An Integrative Medicine Approach to Panic Attacks

Panic attacks can come on quickly and feel distressing — evening frightening — due to their unpredictable and disruptive nature. Roughly 2.7% of adults in the United States had a panic disorder in the past year, and it's estimated that 4.7% of U.S. adults will have a panic disorder sometime in their lives. 44.8% of people with panic disorder report that it severely impairs their ability to do the things they love and that are important to them. Panic attacks are also far more than a personal issue; anxiety disorders cost up to $1 trillion in lost productivity globally.

Thankfully, there are a number of incredibly effective solutions for managing and healing panic disorder! (Mary's story, for example, shows that an integrative approach can effectively eliminate panic attacks in just a few weeks). In this article, we'll explore the root causes of panic attacks and which functional medicine treatments can help you heal to get you thriving once again.

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What is a Panic Attack?

Panic attacks are sudden and intense, involuntary episodes of physical and emotional symptoms that can last for a few seconds or for many minutes. They always involve the emotional sensation of intense fear as well as the sense of being out of control.

Panic Attack Symptoms

Panic attacks can involve a wide range of physical and psychological symptoms that can leave people feeling as if they're losing control or even dying. Panic attacks symptoms can include:

• Heart palpitations
• Sweating
• Trembling
• Chest pain
• Detachment from reality
• Fear or a sense of impending doom
• Breathlessness
• Dizziness
• Physical compliance like stomach aches

People who have had panic attacks can become debilitated when they're happening – unable to do anything else than try to manage until the panic attack is over. It's common for people with panic disorder to experience anxiety and worry that they'll have another attack. Because of this, they can start to avoid people or situations that they fear will cause a panic attack, and this avoidance can disrupt day-to-day living, such as work, school, and social relationships.

Some people who have panic attacks also report other conditions like agoraphobia, social phobia, or substance abuse. Thankfully, there are effective options for managing panic attacks to eliminate these symptoms, ease worry, and get folks with panic disorder back to living fully without fear.

How to Stop a Panic Attack

Breathing techniques like paced breathing, cognitive behavioral exercises, and pharmaceutical medications like the ones covered later in this article can be used alone or together to stop a panic attack in the moment. Your integrative team will help you develop a unique plan to stop your panic attack based on your root causes and preferences.

What Causes a Panic Attack?

The exact causes of panic attacks are not fully known, but they are likely caused by several factors rather than a single incident. Some panic attacks can be attributed to neurotransmitter imbalances, nutrient deficiencies, hormone issues, histamine disorders, mineral deficiencies, vestibular or breathing issues, or environmental/psychological factors.

Before delving into root causes, your practitioner will check to see if you have any medical conditions that might cause symptoms similar to panic attacks: heart disease, endocrine imbalances, gastrointestinal disorders, metabolic conditions, and others. Once those are ruled out, you'll explore other possible causes together.

Nutrient Deficiencies

Several nutrient deficiencies are linked to panic attacks — especially a lack of antioxidants, vitamins C and E, iron, zinc, selenium, and omega-3 fatty acids. It's theorized that a lack of these vital nutrients contributes to oxidative stress and impaired neurotransmitter function, which can result in mental health issues.

Hormonal Issues

Some hormonal issues, such as hyperthyroidism or Graves' disease, can mimic panic attacks, causing insomnia, heartbeat irregularities, anxiety, and sweating. Others, like adrenal issues or Cushing's syndrome, manifest as weight gain, sleep issues, immune system concerns, and more and can be misinterpreted as panic attacks. People who experience the cycling of progesterone and estrogen during the menstrual cycle may also notice their panic attacks are tied to hormone fluctuations.

Neurotransmitter Imbalances

Neurotransmitters help neurons communicate using chemical messages to transfer information. Some neurotransmitters involved in panic disorder include serotonin, norepinephrine, and GABA. People with panic disorder have decreased levels of the calming neurotransmitter GABA in their anterior cingulate cortex and medial prefrontal cortex - parts of the brain involved in estimating and responding to risk. SSRIs - which modulate serotonin receptor activity - are among the most effective pharmaceuticals for managing panic disorder.

Mineral Deficiencies

Deficiencies in minerals like iron can cause people to experience panic attacks more frequently than those who are not anemic. People with panic disorder are more likely to be zinc deficient than those without it.

