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Dad died in 2010 and mum's confidence took a dive. She had an isolated panic attack about 3 years ago, but since December 2014 (following a fall and hospitalization) they have become more frequent - several in the past few days. She is on low dose Citalopram which has helped with her general anxiety but done nothing for the PAs. I'm trying to be encouraging, but just don't know what to do when an attack strikes and am a bit concerned I'm making things worse. I was hoping someone else might have handled this.

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Citalopram (Celexa) is an antidepressant, not an anxiety medication. It can trigger manic episodes. If the primary problem is anxiety, an anxiolytic like Xanax, Ativan, Klonopin would be more appropriate. Ask the MD about an SNRI instead of an SSRI medication.
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Pam has said it all nothing to add, just stay close and hold her.
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Please have her evaluated by a geriatric psychiatrist, someone who knows her/his pharmacology, like Pam does. Write down the details of mom's Panic attacks and give them to the receptionist before mom's appointment.
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Some chemical food additives can cause panic attacks in some people. MSG is a common culprit.
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Exercise is good for a panic attack, but I realize that not all elderly and get up and dash about the house.

Panic attacks aren't easy to make disappear, I know because I have attacks while driving. Use to get similar attacks while waiting in line at a bank or grocery store but those eventually went away :)

Try to notice what happens just prior to a panic attack... what is the trigger and then work from there trying to ease the trigger. Distraction is great, but it has to be a strong enough distraction to make the mind shake loose that panic. For me, thunder storms while driving helps.
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Check into a natural remedy for this. Chamomile Tea and other teas offer a calming sensation without the side effects of drugs. Add coconut oil and organic olive oil to her diet. Olive oil has antioxidants and vitamins A and E. Coconut oil if taken orally either by itself or mixed in food helps with memory loss, anxiety and a hole host of other problems including digestive. Too many people want to opt for the drugs that only take care of the symptoms and not the actual cause.
Consult a holistic doctor and one who specializes in geriatrics.
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Thanks for all the advice. We went back to the GP for blood tests today. She has had an overactive thyroid in the past and was taken off her medication for that approx. 4 months ago. GP thinks that may have something to do with it. Will speak to GP about meds when the results come back. She has appalling balance due to an acoustic neuroma plus no feeling down her left side following a bleed on the brain 3+ years ago. She says she's frightened of "not making it' to where she's trying to get and falling. I can't tell her that this is an unrealistic fear, because it's not :-( We had a 're-enablement' worker in this morning, she was very calm but firm and mum seemed to respond to that. Perhaps it's an approach I have to learn, at the moment I'm like a fussing mother hen.
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In the book "Acupressure for Emotional Healing" by Michael Reed Gach there is a chapter on anxiety and panic attacks which gives illustrations of the points to apply pressure that will have an immediate affect. I was having a lot of anxiety the other night after an episode with my mom and I used this and it helped me tremendously and I was able to go back to sleep.
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Lizzie--
As a life long sufferer of panic attacks, large and small, I can tell you that they are as real and terrifying as anything a Dr, can physically see or test for.

