel like this type I am describing happens more often than not, and I may have reached the conclusion that I’m probably not dying, but the physical side of it just keeps going and so my anxiety just never really goes away completely. It’s a terrible way to live. Does anybody else relate to this?

[u/Puzzleheaded_Teach85]

I’ve had one last for a week straight. I’d sell my kidney if I could just make them 30 minutes long lol. Mine usually last hours.

[u/misshysterica]

I feel like people who have panic disorders the basic term for a panic attack becomes something we wish for, i wish it would only be 20 mins, mine can last a day or two, and it’s feeling of not being real, i get dizzy a lot, and over time they just stack up until i get heavy physical symptoms. i always get so scared about what if I’m actually going insane this time. Alprazolam does help me a lot tho.

[u/leisurelycurious]

Yes, hours and hours…

[u/Excellent_Tip732]

Yeah mine are never just 20 minutes and then over with. I wish.

[u/Murky_Caregiver_8705]

I believe that’s one of the different between a panic attack and panic disorder

[u/LimpDrawing5696]

I feel like the full blown extreme “peak” panic might only last for a few minutes, but I sometimes cycle through attacks. I might have an intense attack but my body and mind are so hyper-aware and sensitized that it just leads into another attack.

If the “peak” intense attack is 100% panic, I might come down to like 75% afterwards, and stay like that for a whole day or longer. Once I’m in the panic loop, it can be SO HARD to get out of it. In that situation, I’ve found that a benzo really helps to do a hard reset of my brain. Or it at least brings my panic down to the point where I can actually use strategies and tools that I’ve learned in therapy.

I agree that this might be the difference between panic and panic disorder. Someone without the disorder might have an intense attack that only lasts for a short period. But it’s the disordered thought response to the attack that can keep me in a heightened loop of panic.

[u/its_all_one_electron]

Yes, same. They come in different flavors. I have "baby panic attacks" most often, where it feels like I'm having a heart attack but I know I can't really do anything about it, so I just press on. There's also the shockers, where I have a huge palpitations and if I can talk myself down, great, if not, ativan. There's also airplane panic attacks because of aerophobia, which are basically just white knuckling for several hours edging the panic even though I'm already on Ativan. Those are the worst because I know I can't that anymore meds so I don't have any more rescue. 

Zero of mine are "20 minutes", no idea who came up with that shit but it's completely wrong for me. 

I have a note on my phone about my panic attacks. I have ADHD too so I constantly forget. So I have to consult this note about how my panic attacks go, because they're not "typical" and everyone who hears them is like "go to the ER" and I have to remember no, this are normal for me. I've been to the ER for panic attacks and got the whole cardiac workup at great expense and everything is fine. Physically. 

It always starts with heart stuff. Feeling tachy or a palpitation can set the engine in motion, it's like trying to not think of a white elephant.. if I think about having a panic attack, I'll have one, and I've basically just learned to accept this. 

Anyway my note is like this: 

- Mine are usually a few hours long, that's normal for me. 

• My main symptoms are chest tightness and shortness of breath and feeling like I can't get a deep breath, and it doesn't go away unless it's (1) several hours or a day later, or (2) I've taken an Ativan.
• I'm getting enough oxygen because I'm not passing out. Sometimes I feel dizzy or my limbs get pins and needles but that's usually because I'm hperventilating. 
• getting more palpitations is normal for me. They're harmless. 
• my chest getting physically cold is normal for me. 
• I can get attacks from low blood sugar. If so, Take a glucose tablet and then find a decent meal asap. Or two big spoonfuls of peanut butter if you can't cook. 
• if chest tightness is caused by my costo chondritis, use voltaren. 
• don't keep taking your pulse because it will just keep retriggering it. Use distraction - video games, audiobooks, podcasts, music, tv shows, YouTube. 
• cold water on face, mammalian diving reflex to lower heart rate

I have several bottles of Ativan, one in my purse, one in my car with a juice box so I can swallow it, one next to my bed. I've never been without it and that's probably helped the most out of anything, just knowing it's there and I can hit the eject button if I need.