Environmental Factors

Exposure to select substances may worsen panic attacks. For example, substance abuse, ingesting caffeine at a level of five or more cups of coffee a day, or other stimulants can trigger or worsen panic attacks. Heavy metal exposures have also been associated with an increased risk of panic disorders.

Trauma

Our brains are wired to remember scary or frightening events so that we can protect ourselves from similar harm in the future. Sometimes, these memories can trigger sympathetic nervous system responses that aren't helpful once the danger has passed. Panic attacks can co-occur with PTSD symptoms like flashbacks and can be treated using similar approaches.

Functional Medicine Labs to Test for Root Causes of Panic Attacks

Your practitioner will evaluate your individual situation and then recommend tests to get to the root cause of your panic attacks. Depending on your history and symptoms, you may be tested for the following:

Nutrient Deficiencies

Testing for nutrient deficiencies can include at-home blood spot tests or blood draws at a local lab to delve into nutrients, micronutrients, and other biomarkers.

Hormonal Issues

Comprehensive hormone panels can assess the fluctuations of progesterone, testosterone, DHEA, cortisol, and estrogen throughout the month using saliva and urine. Snapshots of hormone levels can also be assessed using a blood draw. Your practitioner may also seek a complete picture of your thyroid function by testing for TSH, Free T4, Free T3, and Reverse T3.

Neurotransmitter Imbalance

To help provide a complete picture of your unique metabolism of the inhibitory, excitatory, and other neurotransmitters, your practitioner can use a urine test or order a test to measure neurotransmitter metabolites to understand how your body is processing the neurotransmitters.

Lifestyle Factors

In order to see if environmental or lifestyle factors are contributing to your panic attacks, your practitioner will sit down with you to do a deep dive into your general and psychological health. Follow-up tests may include substance screening to see if intervention recommendations are warranted or testing for toxins like heavy metals, which can impact mental health.

Additional Labs to Check

You've likely had a CBC (complete blood count) and CMP (complete metabolic panel) at your yearly check-up; if not, your practitioner will order those, as well, to check for underlying medical conditions. In some cases, based on your history and symptoms, additional recommendations might include a cardiac health panel along with an electrocardiogram (ECG or EKG) to measure heart health and to rule that out as a reason for panic attack-like symptoms.

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Conventional Treatment for Panic Disorders

Many people begin healing with psychotherapy and medications, which are the conventional treatments for panic attacks. These methods can be extremely helpful for many.

Psychotherapy

There are multiple types of psychotherapy that can help people conquer panic attacks and take back their lives. Cognitive-behavioral therapy (CBT) has been shown to reduce or eliminate panic attacks effectively. It allows individuals to identify and change negative thought patterns and behaviors. Additionally, Exposure Therapy — gradually exposing people to situations that make them fearful while supporting the client with therapeutic companionship, tools, and more — can also help reduce panic attacks. Eye-movement desensitization reprocessing therapy (also known as EMDR) has recently been shown to be as effective as CBT in reducing panic attacks. EMDR involves using eye movements, grounding techniques, and alternating sensations or movements to help the brain disconnect the trigger for emotional responses to thoughts and memories.

Medications for Panic Disorders

Sometimes, medications are prescribed to help reduce the frequency and severity of panic attacks. Antidepressants like selective serotonin reuptake inhibitors (SSRIs) and benzodiazepines work by regulating neurotransmitters serotonin and GABA in the brain. SSRIs are used daily, while certain medications like benzodiazepines can be used as needed for preventing or treating panic attacks.

Functional Medicine Treatment to Manage Panic Disorders Naturally

Using a root cause approach, your practitioner can work with you on effective treatment options to resolve panic disorders — sometimes along with conventional treatments. Some people wonder if functional medicine treatments can be used instead of pharmaceuticals. For many people, they're safe and effective protocols. For others, they're a great addition to their treatment plan. Armed with the information from functional and conventional tests, your practitioner will design an individualized plan that might include a functional medicine approach alone or one that works alongside medications and therapy.

Nutrition to Reduce Anxiety and Panic Attacks

Whole foods diets like the Mediterranean diet are shown to improve mental health conditions in general, including anxiety, and may benefit people with panic disorder. Making the switch to an anti-inflammatory diet can sound intimidating, but it doesn't have to be hard. It can be easy, fun, and delicious if you follow the tips in this awesome article on the Mediterranean diet.