Sounds like she may have some true medical reasons for having PA's. Nevertheless, they're real in the here and now. I myself take Klonipin, and it ALWAYS works for me, even tho I have taken it for years. I can calm down, think out a situation and decide if my anxiety is "legitimate" or "passing through". Sometimes we are anxious for truly serious reasons. Sounds like your mom legitimately feels scared, perhaps just that fear of falling, which is very real. Please don't tell an anxiety ridden person to "calm down" or " "you're being dramatic", b/c to us, it's as real as a heart attack. There are MANY meds she can use to calm her down. Maybe she will find chamomile tea to be calming, and that would be great.
I did try a LOT of holistic/natural remedies, but ended up just acknowledging that I am a panicky, anxious person by nature and gave in to the drug that I KNOW will help me. I'm not proud of it, but I am also no ashamed. I imagine I will be on Klonipin the rest of my life--and that's OK. Let your mom have peace of mind. (If she has trouble swallowing, I do know that Valium comes in a compounded ointment that can be massaged into the forearms. We gave that to daddy when he could no longer swallow and he was so anxiety ridden and miserable. Just wash the stuff off your hands afterwards (or don't, if you also want to calm down. I had more than one VERY peaceful afternoon with daddy as I'd apply the Valium compound to his arms and then rub the rest into my hands, as you do with excess lotion....no one told me to wash it off my hands...I can attest that it works great!
All the best--and yes, don't "cluck" at mom, that just makes anxiety worse. My DH will fuss at me and be so angry for MY anxiety it just makes me feel worse.
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Very sad and aside from everything else I'd like to see her get grief support. It's an idea and would be comforting. Grief counseling before medications I'd say
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You might not have known about it before but it is possible she's been having episodes most of her life. Citalopram will cause anxiety. It stimulates rather than calming down. Anxiety like this is caused by a chemical imbalance in the brain as are other mental disorders. Triggers can be environmental such as loud crowded locations, grief, perceived loss of sanity.
My own generalized anxiety disorder does not give any warning. Learn deep breathing exercises. Help her by coaching her through the timing of the inhales and exhales. Run cold water over the inside of her wrists(I don't know why it works but a psychologist taught me that). It helps me to go to a dimly lit,totally quiet place, and put my bare feet on a cool floor. Lying down in the cool grass in the shade. Perhaps feet on a cold compress, or bag ice wrapped in a pillow case. In my opinion, herbal teas take too long to affect change and they are not
effective because of the level of anxiety being experienced.
Anxiety you described is not what unaffected people think of as " nervousness" . it is far greater and a person really thinks they are literally dying. What I do is talk myself through it knowing I will come out the other end of it without dying just like the other times.
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My partner has Depression and he is prescribed Citalopram. But, I told the doctor it is not enough It is 40 mg. He explained sometimes another drug needs to be added. He added buPROPion HCL XL 150 mg. in the evening. I have normally given the evening drugs at bedtime. But, yesterday his depression popped up badly at mid evening. I gave him his drugs earlier than usual and it took care of the anger issues. I have always been one to back off of arguing with him. It goes nowhere. Last evening, I broke my rule and tried to explain to him what was REALLY going on. He got worse. Don't argue with them...It takes them to a place that is hard to come back from. God Bless
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What else is your mom suffering from? Sometimes, I believe the illness they have also brings on different physical and mental issues. I know with my Partner, he goes into accusations against me. As a young women, I had panic attacks and to this day I have no idea what brought them on. Something in my childhood...Who knows. I did think I was dying. They taught me to take a paper bag and hold it around my mouth and bring in and out my own breathing. It helped and I did not hyperventilate using the bag.
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I completely agree with the people who are saying this is a physiological problem with strong, high levels of anxiety needing to be treated with medication when the panic attack hits, or, preferably, when you or your Mom detect the symptoms of an oncoming panic attack. At these points, it's too late for tea or herbs, etc.

Finding a thyroid problem or any underlying problem is great and could be helpful, but as the panic attack starts, it it far too strong and too late to treat with anything but the appropriate amount of prescribed drug. Anyone who's had serious levels of anxiety will tell you this, and several have.

If your Mom can't talk herself through the attack, you can learn what to say to calm her and help her get through it. That's along with the medicine...an anti-anxiety medicine. It will help her quite a bit to hear your calm reassurance that "the medicine will soon take effect", that "this will soon be over", "help is coming, Mom" and so forth. You may not see the helpful effect of your words right away, but eventually you should be able to. You can also help her to slow down the rate of her breathing when possible, by counting with her: In..2...3...out ..2..3...pace her a little slower than where she is to gradually slow her down when she's able. If she's not ready for that, drop it for a little while and come back to it. You can substitute words for numbers: (in).I...will...be.(out)OK..I...will..You decide the frequency of the "in" & "out". Or just have her say the words with you for comfort to get through the worst of the panic.
These are ideas for you to consider and alter as you see best.
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Midkid, you are so right about telling someone to calm down. My sig other will say to me "just relax".... GRRRRRR.... those are fighting words whenever he uses them. He never had a panic attack so he has zero understanding about what is happening.

