Panic Attacks and Drugs

In this article, I will try to briefly, clearly and accurately determine what a panic attack is, how it manifests itself, why it develops, how it differs from a panic disorder and how associated panic attacks and drugs, and why this unpleasant phenomenon manifested in our society. Let’s go!

What is a Panic Attack?

A panic attack is a sudden episode of intense fear or anxiety that triggers severe physical and emotional reactions, even when there’s no real danger or apparent cause. These acute episodes of fear and anxiety occur unexpectedly and peak rapidly.

Symptoms of a Panic Attack

The symptoms of panic attack can be both physical and psychological, and they typically peak within 10 minutes. The whole duration can range from a few minutes to several hours. The frequency of panic attacks can vary. Some individuals might experience them once or twice in their lifetime, while others might have them frequently. While some panic attacks seem to come “out of the blue,” others can be triggered by specific situations or stimuli.

Physical Symptoms:

• Heart Palpitations or Rapid Heartbeat: This is often one of the first signs, and it can feel like your heart is pounding or racing.
• Shortness of Breath: Individuals may feel like they can’t get enough air or are being smothered.
• Chest Pain or Discomfort: This can sometimes be mistaken for heart problems.
• Trembling or Shaking: This can affect the whole body or just certain areas like the hands.
• Sweating: This can be profuse, even if the environment isn’t particularly warm.
• Nausea or Stomach Cramps: A feeling of unease in the stomach.
• Tightness in the Throat: Difficulty swallowing.
• Dizziness or Lightheadedness: Some people might feel like they’re going to faint.
• Chills or Hot Flashes: Sudden feelings of cold or heat.
• Numbness or Tingling Sensations: Particularly in the fingers or toes.

Psychological Symptoms:

• Fear of Losing Control or Going Crazy: A feeling that one is losing touch with reality.
• Fear of Dying: Even though panic attacks aren’t life-threatening, the fear can be very real.
• Feeling Detached: A sensation that things around you aren’t real or that you’re disconnected from your body.
• Feeling of Choking: Even though there’s no physical obstruction.
• Feeling of Impending Doom: A general sense that something terrible is about to happen.

It’s essential to note that while these symptoms can be terrifying, a panic attack is not life-threatening.

Misdiagnosis

Some symptoms of a panic attack, like chest pain and shortness of breath, can mimic those of heart problems or other serious medical conditions, so it’s crucial to seek medical attention if you’re unsure about the cause of your symptoms. On the other hand, it can be the reason for unnecessary medical investigations and treatments. It’s essential to recognize the symptoms of a panic attack and differentiate them from other medical conditions.

When it`s Panic Disorder?

Certainly, understanding the distinction between a panic attack and panic disorder is crucial for appropriate diagnosis and treatment.

A panic attack as we already know is a sudden episode of intense fear or discomfort that peaks within minutes. It can occur unexpectedly or in response to a trigger or specific fear.

But Panic disorder is a chronic condition characterized by recurrent, unexpected panic attacks and the fear of future attacks. It also includes significant behavioral changes or ongoing anxiety about having further attacks.

Criteria for Diagnosis:

1. Recurrent Panic Attacks: Frequent and unexpected attacks that aren’t tied to a specific situation.
2. Worry About Further Attacks: Persistent concern about having another panic attack or the implications of the attack (e.g., losing control, having a heart attack).
3. Behavioral Changes: Significant changes in behavior related to the attacks, such as avoiding certain places or situations to prevent another attack.
4. Duration: For a diagnosis of panic disorder, the panic attacks must occur for at least one month.
5. Associated Conditions: People with panic disorder may also experience agoraphobia, where they fear and avoid places or situations that might cause them to panic.

I strongly recommend not to engage in self-diagnosis, web-diagnosis, and even more so self-medication. The criteria above are presented for orientation and no more. If you encounter similar conditions, seek the professional help of medical specialists.

