Natural Strategies for Panic Attack Prevention: Why a Comprehensive Approach Matters
Do you get panic attacks - crying, trembling, hyperventilating/inability to catch your breath, sweating, heart racing, chest tightness/pain, nausea - and
Want to avoid psychiatric medication?
Have experienced little to no benefit from psychiatric medication?
Have medication side effects?
Want to come off psychiatric medication?
Want more options for mental health treatment aside from medication?
You’re in the right place. Let’s talk.
As a psychiatrist, I’m trained in several approaches to addressing a panic attack while it’s happening.
These include:
paced breathing
thought exercises, such as visualization and mantras
grounding practices
progressive muscle relaxation
cold exposure
and psychiatric medications, amongst others.
As a holistic psychiatrist, I have found that focusing on PREVENTING panic attacks is far more beneficial than just addressing them in the moment.
Why? Preventing a panic attack takes less energy than having the panic attack and needing to deal with it.
Although it’s commonly thought that panic attacks are primarily a result of negative thought spirals, most people describe them as “coming out of nowhere.” Sometimes identifying what brought on the panic attack might be obvious, but most of the time it’s not.
This is because panic attacks are multifactorial—they result from a combination of different contributors. Those contributors are both physical and non-physical; in the body and in the mind.
Anyone who’s experienced a panic attack will tell you that it’s an overwhelmingly physical experience—crying, trembling, hyperventilating/inability to catch your breath, sweating, heart racing, chest tightness/pain, nausea.
It’s the biggest reminder that mental health conditions involve our brains AND bodies.
So how do we go about preventing panic attacks?
Through research and clinical experience as a holistic psychiatrist, I’ve found that starting with the physical contributors is most effective. It’s the most direct place to start.
Let’s review some well-established physical causes and contributors to panic attacks and how to address them.
Irregular heart rhythms, like SVT’s (supraventricular tachycardia)
As an example, SVT feels like palpitations (pounding or fluttering feelings in the chest), chest pain, lightheadedness or dizziness, shortness of breath, sweating.
If you’re experiencing panic attacks frequently, you need to be evaluated by a cardiologist with an EKG, which takes a snapshot of your heart rhythm. Because the goal is to see what your heart rhythm is like during a panic attack and you likely (hopefully) won’t be having one in the office, a week-long EKG via a Holter monitor worn 24/7 is also necessary.
Too high blood glucose/sugar (hyperglycemia) followed by too low blood sugar (hypoglycemia)
Here’s a list of symptoms of low blood sugar: shakiness, lightheadedness, sweating, nausea, irregular or fast heartbeat, anxiety. Sound familiar?
There are two approaches here:
1) Wear a continuous glucose monitor (CGM) for about a week while eating your regular diet. This small device that sticks to the back of your arm measures your blood glucose level at all times and sends the info to an app. It lets you see in real time how what you eat and drink, and how you move and sleep, impact your blood sugar levels. Another approach is to test blood sugar and insulin via blood work both after fasting and every 30 minutes for five hours after a meal. The CGM provides way more info.
2) Assume that if you drink or eat anything with carbohydrates/sugar in it but without fiber, healthy fats, or protein, you have blood sugar spikes and subsequent hypoglycemic crashes. Switch to eating a blood sugar-stabilizing diet, one that avoids foods with added sugar and prioritizes meals and snacks that prioritize protein, high-fiber carbohydrates, and healthy fats, to keep your blood sugar at a steady level.
Inadequate sleep quantity and/or sleep/wake time inconsistency
Our bodies and brains don’t function well on less than 7-9 hours of sleep consistently.
Aim for this amount of sleep at least 6 days a week.
Our bodies run on an internal clock called the circadian rhythm, which regulates everything from our digestion (via peristalsis aka rhythmic intestinal muscle contraction) to when we’re sleepy or alert (via melatonin and cortisol). To work with our circadian rhythm instead of fighting against it and losing, we need to go to sleep and wake up around the same time every day. There’s a 45-minute +/- window that counts as “the same time.”
Set a sleep-time and wake-time window and stick to it at least 6 days a week.
Caffeine and nicotine
Here are the effects of caffeine on the body: sweating, irregular heartbeat, racing heart, increased blood pressure, tremor, nausea, or diarrhea. An average cup of coffee has 100mg of caffeine, but that’s not a reliable average. A Venti Blonde Caffè Americano from Starbucks has 340 mg of caffeine. Yes…340mg. Moral of the story: you’re probably ingesting WAY more caffeine than you might think.
