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Comment by asxd | Hacker News Reader

I went to the emergency room after working from home for ~6 months when the pandemic hit. I was having severe chest pain, shaking uncontrollably, and feeling very uneasy. I thought something was really wrong, and ended up going to the emergency room, where they told me it was a panic attack, and everything was okay physically.

Like you, it was also the first time I had experienced a panic attack and learned what it felt like.

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I thought something was really wrong

Yeah, the fear of death as they call it. I really didn't understand this phrase before, thinking it was something abstract. It's unlike any other feeling I've had, just off the charts. And I'm (was) not particularly the guy who is scared to watch a horror movie alone in the night.

I've experienced exactly the same as you both except all the way back in 2015 and so I'm going to offer some unsolicited advice in case it's helpful. I had never heard of panic attacks before I got one, had never worried once about my mental health etc. and so I also ended up at the emergency room convinced my death was imminent.

Considering my healthy history my doctor and I agreed to try deal with it on a lifestyle level. I did meditation, yoga and revised my diet. I became more healthy but still had the panic attacks. We then stepped this up to therapy which I did for a year but still had the panic attacks. They were totally random and incredibly draining. My life & work were seriously affected and so I eventually followed the doctors advice to consider medication. Saw a psychiatrist and started the most basic SSRI at the minimum dose for panic disorder. I had a few attacks during the first two weeks and then they just stopped entirely. 100% completely. Haven't had one since.

So - my advice. If you are seriously struggling with panic attacks on a continuing basis despite a reasonable level of lifestyle interventions please don't do what I did and basically resist trying psychiatric medicine because you're healthy, successful and happy in your life and can't see a "legit" reason to be on meds. It felt like a much bigger intervention to me than it really is. I know for some people dealing with this sort of thing isn't this easy but for a lot it seems it can be.

(Also I don't blame my doctors at all, I always felt well informed about the options available to me. Obviously in retrospect with the way my life was affected meant I should have seen a reason to try meds sooner. At least the year of therapy was good for me even though it didn't stop the panic disorder!)

I wonder if something like St Johns wort would be enough to keep the panic attacks at bay if the SSRI is so light. Not that in your shoes I’d want to risk a switch after years of success. But it might be a good thing to try for someone who is hesitant to be prescribed.

Just wanted to add here for anyone considering St. John’s wort - it has a ton of negative interactions with lots of very common drugs, so check to make sure you aren’t already taking something that will interact with St. John’s wort. Ask your doctor.

For example, it can make birth control pills fail, allergy meds build up in your system, and serotonin build up if combined with another anti-depressant.

In my case I tried to convince my therapist to prescribe medications, but he resisted. I mean he more like advised me to try CBT way and only fallback to pills in case of failure, because they only serve as a crutch if your thinking process went wrong. It just happens that some people need this crutch temporarily and will be fine later by themselves. After 4-6 sessions I picked my PAs apart without any medications, but stayed to fix my other issues for a year. So ymmv, I guess.

Yep. The fear is real. I used to be close to someone who had regular panic attacks, and now after my own experience I feel awful about not taking them more seriously.

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