Causes, Triggers, and Mechanisms

Biological Causes

• Genetics: There’s evidence suggesting that panic disorder and the susceptibility to panic attacks may run in families, indicating a genetic predisposition.
• Neurochemical Imbalance: Panic attacks can be linked to malfunctions in the release, uptake, and extracellular build-up of certain neurotransmitters, including norepinephrine, serotonin, dopamine, and gamma-aminobutyric acid (GABA). These neurotransmitters play a crucial role in mood regulation and response to stress.
• Medical Conditions:
  • Respiratory Abnormalities: Individuals with panic disorder often have increased sensitivity to CO2 and may hyperventilate, leading to panic-like symptoms.
  • Thyroid Dysfunction: Conditions like Graves’ disease can produce symptoms that overlap with panic disorder, making it challenging to distinguish between the two.
  • Low blood sugar levels, and certain cardiovascular diseases can trigger panic-like symptoms.

Psychological Factors

• Conditioning and Learning: Early conditioning episodes, where an individual learns to associate certain stimuli with fear, can play a role in the development of panic disorder. Over time, anxiety becomes a precursor to panic.
• Cognitive Factors: Individuals with heightened sensitivity to anxiety symptoms or those who misinterpret bodily sensations can be more prone to panic attacks.
• Misinterpretation of Bodily Sensations: Some individuals may misinterpret normal physiological responses as signs of a serious health condition, leading to heightened anxiety and panic

Environmental Triggers

• Stress: Significant life stressors, such as the death of a loved one, divorce, or job loss, can trigger panic attacks in susceptible individuals.
• Traumatic Events: Experiencing traumatic events, such as accidents or assaults, can initiate panic attacks in some people.
• Pandemics and Global Crises: Situations like COVID-19 have been a significant stressor, leading to an increase in mental health issues, including panic attacks. The fear of contracting the virus, especially if a family member has been diagnosed, can induce panic attacks in some individuals.
• Substance Use: The use of certain substances, including caffeine, alcohol, and cannabis, can induce panic attacks in some individuals. So here we are.

Panic Attacks and Substances

The relationship between panic attacks and the use of psychoactive recreational drugs is multifaceted.

Cannabis-Associated Panic Attacks

Cannabis use, both for medical and recreational purposes, has been on the rise. While cannabinoids have therapeutic effects for conditions like pain, anxiety, inflammation, and nausea, cannabis dependence is also associated with anxiety.

The direction of causality remains a topic of debate: it’s unclear whether anxiety disorders lead to cannabis use or if cannabis contributes to the development of anxiety disorders.

A new and notable case study highlighted a patient who developed panic attacks after 10 years of chronic cannabis use, despite having no prior psychiatric history. This suggests that long-term cannabis use can potentially lead to the onset of panic attacks in certain individuals.

Here I will not miss the opportunity to repeat one of my takes. Hybridization and selection of cannabis have given us amazingly highly active strains today. In some of them, the concentration of THC reaches 20% or more. Cannabis and its products in the modern world are often not a light drug, but a powerful psychoactive substance with psychedelic properties. Hence the frequent complaints of panic attacks, derealization, Hyperemesis Syndrome, and psychosis.

Harm reduction for weed use

Psychedelics

Psychedelics, such as LSD, psilocybin (magic mushrooms), and DMT, alter perception, mood, and various cognitive processes. They can lead to profound alterations in perception and consciousness. In some cases, this can result in a “bad trip,” characterized by intense fear, paranoia, and panic. The unfamiliar and sometimes overwhelming sensory experiences can trigger panic attacks and high levels of anxiety. Also psychedelics primarily affect serotonin receptors in the brain, leading to altered sensory perception and shifting the chemical balance of neurotransmitters.

Harm Reduction for LSD

Opiates

Opiates, such as heroin, morphine, and prescription painkillers, act on opioid receptors in the brain to produce pain relief and euphoria. While opiates are primarily depressants and can produce feelings of relaxation and calm, they can also lead to respiratory depression. The sensation of slowed or shallow breathing can induce panic in some users, especially if they feel they can’t breathe.

Harm reduction for opioid use

Stimulants

Stimulants, such as cocaine, amphetamines, and methamphetamines, increase the activity of the central nervous system. The use of stimulants can lead to increased heart rate, blood pressure, and heightened alertness. These physiological changes can sometimes trigger panic attacks, especially in predisposed individuals. The intense rush or “high” from stimulants can be mistaken for the onset of a panic attack, leading to increased anxiety.

