How Do You Stop Anxiety Attacks?

People who have anxiety attacks may have a low level of anxiety as a baseline that increases with certain triggers.

Anxiety attacks are a type of heightened anxiety that comes on gradually and involves feelings of increased anxiety or stress, along with physical symptoms. 

An anxiety attack is not the same as a panic attack, which comes on suddenly and involves intense feelings of fear or an impending sense of doom that lasts for a short time, usually only a few minutes. 

Symptoms of an anxiety attack tend to come on gradually. People who have anxiety attacks may have a low level of anxiety as a baseline that increases with certain triggers. 

Symptoms of an anxiety attack include:

• Restlessness
• Excessive worry 
• Feeling on edge
• Irritability
• Muscle tension
• Being easily fatigued
• Difficulty concentrating
• Sleep problems
• Being easily startled
• Increased heart rate

Generalized anxiety disorder and anxiety attacks may be caused by: 

• Genetic factors
• Environmental factors such as early childhood trauma
• Underlying medical conditions
• Use of certain substances, such as over-the-counter (OTC) medications, herbal preparations, and illicit drugs 

Certain conditions can trigger anxiety attacks, such as:

• Caffeine
• Stress
• Loss – of a loved one, pet, job 
• Problems with relationships
• Heart problems
• Illness
• Side effects from medications
• Low oxygen levels from being at high altitudes, having lung diseases such as chronic obstructive pulmonary disease (COPD, including emphysema or chronic bronchitis), or a pulmonary embolism

Anxiety disorders are usually diagnosed with a psychological evaluation. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, provides diagnostic criteria for an anxiety disorder. 

Lab studies to help diagnose or exclude medical conditions that may cause anxiety disorders and anxiety attacks include:

• Complete blood cell (CBC) count
• Chemistry profile
• Thyroid function tests
• Urinalysis
• Urine drug screen

Tests to rule out central nervous system (CNS) disorders that can cause anxiety disorders and anxiety attacks include:

• Electroencephalography (EEG)
• Lumbar puncture
• Brain computed tomography (CT) scan
• Magnetic resonance imaging (MRI) of the brain 
• Neurologic consultation 
• Positron emission tomography (PET) scan

Tests to rule out heart conditions that can cause anxiety disorders and anxiety attacks include:

• Electrocardiography (ECG) 
• Treadmill ECG

Treatment for anxiety disorders and anxiety attacks typically involves a combination of medication and/or psychotherapy. 

Types of therapy used to treat anxiety disorders and anxiety attacks include:

• Behavioral therapy and cognitive-behavioral therapy (CBT) 
• Computerized CBT (Fear Fighter) 
• Psychodynamic therapy 
• Interpersonal psychotherapy 
• Relaxation therapy
• Supportive psychotherapy
• Mindfulness therapy

Medications used to treat anxiety disorders and anxiety attacks include: 

• Antidepressants
  • Selective serotonin reuptake inhibitors (SSRIs) such as paroxetine (Paxil), escitalopram (Lexapro), sertraline (Zoloft), fluoxetine (Prozac), fluvoxamine (Luvox), and citalopram (Celexa)
  • Serotonin and norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine (Effexor and Effexor XR) and duloxetine (Cymbalta)
  • Atypical antidepressants such as nefazodone (Serzone), mirtazapine (Remeron), and trazodone (Desyrel)
  • Tricyclic antidepressants such as imipramine (Tofranil) and clomipramine (Anafranil)
  • Monoamine oxidase inhibitors (MAOIs) such as phenelzine (Nardil), selegiline (Emsam), tranylcypromine (Parnate), and isocarboxazid (Marplan)
  • Benzodiazepines, especially in emergency situations, such as lorazepam (Ativan), clonazepam (Klonopin), and alprazolam (Xanax)
  • Anti-anxiety drugs such as buspirone (BuSpar)
  • Anticonvulsants such as pregabalin (Lyrica), divalproex (Depakote), and gabapentin (Neurontin)
  • Antihypertensive drugs such as clonidine (Catapres), propranolol (Inderal, Betachron E-R, InnoPran XL), nadolol (Corgard), and atenolol (Tenormin)

Other treatments used for anxiety disorders and anxiety attacks include: 

• Cranial electrotherapy stimulator (CES) 

In severe cases, hospitalization may be indicated to treat anxiety attacks, when the following is present: 

• Severe functional impairment (cannot meet own daily needs)
• Suicide or homicide risk
• Deficits in social skills 

Dietary changes that may help treat anxiety attacks include:

• Avoiding caffeine
• Using caution with over-the-counter preparations and herbal remedies because ephedrine and certain herbs may cause or worsen anxiety symptoms

To prevent an anxiety attack:

• Make sure your anxiety symptoms are well managed with psychotherapy and/or medications as prescribed
• Avoid known triggers
• Manage stress

To stop an anxiety attack once it has started: 

• Try deep breathing techniques
• Exercise 
• Do something relaxing like get a massage or take a bubble bath
• Aromatherapy and essential oils such as lavender, bergamot, and chamomile may be helpful
• Talk to someone you trust about your feelings of anxiety
• Use positive affirmations 
• Question your anxiety – is something really wrong, and what is the evidence? 
• Listen to music that relaxes you or makes you happy
• Try progressive muscle relaxation