Panic Attack

Please read the Drugs Forum Disclaimer. This information wiki on panic attacks has not necessarily been been verified by a medical professional, and the information may be inaccurate. Large amounts of the information presented are based on anecdotal evidence.
Read This First!
In most cases panic attacks will not be a serious health concern for healthy individuals. For healthy people that are cardiovascularly healthy the best cure for a panic attack is time, hugs, reassurance and monitoring by friends until they calm down. However, Below is a list of symptoms that, if severe enough, should receive immediate attention by EMS personnel. If any of these are present, it may be necessary to call 911.
Emergency numbers in Europe:
Universal GSM/GPRS number (mobile/cellphone) in Europe is 1-1-2
Emergency number in the UK is 9-9-9
In Australia the number is 000, however it is 106 for teletype (TTY) phones and devices and 112 redirects there automatically from all GSM phones.
Symptoms

• Shortness of breath and rapid breathing that cannot be brought under control through conventional methods such as calming down and trying to breathe slower
• The inability to breathe without great struggle for a considerable period of time.
• Elevated heart rate over 150 bpm, that doesn't subside after a short period of time
• Profuse sweating or violent shaking accompanying any of the above symptoms
• Dizziness that leads to the inability to stand or walk
• Nausea or vomiting as a result of an attack
• Induced by an overdose or an adverse reaction to a drug you have no previous knowledge of

The above symptoms, accompanying a attack, can be different issues that are caused by the attacks that can lead to everything from brain damage to death. If you feel a attack is out of control for any reason, seek immediate medical attention. If you feel that you suffer from an anxiety disorder, meet with your physician and tell him your symptoms and he will provide you with a diagnosis.
Note on calling an Ambulance - [NB: this mostly applies to US residents]
Calling an ambulance should be done if the subject is in medical danger, or if you don't have enough experience or knowledge of what the subject is experiencing to be certain of their lack of need of treatment. If the subject is wild and attempts to hurt himself or herself, they should be restrained. Sending authorities into the picture has an extremely high risk of legal trouble for everyone involved. A scary night of babysitting someone off their rocker is certainly no laughing matter, but it is always preferable to years in jail and a permanent criminal record. Not to mention the gigantic, monstrous hospital bill that someone is going to have to pay. Also, a hospital is rarely knowledgeable when it comes do dealing with psychedelic drugs in the first place.
This only applies when one knows for certain what drugs the subject is on. When that situation is unknown and a potentially dangerous drug interaction is taking place, then getting medical personnel involved is a better idea. Still, it should only be done when there is a clear medical emergency and not just someone freaking out in hyperspace. So, it is a good idea to monitor someone's vital signs throughout the experience.
In regards to psychedelics:

Instant transfer of the individual to a psychiatric facility in the middle of the LSD experience is not only unnecessary, but represents a dangerous and harmful practice. It disregards the fact that the LSD state is self-limiting; in most instances, a dramatic negative experience if properly handled will result in a beneficial resolution and the subject will not need any further treatment. The "emergency transfer" to a psychiatric facility, particularly if it involves an ambulance, creates an atmosphere of danger and urgency that contributes considerable additional trauma for a person who is already extremely sensitized by the psychedelic state and the painful emotional crisis. The same is true of the admission procedure in the psychiatric facility and the atmosphere of the locked ward which is the final destination of many psychedelic casualties. ref. 1
Introduction to Panic Attacks
Panic Attack. Noun.
The sudden onset of intense anxiety characterized by feelings of intense fear and apprehension and accompanied by palpitations, shortness of breath, sweating, and trembling. Also called anxiety attack.
It appears that the majority of users who experience a panic attack fit into a certain category. Victims of the panic attack tend to be younger, either in high school or in college. Their inexperience in the use of drugs is a contributing factor to their perceived fears, which result in the classical panic attack. Often times consuming more of a certain substance than usual, or a more potent form than usual, can trigger a panic attack. The setting is also a huge psychological factor and depending on where you are, it can allow your mind—in combination with your personality—to distort what you see. Users typically think the drug is to blame, yet people often forget the power of their own mind to distort reality and make a fuss out of something that is just a perception. At the end of the day though, it is all in your mind.