I'll make note about Klonipin and ask my primary doctor about that. Right now I use Librium which can take the edge off but doesn't help me much when I panic while driving :(
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FF I get panicky driving at times and if it gets too bad find somewhere hopefully populated and get out of the car for a few minutes. Get a cup of whatever you prefer but with sugar or add a sweet snack. Keep away from the caffiene and make sure your bladder is empty. If you are driving the parent is their tank map out places on the route to stop. "Sorry Mom and Dad I need to run into the hardware store I need a box of?"You two stay in the car I will only be a couple of minutes. Hop out before Dad can follow you. Get in the store take a cart to lean on and find a display and just stand there concentrating on deep breathing. You don't need to buy anything just walk purposely back to the car and if Dad escaped tell him firmly you will never take him out again if he does that. Always allow extra time when going to appointments. Give them any excuse you can think of ie road works. Hope that may help. just tell SO to lay off and find a quiet place till it passes or the pills kick in. You can't just relax but you may be able to if you can sit somewhere quiet and gradually relax from the tips of your toes to the top of your head. (You really do need that recliner)
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Since her anxiety attacks escalated after the onset of her falls - her fear appears to be real. You also indicated in a later post - that she has 'balance issues'. Even more reason for her to be concerned about mobility. Does she have access to, or use a walker? Maybe installing some grab bars in difficult spaces?
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Panic attacks are a whole new area for me. Mom's in rehab therapy right now and although she's progressed in some ways, whenever she's asked to get out of bed she freaks and the BP and heart rate goes through the roof. Totally new thing for her too, until a few weeks ago she was not a very anxious person at all. I've finally gotten some actual healthcare professionals to take this seriously and she's scheduled to see a mental health specialist to see if we can find a way to break through and ease them to a manageable degree. I'll be happy to share if and when we make any progress! Good luck!
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I guess saying more on this subject may be useless...but panic attacks of the nature you describe in your mother--and seemingly her inability to deal with them (she sounds as if she has some dementia, perhaps--definitely some other health issues) makes me stick to my belief that a good antianxiety med is in order. Trying to tell my mom to "count down" or "calm down" or ANYTHING is useless. It would be (and was) useless for the kind of panic attacks I get where I truly think I'm having a heart attack. Many times I DO just "deal" with it...and I have learned many coping mechanisms, so the Klonipin is NOT necessarily the first go-to--but in many elderly people, they cannot always "voice" the underlying causation and every emotion that's uncomfortable (fear of falling) becomes panic to them. They are truly miserable. My own hubby was of the "oh just calm down" vein, until he experienced several PA's of his own that all landed him in the ER. EVERY TIME it was dxed as a panic attack. A dose of Valium or some other benzo and several thousand $$ worth of tests and the result was he was having panic attacks. He now takes mine a lot more seriously. I would explore the antianxiety med and also look into ways to actually MAKE her feel safer. Also, for some people, the fear of dying (which of course is very real, as we age) can cause HUGE panic issues.
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My mother used to have terrible panic attacks, mostly in the middle of the night or early morning. They were so bad she would sometimes throw up and often defecate in the bed. She would call my sister two or three times a week and off they would go to the ER, only to discharge her a few hours later. The doctor prescribed clonzapam before bed and that seemed to help. Also told her to take one if she started to feel one coming on. They started because her husband was a domineering mysogynist who used to tell her she was having a heart attack and force nitro down her throat - when he was the one causing it. When he died, they escalated. This went on for several years until we moved her to AL. She had two attacks over a period of a year, both times they put her in an ambulance and she went alone to the hospital, and then had to take a taxi home. Amazingly, she never had another one. I think the key is to get control of the attacks with some meds, and then help her to learn to cope with one before it starts - there are signs they can recognize and then be able to control - even with some psychiatric counseling.
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Yes--AmyGrace, you made my point better than I did. Clonazepam is Klonipin..generic name for it.

