Causes

Alcohol

• Drinking too much alcohol – more than seven standard serving drinks or drinking hard alcohol – virtually guarantees a panic attack occurring the day after the alcohol wears off.
• Overall amount of alcohol consumed during a period is the dominate factor here rather than purely the rate of consumption. So if you have two drinks at lunch and three at dinner that same about the same net effect as five drinks at dinner
• Concentration of drinks does have an effect on sleep and ability to remain asleep over night. Drinking beer makes me sleepy and generally allows me to stay asleep. Drinking wine or hard liquor allows you to fall asleep faster but than causes you to wake up once the alcohol wears off and the body kicks in the reaction in the stimulation direction to offset the depressant effect of alcohol.
• Irony of alcohol that it is consumed specifically for anxiolytic effect but the more that you drink the more intense the anxiety the following day.
• The anxiety the day after and the sleep disturbance rarely balances out the pleasure of the anxiolytic effect of the drink.
• As I age the anxiolytic effect of the alcohol seems to fall and the post drinking anxiety has risen
• Nominal to no anxiety from drinking up to two drinks

Caffeine

• Overall caffeine consumption should be targeted below 200 mg for the day with the bulk coming in the morning via a cup of regular coffee
• More caffeine throughout the day should generally be avoided
• Coke in general is probably something to limit to being a treat or no more than once a day as the phosphoric acid eats away teeth and the caffeine contributes to anxiety

Nicotine

• As much as I like the occasional cigarette my body CANNOT handle nicotine and each cigarette does damage
• Every time you smoke a cigarette it causes you to go into a full on panic attack with all the symptoms of a panic attack
• Smoking a cigarette was the triggering factor for you on 10/09/10 – so the reality is that your body cannot handle nicotine.

Exercise

• Lack of exercise has played a roll in most of the panic attacks but exercise on an empty stomach also seems to call anxiety
• My body has a high energy preset so without exercise that just builds up and raises overall anxiety
• So both overall exercise is important to reduce baseline stress plus exercise in acute stressful situations to reduce stress

Panic Attack

• Overwhelming sense of doom
• Utter terror
• Racing heart rate, clamy hands
• Suicidal ideation
• Feelings of losing your mind and grip on sanity

First One

I had my first panic attack sometime in my early twenties – if I had to guess I would say it was around 24. At the time I just remember having the feeling of being hit in the head and feeling like I was going crazy. I got an appointment with a first doctor that could see me – Dr. Zeitz – early on Monday – the current day was a Saturday. I remember waiting all day Sunday – going to see a movie – and not being sure if or what would happen next. Was I about to going crazy at any given minute or was that just a random episode.

I saw doctor on Monday and he explained that, yes I had had a panic attack, and, yes they could be treated. He put me on a combination of Zoloft and Clonopin (as needed). The Zoloft took three weeks to kick in but once it did it pretty much get rid of everything relating to a panic attack and much else as well.

Post Sonoma

• The one at Malhotra house
• Drinking the night before
• Snuck a cigarette (?)
• Resulted in giving up hard alcohol – which was a good choice

Lunch

• Near miss during lunch in DC.

Saturday, October 10, 2010

This one was a doozy. It was the middle of the night at 1AM and my wife was out of town with her friends in New York. I had spent the night before out smoking and drinking a bottle and a half of wine. The day of I had been fine from 11 AM to 1230PM at which point I started feeling a little fuzzy. I stopped to smoke a cigarette and went from feeling bad to a full fledged panic attack. I took some Clonopin, got Angel on the phone and talked myself downstairs to the concierge lounge to lie on a couch while I recovered. With another twenty minutes all was well went back upstairs and went to bed.

This was the supidest thing that I could have done. Poor Angel gets a call from me at 1AM because I am having a panic attack and need to get talked down. It ruins her weekend with the girls and make me wonder what kind of person am I that I need to be constantly managed by my wife to keep within the limits of well living. I can no longer imply or think that Angel has imposed any of these limits on me – I have to take them on myself and own them. Otherwise I will never move forward.