A panic attack as a result of drug use has some unique symptoms to it that you should be aware of. A racing heartbeat, or the feeling that you are going to have a heart attack, is one of the most commonly reported effects. Another heart related symptom is being able to feel your heart beat throughout your entire body, like a pounding almost. Palpitations might accompany this feeling too, as your anxiety might focus on your heart skipping beats. Hot and cold flashes as well as sweating have been reported. Another common symptom is tingling in the body and numbness of the limbs. Trembling or uncontrollable shaking has been reported, especially if you go from one altitude to another, smoke cigarettes, consume lots of caffeine, or take medications like Ritalin. Some users report visual and auditory hallucinations. Just remember, this is a psychoactive drug, but it is also commonly a drug that has been used for thousands of years and many have been able to do so in a calm and controlled matter. ref. 2
What to do
For the Victim
If you do experience a panic attack, there are a couple of things you can do to help cope with it. First off, relax! Try to lie or sit down and just close your eyes. One of the main things that people do mid panick is to tense up every muslce in their body, which further increases heart rate, try and lower your shoulders and slowly relax each muscle one by one. While you are doing this, take a big, deep breath through your nose and hold it for a couple of seconds. Then exhale slowly through your mouth. Do this for a good minute. Keep reminding yourself that this “feeling” is all in your mind, that you are going to be okay. Breathing is the most important part of this, it really helps calm you down. Try stepping outside to get a breath of fresh air if you can do so safely. Often times being surrounded by a large group of loud people and music can further increase your panic attack, so just get away. Find an escape somewhere and just breathe! Get a glass of cold water and maybe some bread or crackers. Try to divert your attention away from your panic attack by watching the television, eating food, or taking a cold shower. Anything that can take your mind away from what is going on is going to help, which is another reason why breathing is very important.
For the Trip Sitter
The first thing to remember is the importance of this role. The trip sitter stays sober and calm during the entire trip. Study the substances that will be taken, and it is preferable to be 'straight'... the sitter must measure the risks and consult whatever source for advice if in any doubt. Additionally, it is very helpful if the sitter has a good understanding of the substance being taken, or experience with it in the past. At all times, maintain the safety of the tripper, but this will vary from substance to substance. Here are some points to consider:
1) Get the subject to recognize that they're under the influence of a drug, and that the experience will end. If you do this they will almost always be able to get control of themselves. It's OK to be miserable on drugs, as long as the subject recognizes that these feelings are drug-influenced and that they will end.
2) If the subject cannot recognize that they're under the influence of a drug (i.e. they've "lost insight") and they are panicking they should be calmed and restrained if calming fails. Calming someone completely off their rocker is easily done by taking advantage of how easily distracted someone in a massively zonked-out state is. Change their environment - music, going outside if there is nobody around, turning the lights on and off, isolating them from others, etc. Give them something for their trip to latch onto that's something other than what's sending them off the edge. But if all of that fails, then restrain them, but don't ever get violent. The drugs will wear off in time.
3) Monitor their vital signs, and only call in medical aid when the subject has serious medical problems - severely elevated pulse, hypertension, seizures, difficulty breathing, etc. Off the wall behavior is not a medical emergency and is only needlessly going to get someone in trouble. Possibly everyone around them too. The US health care industry is not there to help you but to make money off you, and incidentally so is the drug enforcement industry, both of which you will be calling in to "help."