The release of large amounts of dopamine and norepinephrine in the brain can lead to feelings of euphoria. However, the sudden surge can also cause anxiety, paranoia, and panic in some users.

Harm Reduction for Stimulants

Euphoriants

Euphoriants are substances that produce feelings of euphoria and well-being. MDMA (Ecstasy) is a common example.

While MDMA primarily produces feelings of love, warmth, and empathy, it can also lead to dehydration, hyperthermia, and serotonin syndrome. These physical side effects, combined with the intense emotional experiences, can lead to panic attacks in some users.

MDMA increases the release of serotonin, dopamine, and norepinephrine in the brain. The surge in serotonin can lead to mood elevation but can also result in serotonin syndrome in high doses.

Harm Reduction for MDMA

Novel Psychoactive Substances (NPS)

Unlike traditional illicit drugs, the influence of NPS analogs on neuropsychological functioning is less understood. Recreational NPS users have shown elevated “hot” (emotion-laden) cognition without “cold” (non-emotional) cognitive deficits. In contrast, individuals seeking treatment for problematic NPS use exhibited pronounced “cold” cognitive dysfunction. High trait impulsivity and poor self-control might increase the risk of NPS/polydrug use severity.

Often, the use of NPS drugs, such as Mephedrone or Alpha-PVP, is accompanied by pronounced paranoid affect and panic thoughts. Combining the effects of stimulants and euphoretics, representatives of NPCs are more likely to cause panic states.

Harm Reduction for Mephedrone

Other Drugs

Other drugs, such as benzodiazepines can be used to treat panic attacks and anxiety disorders. However, misuse or withdrawal from these drugs can also lead to increased anxiety and potential panic attacks.

It’s essential to understand that relationship between drug use and panic attacks can be influenced by various factors, including genetics, environment, dosage, presence of other, frequency of use, the presence of other substances and underlying conditions.

Dealing with Panic Attacks

Deep Breathing: Focusing on your breathing can help you calm down during an attack. Try taking deep breaths in and out, counting to four for each inhalation and exhalation.

Grounding Techniques: Techniques such as the “5-4-3-2-1” method, where you identify five things you can see, four you can touch, three you can hear, two you can smell, and one you can taste, can help divert your attention and bring you back to the present moment.

Avoid Caffeine, Alcohol, and other Substances: They can provoke panic attacks in some people.

Stay Informed: Understanding what’s happening in your body during a panic attack can help you feel more in control.

Join a Support Group: This can help you connect with others who are experiencing the same challenges.

Cognitive-Behavioral Therapy (CBT): This form of psychotherapy can help patients recognize and change negative thought patterns and behaviors that trigger or contribute to panic attacks.

Medication: Antidepressants such as selective serotonin reuptake inhibitors (SSRIs), serotonin-noradrenaline reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), and benzodiazepines are recommended as first-line treatments. I believe that they are necessary only in cases when other methods do not help or when the severity of symptoms is too serious and interferes with life. It’s essential to start with the optimal dose, maintain proper duration and consistency of use, and gradually discontinue the medication to prevent recurrence.

This part deserves more detailed consideration and clear practical recommendations. I will definitely come back to the question of How to deal with a panic attack in the future.

Summary

I think we can safely say that panic attacks are becoming more common in our reality. We live in a world full of stress, psychological pathogens and ways to cope with them, which in practice create even more problems.

The influence of psychotropic substances on the neurochemistry of the brain, the lack of knowledge and understanding about the principles of Harm Reduction, the illegal status of substances and, as a consequence, the absence of quality standards – all this creates an etiological background for the development of panic attacks. And it would be fine, it was just them.

Panic attacks are very unpleasant, frightening and often difficult experiences and conditions that can invalidate a person to an extreme degree of severity. But we have more or less learned to cope with panic attacks, while other consequences of chaotic and illegal interaction of people and substances still remain for us a whole pool of unsolvable problems.