And yes, it would be wonderful to live PA free. I don't know that I will ever be there.
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Please don't let this continue on. It's is terrifying to have panick attacks and they only snowball once they get started. Take her and get her on clonipin and paxil.
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Thank you to everyone for your posts. Blood results all came back normal. So no answers there. Mum's health not bad really for 86. She has an acoustic neuroma, so no sense of balance and can't feel her left side. We have frames, rollator and grab rails around the house. For the most part she is OK indoors, but frightened of going out to her usual activities. She has just had a rough night, and I think it's anxiety over going to a lunch club today.
I'm going to speak to her GP again today and see if he will change her medication, when I saw him on Monday he was talking about trying something else.
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Good idea to speak to the GP. Your Mum has a very realistic fear to hear this description. God bless her and you.
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Pray with her...she knows the end is near & she is afraid!
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The problem with treating anxiety and panic is that they no longer prescribe xanax and it's being phased out. They will replace that with Klonopin but that too is being phased out. These medications also require monthly Dr appts, like the pain meds. Very inconvenient and nearly impossible for most disabled seniors.
I have no clue as to what a geriatric psych doc can do with these medications no longer available. :(
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Grace27,
I'm on clonazepam/Klonopin and see my Dr. every 3 months. I have no problem getting my prescription refilled by phone. I know other family members who haven't had trouble here in FL. Could the problem be in your area? Possibly different restrictions where you live? Klonopin & xanax are lowly schedule IV drugs and don't require monthly app'ts.
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I suffered with Panic attacks years ago. I know how mine was successfully treated, but I don't know that would work for a senior in her 80's.

I will say that my cousin, who is 63, and suffered from extreme anxiety and dementia was placed on Cymbalta. It is for depression and generalized anxiety disorder. It has changed her life. She no longer is anxious and she appears content most of the time. I'm not sure if your mom has tried that one or not.

When I was diagnosed with anxiety attacks, I was in my 30's. Once I found out what there were, I read everything I could get my hands on and educated myself about them. I also carried a .25 Xanax to take if I felt one coming on. I only had to take it a couple of times. Then I was able to calm myself, telling myself what was happening. Eventually, I didn't have anymore.

They are very real and terrifying. I would not stop until I was sure my mom had relief. With me, just knowing that I had a pill that would stop it, helped me conquer it. Later, you don't even need to have the pills in your purse anymore.
It is individual and that was my experience.
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I have no problem getting my Klonipin with a twice yearly visit with my Psych doc., and I have not heard that it is being phased out, nor that Xanax is being phased out. Valium has been around for 60+ years. Other drugs are always being developed, but I think that the tried and trues and always going to be with us. Yep, Benzos are not under the scrutiny that the narcotic drugs are under---as far as the OP, I do wish you luck in finding something for you mom. Being anxious over even possibly "pleasant events" is real and uncomfortable. Just being aware of the person suffering anxiety, VALIDATING that it is "REAL" and not just in your head..is helpful., I know when my hubby tells me to calm down and get a grip, I will inevitably feel much worse. Your mom's anxiety is a real as a sore throat or headache. Keep on trying to find a good drug match for her. Benzodiazepenes work almost immediately, but also "leave" fairly quickly. antidepressants take time, esp when working with anxiety--you may need to try a few different ones for your mom to find the right mix. Sounds like you are taking good care of her and keeping her safe.
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My panic attacks were from real or perceived rejection. My sister said to always call someone once this happened. For example, even if someone hurt my feelings. Panic attack averted! Glad sis was there, or a friend.
Today, I just repeat "Nothing bad is happening now", if that should happen, and it rarely does anymore.
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