The short version

My name is Kevin McMillan. I'm 29, I'm an insurance claims adjuster in Philadelphia, and I have panic disorder. On a Tuesday in March of 1995 I was stuck in traffic on the Schuylkill Expressway, and out of nowhere my heart started slamming, my chest got tight, my hands went numb and I was absolutely sure I was dying. I pulled onto the shoulder and a state trooper called an ambulance. At the hospital they ran every test there is. My heart was fine. Everything was fine. They told me it was probably a panic attack and sent me home. I felt humiliated.

Over the next six months I had more of them. I stopped driving on the expressway. Then I stopped going to the mall. Then I started making excuses about lunch with the guys from work. My world was getting smaller every week, and I didn't tell anybody, because how do you explain that you're scared of being scared?

That fall my family doctor put a name on it, and I got real help. Today I drive the Schuylkill to work every day (in traffic, like everybody else, cursing, like everybody else). I haven't had a full-blown attack in over a year. I still get anxious sometimes. I know what to do with it now.

I get a lot of e-mail, and the same questions come up, so the rest of this page is those questions and my honest answers. I'm not a doctor or a therapist. I'm just a guy who's been there.

Questions people ask me

Q: What exactly IS a panic attack?
It's a sudden wave of intense fear that comes on fast, usually peaks within about ten minutes, and then fades. It comes with physical symptoms that feel very real, because they ARE real: pounding heart, sweating, shaking, feeling short of breath, chest tightness, dizziness, nausea, tingling or numbness, hot or cold flashes, feeling like things aren't real, and a feeling that you're losing control, going crazy or dying. Your body's alarm system is going off when there's no fire.

Q: How do I know it's panic and not my heart?
You don't, the first time, and you shouldn't guess. If you've never been checked out, or if something feels different from your usual attacks, get medical help. Call 911 or go to the emergency room. It is NEVER wrong to get checked. I've been to the ER three times for panic and I don't regret one of them. Once your doctor has checked you and knows what's going on, the two of you can talk about how to tell the difference in the future.

Q: Am I going crazy?
No. I asked my therapist this about fifty times. Panic disorder is a real, common, treatable condition. Millions of Americans have it. You are not crazy and you're not weak.

Q: What's panic disorder, then?
From what I understand, it's when you keep having panic attacks out of the blue and you start worrying all the time about having another one, or changing your life to avoid them. Some people start avoiding places where they'd feel trapped or embarrassed if an attack hit, like highways, stores, crowds or bridges. That's called agoraphobia, and it's where I was headed.

Q: Can it get better?
Yes. This is the most important thing on this page. Panic disorder is one of the most treatable problems there is. Most people get a lot better with the right help.

Q: What helped you?
In this order:

1. A full physical. My doctor checked my heart, my thyroid and some other things that can cause similar symptoms, so we knew for sure. That alone calmed me down a lot.
2. Therapy, specifically cognitive-behavioral therapy. My therapist taught me how panic works, how my scary thoughts ("I'm having a heart attack") were pouring gas on the fire, and how to answer them back. Then, very slowly, with her help, I started doing the things I'd been avoiding, one small step at a time. The first step was sitting in my parked car next to the on-ramp for ten minutes. It took four months to get to driving the whole Schuylkill at rush hour. Four months is nothing compared to the rest of my life.
3. Medication, for a while. My doctor prescribed a medication that helped take the edge off while I did the work in therapy. I took it for about two years and came off it slowly, with my doctor. I'm not going to say which one, because that's between you and your doctor, and different things work for different people. Don't ever start or stop anything on your own.
4. Cutting way back on caffeine. I was drinking six cups a day. Caffeine can make the jittery feelings worse. Now I have one. It's a very good one.
5. Slow breathing. My therapist taught me to breathe slowly, low in my belly, instead of fast and high in my chest. It doesn't stop an attack like a light switch, but it helps me ride it out.
6. My fish tank. I'm serious. I have a 29-gallon tank with neon tetras in the living room, and ten minutes of watching them swim around is the calmest I ever feel. Find your fish tank, whatever it is.
7. Telling people. My wife Jen. My brother. Eventually my boss. Almost everybody was kinder than I expected. Two of them told me they'd had attacks too.

Q: What should I avoid?
Alcohol as a fix. It feels like it helps for an hour and then it makes everything worse. Trust me. Also, avoiding everything. Every time you skip something because of panic, the fear gets a little bigger. Every time you do something scary and live through it, it gets a little smaller.

Q: I'm scared to see a doctor about this.
I get it. I sat in the doctor's parking lot for fifteen minutes the first time. You can write down what's been happening and just hand them the paper if it's easier. Doctors see this all the time. You won't be the first person that week.

Where to find help

• Your family doctor, first.
• A psychologist, psychiatrist or therapist who treats anxiety disorders. Ask if they use cognitive-behavioral therapy.
• The Anxiety Disorders Association of America, which has information and can help you find therapists and support groups.
• The National Institute of Mental Health puts out free booklets about panic disorder.
• Your local mental health association or community mental health center, especially if money is tight. Many have a sliding scale.
• Support groups. Mine meets every other Monday in a hospital conference room. Sitting in a circle of people who all nod when you say "I thought I was dying in the frozen food aisle" is its own medicine.