4) Don't administer even more drugs unless you know what you're doing.
5) The most important aspect of handling a bad trip is the re-integration period afterwards. They have to understand that a) their feelings were the result of a drug experience only and b) figure out how and why this experience went wrong, and if it did in the first place. A lot of so-called "bad trips" are simply people confronting things about themselves that they are in denial about. There is no denial with psychedelic drugs. All self-delusion barriers come down and the subject sees only the bitter truth.
6) Better yet, don't let SWIY give psychedelic drugs to someone that's not likely to handle them!
-It is preferable and recommended that the sitter is a good friend of the person being sat.
-Often in the case of a bad trip, physical touch is not a good idea, the offer of a hand to hold or a hug, but do neither until you are sure that the tripper is happy that this happens.
-Adding a nice thing or something the tripper likes is a positive... for example, adding a familiar face to a crowd, or another 'friendly' image.
-Pen and paper are good tools to have to hand, as often there is a point of non-vocalizing, and being able to convey thoughts, feelings etc can be a godsend to the tripper.
-An important thing to remember is that trips can go wrong, and to stay calm and focused on helping the tripper... now is NOT a time for the sitter to panic.
-Do not be afraid to call for help if necessary, and in some cases, if there is a serious risk of injury, an emergency call may be necessary.
-Be aware at all points of the trip, and be ready to help the tripper to distinguish why and how things are happening.
Extremely bad trips
What follows is based on swim's experience of two extremely bad trips which swim was the sitter for. These were of a level in total contrast to other “normal” bad trips which swim has seen and even experienced himself. The drug in question is LSD. This information is intended to inform future trip sitters. This is a work in progress which requires validation from more experiences so please share them if you have any (experiences from the perspective of a sitter preferred but not required). Remember though, this is about extremely bad trips only. One of these bad trips resulted in short-term psychosis and then PTSD, for example (in a normal sane person). The other miraculously snapped out of it and had no recollection of it whatsoever, even though it lasted 5 hours, and so wasn’t traumatised.
It should be noted that bad trips of such magnitude are extremely rare and you (the future trip sitter) will be very unlikely to encounter and have to deal with such a bad trip. Nonetheless, much of the information provided is relevant to less bad trips also and it never hurts to get more knowledge. Actually, if swiy suspects that learning just how bad trips can get will be bad food for thought when swiy is next tripping, it might indeed hurt to get more knowledge...
General pointers:
-The mind can only begin to relax once the body has relaxed
-If they appear to shrink away from physical contact or bat you away if you touch them, always back off. This applies unless you feel it is an emergency and you have to stop them harming themselves.
-Never crowd round them, never raise your voice: always speak with an extremely calming tone. Never shake them and never yell “calm down!” even if they start going berserk.
-If they are lying down, make sure it is on their side in case they vomit.
Signs that a bad trip is becoming a very bad trip:
-extreme short term memory loss. Eg, if you tell them they are having a bad trip in response to them asking "why am I feeling like this?" then they will ask exactly the same question 30 seconds later.
-confusion
-acting in uncharacteristic ways
Signs that someone is in an extremely bad trip:
-They start crying or whimpering
-They have their eyes closed
-They are unresponsive to any verbal and/or physical communication
-They are sitting or lying in a clenched position and have been doing so for a while. Clenched means that they are tensing a muscle group, such as crossing their legs and holding them to their chest with their arms.
-They sometimes murmur incoherent phrases
-If their eyes are open, they seem blank and they don’t seem to be aware of their surroundings
-they appear to be in one of the phases listed below
-They take their clothes off