To stop, you can cut down on your nicotine intake slowly over time or stop cold turkey. Whatever method will allow you to actually stick with it is the best one for you. You could also replace coffee with decaf to keep the ritual without the anxiety side effects.
Here are the effects of nicotine on the body: racing heart, increased blood pressure, nausea, diarrhea. Both caffeine and nicotine exert their effects by increasing the amount of norepinephrine or adrenaline being pumped out by our adrenal glands.
Avoid cigarettes (for cancer reasons as well) and nicotine vapes. The amount of nicotine in vapes is MUCH higher than in cigarettes. The more nicotine, the more pronounced the bodily effects. To stop, you can cut down on your nicotine intake slowly over time or stop cold turkey. Whatever method will allow you to actually stick with it is the best one for you.
Alcohol withdrawal
Alcohol acts on the GABA receptors in the brain. If you drink alcohol daily for several weeks, your brain adjusts to this daily use by decreasing the number of GABA receptors. This is the body’s method of maintaining homeostasis, or a state of steady internal physical and chemical conditions. When you stop drinking alcohol, the lower number of GABA receptors results in an imbalance in favor of excitatory neurotransmission, aka increased brain activity, when there shouldn’t be. This feels like a racing heart, shaking, sweating, anxiety, nausea. The good news is that after about 3-4 months of not drinking, the number of GABA receptors more or less recalibrates. There is also an element of dehydration and blood sugar highs then lows contributing to anxiety stemming from alcohol use.
The exact amount of time or number of drinks needed for someone to become physically dependent varies from person to person. The more often you drink and the more alcohol you consume, the more you increase your risk of developing a tolerance. Anyone experiencing alcohol withdrawal symptoms should be admitted into a medically supervised alcohol detox as soon as possible because alcohol withdrawal is life-threatening due to risk of seizures. If you drink alcohol consistently, you must consult with a medical provider before stopping.
If you drink alcohol occasionally, try drinking even less.
Hangover
A hangover, especially from heavy binge drinking, is a mini-version of alcohol withdrawal with GABA neurotransmission negatively impacted. A large part of it also stems from a sugar crash since all alcohol has carbs and most alcoholic drinks have sugar added to them. It also has a lot to do with dehydration since alcohol leads to increased urination.
Cannabis withdrawal
The signs and symptoms of cannabis withdrawal are: anxiety, physical tension, sweating, and stomach pain. These typically begin 24–48 hours after the last use, and most symptoms generally peak at 2-6 days. Some symptoms last up to 3 weeks or more in heavy cannabis users because THC gets stored in fat cells and leaks out over time. The cannabis might be calming your nerves while you’re on it, but it’s a double-edged sword that leads to increased anxiety when you stop it.
Withdrawal from cannabis is not life-threatening so you can stop cold turkey. Some people do so while others decrease slowly over time. Whatever method will allow you to actually stick with it is the best one for you.
Hyperactive thyroid
A thyroid pumping out too much thyroid hormone results in nervousness, tremor, rapid, and irregular heartbeat.
Ask your psychiatrist or primary care doctor to order blood work to evaluate the function of your thyroid, specifically TSH, free T4, free T3, reverse T3, Thyroid Peroxidase Antibodies (TPOAb), Thyroglobulin Antibodies (TgAb).
Asthma
Common symptoms include shortness of breath and chest tightness or pain.
See your doctor and ask to be evaluated for asthma to rule this out.
Sleep Apnea
People with sleep apnea stop breathing intermittently throughout the night. The resulting build-up of carbon dioxide and low levels of oxygen leads to a high amount of norepinephrine. This can lead to waking up feeling breathless or with a racing heart.
See your doctor and ask to be evaluated for sleep apnea to rule this out.
Dehydration
Symptoms of dehydration include lightheadedness, increased heart rate. Dehydration also leads to electrolyte imbalances, which cause symptoms of panic attacks.
Aim for at least 80 oz of water daily.
Low omega-3 fatty acids
Low levels of omega-3s are linked with higher levels of anxiety disorders, including panic attacks.
Aim for 2-3 grams of omega-3’s daily, with the dose containing at least 60% EPA (e.g., 1,500 mg EPA and 500 mg DHA).