A trained practitioner can review your test results to design a customized food-as-medicine meal plan to replete micronutrient deficiencies that may be contributing to panic disorder. This might include increasing sources of nutrients like iron, omega-3s, or zinc, depending on what your current diet lacks.

Supplements and Herbs to Help With Anxiety

In some cases, targeted nutrition supplements may also be part of a nutrition strategy.

Inositol

Inositol, for example, is a nutrient that is effective for reducing panic attacks when used consistently for over a month.

Omega-3s

Omega-3s - a type of fatty acid usually derived from fish, walnuts, chia seeds, or flax seeds - can help improve anxiety when taken at doses of 2000mg per day.

Magnesium

Magnesium has been shown to benefit mild anxiety and stress-associated mood disorders, especially when combined with vitamin B6.

Passionflower

Passionflower appeared in one study to be as effective at reducing anxiety symptoms as pharmaceutical benzodiazepines. Please work with your practitioner before swapping out any medications for herbs, as it may not be appropriate in all cases.

Kava

Kava root has been used for centuries to reduce anxiety and may relieve anxiety symptoms without the side effects typical of many anxiety medications, like fatigue. It can cause liver damage if used in excessive amounts long-term and is not safe for people with compromised liver function.

Lavender

Lavender oil is as effective at reducing anxiety as the popular benzodiazepine Ativan. Please do not attempt to swap out any medications for herbs without the assistance of your practitioner, as it may not be appropriate for everyone.

Ashwagandha

Ashwagandha was found in a 2022 systematic review to significantly reduce anxiety and perceived stress at doses between 300mg and 12,000mg per day. Individual dosing will depend on your unique physiology and needs.

Hormone Optimization

Your practitioner may recommend hormone replacement or develop a protocol to increase normal hormone production using a combination of lifestyle, nutrients, and supplements. In some cases, your practitioner may refer you to an endocrinologist if your issue is hormonal in order to develop an integrative plan that includes hormone replacement.

Neurotransmitter Optimization

Researchers have found that improved sleep and stress management, and supplementation with omega-3 fatty acids, vitamins C and B12, folic acid, zinc, magnesium, and CoQ10, can help to reduce oxidative stress and optimize levels of GABA, serotonin, and dopamine, with beneficial effects on mental health.

Minerals and Heavy Metals

Your practitioner may recommend calcium, zinc, magnesium, or other supplements based on your specific needs. If heavy metals are present, your practitioner may use a chelation agent supplemented with antioxidants during the detox process. Antioxidants like glutathione and ALA can support the body as it eliminates heavy metals.

Lifestyle Modifications

In situations where substance abuse or lifestyle causes such as excessive caffeine are identified as factors in panic attacks, functional practitioners will work with conventional practitioners to seek the most effective ways for people to withdraw from these behaviors and embrace a healthier lifestyle. This could include a combination of a targeted whole foods diet plus CBT, inpatient therapy, partial hospitalization, or other counseling.

Complementary and Alternative Medicine for Panic Disorders

Below are some of the most beneficial complementary and alternative medicine therapies for reducing panic disorders.

HRV Biofeedback

Biofeedback is a type of therapy that incorporates measurements of vitals to help people become aware of internalized stress and effective methods for controlling it. During a biofeedback session, a client will work with a practitioner to measure heart rate variability, breathing, and sweat rate. They then learn and practice breathing and mindfulness techniques that allow them to control their physiology and feel calm on demand. One example of an effective biofeedback intervention is resonant frequency (RF) paced breathing. This involves regulating breaths per minute for specified times throughout the day or at the onset of a panic attack to prevent it from escalating.

Mindfulness Practices

Yoga is effective for reducing anxiety and panic attacks and comes with major health benefits like increased flexibility and improved strength.

Acupuncture

Some studies show that acupuncture can reduce anxiety and improve mood, mediating the impact of panic attacks. It's a safe, effective CAM (complementary and alternative medicine) treatment with statistically significant effects.

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Summary

You and your loved ones can use an integrative medicine approach to effectively stop and heal panic attacks, including medications, mindfulness practices, nutrition, and more. You can read an example of how Mary healed her own panic attacks in just a few weeks using an integrative approach like the one outlined above.

‍Citations for this article can be found here.