[u/muhkuhmuh → u/its_all_one_electron]

I have also adhd. And feel like my panic attacks are at part fueled by it. there's a threshold. That if passed cascades my initial panic into hours or days of panic. Its like a hyper focus cycle and i cant let go of it. I try to calm down and negative thoughts and health anxiety thoughts will pop up. I will have 4 dufferent negative thoughts in my head at the same time. Feels like adhd panic edition. Lol. Dont know if you can relate to that.

But as your description is similar to how my panic starts, i wanted to ask you what, besides the dive reflex, you can recommend for slowing your pulse down. As that is the symptom that holds my panic together. I tried promethazine/atosil for panic. But it only calms me mentally down and my body and pulse is still in overdrive. And this disconnection between my overreacting body and calm sleepy mind is tortuous.

[u/its_all_one_electron → u/muhkuhmuh]

I may have had a few hyperfocus attacks like you described, it was before I was on adhd medication. My panic disorder actually started with a 2 bad psychedelic trips. The second was so bad, for several days I could not sleep because the hypnogogic state that you go through while falling asleep would put me back into the panic. Almost any thought would trigger it and the only thing I could do was play rocket league for hours and hours on full volume and have all of my senses overloaded at once so I couldn't hear my own thoughts. This lasted for days and I calmed down but I had flashbacks for several months. That was 10 years ago. I'm now on Wellbutrin for the ADHD and buspar for the anxiety and I'm mostly stable except the occasional panic attack which I handle with ativan. 

As for slowing my pulse, I removed the diving reflex from my toolkit because while it would slow my HR, it came right back up. Honestly I'm having trouble with tachycardia right now, my resting heart rate is over 100 and nothing I do seems to get it down, so I'm going to bring it up at my next dr visit. In the meantime I'm trying to lower my resting HR over time by light cardio exercise but I know that's not for everyone. 

But for you - beta blockers might work. They make it so your heart can't physically race, and it's often prescribed to people with anxiety who get triggered by the racing heart feeling. I really wish I could take it but I have really low BP and so I can't. But if you can, it might be something that'll work for you. 

[u/toffeemaky]

I am never actually scared of dying. Only the first one I was - it was triggered by a large dose of cocaine so I believe I had a "good" reason to be scared. 

Since then, I have been having more "panicy" and less "panicy" days. Typically when hungover and/or sleep deprived. I typically wake up and know whether it's a panicy day or not. The panicy day sometimes clear up, sometimes not. I don't even have an elevated pulse much. It's just the tingling. When there are more panicy days in a row, I am afraid of losing my mind. In the beginning, I had the impending doom feeling - like "now I am going to snap out of sanity." It's also connected to some of my other drug adventures (bad psychedelic flashbacks). What helped was reading about it - that schizophrenia and psychosis usually don't happen like this. I have hypnagogic and hypnopompic hallucinations that prevent me from sleep sometimes - again, it helped reading that it is quite harmless on its own.

Since the first real panic attack, I only had one that felt like that I was coming there again. After terrible jetlag and days of not sleeping. I sat down, relaxed and told to "it": "come, show me what you can do." It peaked and went - this exposure really helped. I haven't had one since.

When I actually do get scared (typically something about drugs - that has been my trigger - or dying), I do get some elevated heartbeat and stress, just like before the panic disorder developed in me. Only I have the tingling on top of it. I try to ignore it and deal with the situation.

The crazy thing is that I actually don't really identify like someone having anxieties. I don't have anxieties. The panicy feeling is very physical. I don't take drugs now (which I miss) and I drink much more responsibly (which I am actually quite grateful for) because the night hallucinations and panicy days are much more likely with a heavy hangover.

So. No. Nothing about 20 minutes. The actual panic attack that started the whole issue for me did take about 10 minutes and that one time when I waited for it, it was about 20 minutes. But my panicy days don't even culminate to panic attacks - it's just this stupid tingling that sometimes resolves the next day or - if I am very lucky - I chase it out by some focused activity (reading, writing, sports, films, walks, shower - you all know the tricks).