Dr. Amy Nett: OK, so this is a patient who might not have supplements handy, but they do have anxiety and I’m not able to see them while they’re going through that panic attack. Great question. My favorite approach for when people are having a panic attack … Mind you, this is so difficult. If you’re going through a panic attack and you’re pretty convinced that you’re going to die, it’s hard to do anything, but I tend to use a breathing exercise with patients. It’s very straightforward. It’s having people breathe in on four counts, hold their breath for four counts, and breathe out for four counts. This is something that I feel like most people are able to do even in that very scary feeling of having a panic attack. Sometimes when people are in my office, I just practice this with them. I just have them sit there and I say, OK, breathe in. One, two, three, four. Hold your breath. One, two, three, four. And exhale, two, three, four. And I have patients practice it. I normally recommend patients do a parasympathetic nervous system practice. It’s something I talk about at just about every case review appointment. I give them resources for guided meditations, body scan, something like that, and I generally recommend for something like that, you want to practice it at home. Have your patients practice it at home so that when they’re in the moment of having a panic attack, it’s a very easy, familiar practice because you don’t want to be doing something new for the first time in the middle of a panic attack. I’ve found that that breathing exercise seems to be one of the more helpful because the counting gives you something to do and then it also helps to regulate your breathing. I would try that one, but I don’t know if other people have other suggestions that they want to post on the Facebook group.
Then the other part of that question that’s being asked is, “What supplements could one keep on hand for acute attacks?” Yeah, aside from benzodiazepines, I’m guessing. Depending on the severity of the panic attacks, I don’t do it frequently, but I do occasionally use Xanax, a benzodiazepine. It depends on the severity of the panic attack, but that’s always something you could talk to your patients about. It is an option, so keep that in mind. If the panic attacks are pretty significant, if they can be debilitating, especially if people are ending up in the urgent care department or hospital because of their panic attacks, just think about doing a low dose.
If you want an herbal supplement, are you thinking about a supplement maybe with depression, or is it really just anxiety and sort of feeling overwhelmed? “Mostly just anxiety.” OK. Mostly for anxiety, I would probably think about Relora. That’s one of the ones I like, Relora. I believe that contains two different herbs. One of them is magnolia bark. You could do Relora. Pure Encapsulations has some Relora. And the other one I might do would be Kavinace, which helps to increase GABA and, to a lesser extent, I think, also serotonin. NeuroScience is the brand that makes Kavinace. Kavinace, you can take up to six capsules daily. I often use it mostly for sleeping, but I also tell people you can take it throughout the day. You can take two capsules midday, two capsules later. If you’re having panic, start with two capsules of the Kavinace.
Depending, again, on how frequently the anxiety and the panic attacks are sort of coming about, think about a CBD oil. I really like … Well, I don’t know if I should say “really like,” but I’m starting to use with more patients the Ojai Energetics Super CBD Oil. It’s not inexpensive. It’s a little less expensive than going to the emergency room with a panic attack, but I think it’s about $70 a bottle, and a bottle probably lasts maybe 30 days, the Ojai Energetics Super CBD Oil. You start with taking it twice a day, and then you decrease to just once per day, generally before bed. That’s had a really calming effect on some of my patients. To a large extent, what it’s doing is decreasing the inflammation, so CBD oil if there are fairly frequent panic attacks.
The dosing and timing for Relora by Pure Encapsulations, take that one as instructed on the bottle.
Then CBD oil, for that one, if you can, follow up on the Facebook page. I’m thinking it’s, like, take one and a half dropperfuls twice a day for the first two weeks and then just before bed for the next week. Follow up on that one for a little bit more.