Note that while these can be characteristic of a bad trip, just because a tripper is exhibiting one or more of these signs does not mean that they are in a very bad trip.
If they are responsive to verbal communication then that is a good sign. Talk to them, but be careful what you ask. Asking them their name can confuse them- Once I asked a person their name and date of birth over and over to try and keep them talking because they would not open their eyes and they started to think they had been in a car crash, were being questioned by a paramedic, and that they had killed people…
If they are unresponsive to verbal communication, they are very far gone and very possibly they will get a lot worse. Unresponsive means that either they don’t show any sign that they know where they are, what they are, or what is happening.
Different phases:
When on a very bad trip, the tripper may go through different “phrases” which can be very different. They are phases, not stages, because all bad trips are different and do not really follow a definable chronology.
"Looping" phase:
When in an extremely bad trip, people may perform a physical movement or action that they then repeat with increasing violence/intensity. The physical effort involved in each loop increases, and each movement is a more strenuous, more intense version of the prior movement. This continues until the entire body is strained to its maximum, and they collapse.
This is better described by an example: A very scary version of this is when they start yelling. It starts with a moderately loud growling noise accompanied by a tensing of the arm muscles, it sounds quite like a motorcycle revving. Then, they pause for breath and relax their muscles and then they begin the second loop in which they growl louder and tense their muscles even more. After a few loops, they jump to their feat clenching their arms in front of them, roaring as hard as they can. After this peak, they instantly forget how to stand, and fall over again. Make sure you catch them and lower them down safely. Another horrific one to watch is when they get stuck on a loop of breathing through their nose with ever increasing violence. At the peak of this, they are forcing the air in and then out of their nose with incredible force, throwing their shoulders and head back and forth like a piston creating such a loud noise it seems likely their sinuses will rupture, although that did not happen. Do not try to hold or cover their nose, as they will probably just rupture their eardrums instead.
Once they have finished one loop and collapsed back on the floor, they will instantly pick up on whatever physical movement they happen to make next, and turn it into a loop. Dangerous loops for example, are things like smashing their teeth together with ever increasing force. If you see them do this, force a towel in their mouth. They are likely to carry on and not notice at all, but their teeth will be saved.
It should be noted that they will not have any recollection of performing these “loops”. (in swim's experiences)
In situations like this, getting them to calm and rest their physical body is needed if they are to get out of the looping stage. They will not be conscious so you will have to physically move them into a relaxed position. Hopefully, after being relaxed for a while, they will stop looping. Later on, they may give a sign that they are going to start looping such as beginning a loop movement. Swim found that saying "no, don't do that" in a very calm relaxed tone stopped them re-entering the looping phase every time.
When they are in this stage, they will be totlly oblivious to the external world, and all you can really do is stop them harming themselves, and try to keep them comfortable. There may be times when they come out of it a bit and try to communicate saying things like "how do I get out of it?"- tell them to relax their body and think about nice things. They will not be able to stand or sit up, so put some cushions under them. The looping stage does not last for very long- 45 mins at most- (more experience reports needed to validate this) but a tripper can re-enter it again.
In addition to physical loops, mental looping is described by many and seem to be more common than physical looping. I have condensed an experience report I found on the internet which described this:

The advise given is debatable, especially about the part where 'tricking' the trippers mind is recommended. It seems a danger that important trust might be lost if the tripper believes they are being tricked by the sitter. If it alleviated anxiety, however, then perhaps it was a good strategy. As I said before, it is debatable and should be debated. The state of consciousness described is clearly extremely fragile.
Seizure phase:
People on a very bad trip may start shaking their body, with their eyes rolling back into their head. DO NOT crowd around them yelling “whats wrong?!” and shaking them. Try to remain calm and support their head, saying calming things.
Catatonic phase:
When they sit or lie down with their eyes open or closed and don’t really move or say anything, often in a clenched position. Put a blanket over them and hold their hand if they don’t object. If they have their eyes closed and are in a clenched position and appear to be getting anxious then gently lift their eyelids for them and say “hi, X, it’s me Z”. If this makes them more anxious, then you can either choose to carry on holding them open and try to soothe them, or you can close them again and try to soothe them- (more experience reports are required for this advise). They may ask for water. When asked things like “how are you feeling?” they might reply with things like “you should just be yourself…” Try not to laugh at them even if you are in need of some humor as it can confuse them although they will probably simply not register your response.
S Cohen describes this as a defencive mechanism against the painful emotions encountered in a bad trip:

Traumatised phase:
Consists of sitting or lying down and just crying and being really upset, usually straining arm muscles, often pausing for a second in total confusion to look around, and then crying again. This can last for hours. They will likely be semi aware of surroundings in the sense that they will be able to "see" the room they are in and the people they are with, but they will not really take in the information properly, and will be very confused, upset and worried. For example, if you offer them water, they might recognise it but will not likely take it. In this state, it is best to help them calm down by looking cheerful if they look around them, and saying calming soothing things.
Coming out of it phase:
They seem to be getting better and can get up, move around and talk almost normally. If they are completely normal, then great, they have “snapped” out of it- which is very possible, even snapping out of violent looping back to total normality is possible. If, however, they seem a bit weird and confused then it is VERY important that you keep them company and talk about really simple things, perhaps put on some calming music. Signs of confusion include not seeming to remember much if any of the experience, mixing up words and meanings, extreme short term memory loss, repeatedly saying they want something but they don’t know what, such as saying “come on guys!” “what do you want?” “I don’t know…” DO NOT suggest that they try to get some sleep. They may seem fine and even happy and will probably laugh at jokes but if they show signs of general confusion then there is still real danger that they may fall back into the catatonic or even the looping phase, EVEN if they are nearing the 12 hour mark. Bad trips of this magnitude can easily reach the 18 hour mark. They need to stay awake and happy until the effects have fully worn off AND they are EXTREMELY tired before going to sleep.

Violent, aggressive, self-destructive behavior This is not based on swim’s experience, but is based on a compilation of reports and articles he has read.
From an experience report I came across on the internet:

Some quotes from Drugs-Forum:

Although extremely rare, such reports are always seen as very significant and therefore there are a large number of reports of a similar theme to these quotes. As the first quote demonstrates, constant vigilance is required to prevent self-harm as a person can hurt themselves in the blink of an eye. If possible, a person should be taken to a room/place which does not offer much opportunity for harm as soon as the bad trip initiates. Physical restraint may indeed be necessary for extremely hostile people.
A note on physical restraint:
This may be required if they are thrashing around near something very hard or sharp, or if they are displaying hostile or self-destructive behavior. Remember, physically retraining someone on a bad trip is likely to make them worse and holding someone in the wrong way can easily result in a dislocated shoulder or something similar. If you feel you are not physically strong enough to restrain the tripper, call for help. Also, try to keep contact time and force to a minimum. For example, steer someone gently but forcibly away from danger, rather than grabbing them and trying to hold them on the floor. Of course, only you can really judge what is necessary.

*Note: It also may or may not be legal to physically restrain someone in your country, because if you injure them, you could be at fault.[/U]
The decision to administer Benzodiazepines:
Benzodiazepines will diminish anxiety and sedate people on very bad trips. They are the drugs most likely to be given to a bad tripper taken to hospital. Obviously, these drugs can not be forced in the mouths of people who are really freaking out as they will just choke, but in swim’s experience, however, there are brief “interludes” in very bad trips when people “come out of it” for a few seconds, usually to say “why is this happening to me?!” or something. Those are the occasions where you could offer them a benzodiazepine, sedative, or anything you think might help (research drug effects and interactions beforehand).
Dosage for extremely bad trips (assuming no other depressant type drugs have been taken):
Diazepam (Vallium): 20-30mg
Alprazolam (Xanax): 2-3mg
Some people argue that forcibly interrupting bad trips can have a negative psychological impact and that therefore people should be left to work their way out of it and the experience will be ultimately rewarding. I am not going to presume to have the answers, but I will note that from swim's experience that extremely bad trips are better ended sooner rather than later. In swim's experience, an extremely bad trip can go on for 18 hours+ and can be the most horrible experience of a persons life. Swim's friend also lost several months of their life to short-term psychosis which was also awful, and nothing was gained from the experience. I believe that if the trip had been halted earlier- when he was not actually “conscious”- still in the looping phase- then he would not have remembered any of it or at least remembered less of it and therefore been less traumatized. The other experience swim had of an extremely bad trip involved the tripper suddenly snapping out of the trip having been in the looping phase just minutes before and he remembered nothing of it and so was totally normal despite the incredible intensity of his bad trip. Judging from swim's experiences, if someone is in the looping phase it is better to try and get them to take a Benzodiazepine. If they are in a catatonic or traumatized stage then it is less clear if they would benefit; but swim believes they will.