Inadequate Vitamin C or E
Vitamin C and E are crucial in handling oxidative stress, which is implicated in anxiety-related disorders, including panic attacks.
Speak to your psychiatrist to see if you would benefit from Vitamin C or E supplementation.
Low Vitamin B6 or iron
Adequate vitamins and nutrients are required for optimal body functioning. Low serum levels of vitamin B6 and iron are involved in panic attacks.
Speak to your psychiatrist to see if you would benefit from Vitamin B6 or iron supplementation.
Low Magnesium
Magnesium is crucial for the proper functioning of GABA, which is neuro-inhibitory. This means it appropriately decreases brain activity. Without GABA, there is less appropriate neuro-inhibition, meaning there’s more brain activity where there shouldn’t be. This is tied to anxiety and panic attacks.
Take 200-400mg Magnesium glycinate total daily, with about 100mg in the morning and about 300mg in the evening.
Screening for the above causes and contributors to panic attacks is the first place to start to prevent of panic attacks. Everyone’s combination of contributors is unique. Determining which are and which aren’t part of your mental health picture leads to the creation of a unique treatment plan for panic attack prevention.
Please do not settle for a doctor telling you that your symptoms are “all in your head.” There are many well-established causes and contributors to panic attacks. It behooves your doctor to check for every single one in order to determine which are and which aren’t contributing to your mental health symptoms. Without assessing for these causes and contributors, the treatment plan will be lacking crucial elements.
Once the above have been addressed, or are well into the process of being addressed, the next step is to look back at past panic attacks and identify “triggers.” This allows us to make changes based on this information to either avoid those situations or, more likely, plan to apply a new thought process and mental framework around them to make a panic attack less likely. Ex: If riding a rollercoaster leads to a panic attack and you’re okay with not riding rollercoasters, avoid all rollercoasters. If you decide that riding rollercoasters is a necessary part of your life, it’s time to try a new thought process and mental framework around riding them and get back on them.
This sort of reflection and deep dive into the thoughts you have around the situations that typically lead to panic attacks is best done with a cognitive behavioral therapy (CBT) trained therapist. AND it’s best started once the above physical causes and contributors are screened for and addressed, or in the process of being addressed, by a holistic psychiatrist. Remember, the brain and body are the common denominators to non-physical causes and contributors. No matter whether we change our environment, situations, thought patterns, or mental frameworks, our body and brain come with us.
Sometimes panic attacks occur seemingly without “triggers,” as in the case of complex PTSD, especially when memories have been repressed. I recommend this be explored with a trauma-informed therapist AFTER the above physical causes and contributors are screened for and addressed by a holistic psychiatrist. It’s much more direct to screen and test for the above-listed conditions and get a concrete yes or no than it is to wonder whether you have repressed traumatic memories. Let’s start with the tangible first and then move toward the more abstract.
In addition to the above healing approaches, there are other ways to decrease the chances of getting panic attacks via nervous system regulation including:
Increasing HRV (heart rate variability) through regular movement, cold exposure, and specific breathing patterns such as coherent breathing.
Increasing signals of safety to the nervous system through consistent routines, mind-body movement such as yoga, meaningful in-person social interaction, time with animals, calming physical touch like hugs, singing or humming, and specific meditation such as loving-kindness meditation.
Daily stress recovery via 10 minutes of a repetitive activity (cleaning, walking, crocheting, coloring) in silence as well as time in nature.
Between addressing physical causes and contributors, cognitive behavioral therapy, and nervous system regulation, there are many treatment options for panic attacks outside of medication!
This is a glimpse into a holistic psychiatrist’s treatment approach.
It’s been helpful to many, especially to those who:
Want to avoid psychiatric medication
Have experienced little to no benefit from psychiatric medication
Have medication side effects
Want to come off psychiatric medication
Want more options for mental health treatment aside from medication
Brain-Body Psychiatry was created to bring you better mental health treatment through holistic psychiatry.
We all need support, guidance and accountability in making changes to positively impact our mental health.
Brain-Body Psychiatry partners with you to guide you to your full potential.
With care,
Dr. Luisa Cacciaguida
Disclaimer:
This blog post is intended to be informative and does not replace individual medical advice. Always consult with your healthcare provider or a professional for any personal medical decisions or concerns you may have. Everyone's health situation is unique and should be evaluated by a healthcare professional.
This blog post is designed as a general guide. This is not a substitute for personalized medical advice, nor is a patient-physician relationship established in this blog post.