*Note: It also may or may not be legal to administer medication to another person in your country. If they happen to have an allergic reaction to the medication, then you will be responsible for injuring them and this may result in a law suit against you.
More information about Panic Attacks
What they are
Roughly 5% of Americans suffer from a persistent anxiety disorder. These are disorders that need to be treated with medication and other treatments such as therapy. A much larger percentage of the population however suffers from non-persistent anxiety.
If you are suffering from a anxiety attack more than once a month, there is a good chance you could be suffering from a anxiety disorder. It is not uncommon for most people to feel anxious at any given time throughout the day. It is even common for the average population to suffer a panic attack. But recurring attacks and frequent attacks are a good indicator of a disorder.
This section needs to be expanded. More information about panic attacks.
Prevention
1. Know your substance, know your source. - It is crucial that any individual who partakes in drug use know what they are getting, how pure it is, how strong it is, how much to take, and who they are getting it from. Stories that begin with "My buddy X got 3 little yellow pills from Y who bought them from Z, and I took them..." are usually bad news. Do your research, ask questions, read books, before you do drugs!
2. Don't trip alone. - If all goes aloof, having a friend help you through a difficult situation may only be possible if that friend is there. If by any chance you need further medical attention, having a friend ready to help you may save your life. Make sure this friend knows what you are taking, what you expect, and who to call first depending on the nature of the situation.
3. Have a game plan. - It's early Sunday afternoon, you fed your pet fish, and you have no further obligations for the day. Good. But if you just got home from work on Monday night, have dinner plans with your in laws in 2 hours and have to complete an architectural assignment that your boss wants Tuesday morning, bad time to do drugs. Make sure there is an adequate amount of time, and you know what you want to do with your time, ahead of time. Plan in advance.
4. Mind your Set, mind your Setting. - Set refers to the mindset of the user who is about to change their brain chemistry. Is it stable? Are they happy, sad, angry? Are they looking forward to the experience, or scared of it? Are they a well-grounded individual, or are they susceptible to radical thinking? These are things to consider.
Setting refers to the surroundings that the user finds themselves in. Is it comfortable? Is the environment drug friendly? Are the people present close friends? Is everyone on the same page, same verse, same level? These are also some things to consider.
Specific drug reactions
These sections need to be written.
Cocaine
Marijuana

Ketamine
Salvia Divinorum

LSD

The Aftermath
What happened?
This section needs to be written. It will include PTSD, and effects of having a panic attack on the mental state of the individual.
What now?
First, remove the source of the problem. The individual must stop consuming the drugs, or possible several drugs that may be part of the problem.
Second, reassess the situation. The panic attack was initially caused by an unknown or alien substance where the individual did not expect what they got. It probably could have been done in a safer way. List some things that could have prevented the panic attack. Think about why the panic attack happened, and what could be done to stop it from happening.
Third, reaffirm positive beliefs. Many people have previously enjoyed an altered state of mind without having a panic attack. They were able to enjoy the experience, so swiy probably can too. Understand that some drugs carry health risks, while others are more safe and less toxic.
Finally, reintroduce the substance. Start small, very small: one toke, one hit, one bite, one bump, but just one. Wait 10 minutes. Wait an hour. Wait a day, whatever need be. Then take a little more. Wait again, and go on from there.
Overall, remember to know positive. One must know they will be okay, not think that they will be okay. Be safe!
This wiki needs expansion. See this thread.
Acute Anxiety Management group - discuss and contribute to this wiki here.
References
1. Crisis Intervention in Situations Related to Unsupervised Use of Psychedelics; Stanislav Grof, M.D.
2. Higher Logic. Marijuana.com. Accessed January 14th, 2009. http://www.marijuana.com/medicinal-m...y-attacks.html


Contributors: Richi, bananaskin, TommyRowe, Third/Eye[FONT=verdana], Durd1e
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[VAR]description|This page is anecdotal information regarding how to handle a panic attack, when, and when not to seek medical attention.[/VAR]