My mom has anxiety attacks that come on unprovoked out of nowhere, but the doctor wants to keep her off medication. What can we do?

I've been thinking about this for the last hour. This is my personal opinion, and not meant as advice.

If I make it into my 90s I think my goal will be to have the chance to be content, to be comfortable, and as pain-free as possible. If I had the choice between living with some symptom that reduced my comfort and prevented me from being content or taking some pill that would remove the discomfort but put me at risk for dying sooner with liver problems, I would take the pill. What is the point of ensuring a longer miserable life? I hope at that point in my life I have a doctor who listens to elderly patients!

I typed my answer about this doctor being clueless and cruel early this am and had to leave for work. Let me expand upon that comment with my personal experiences.

My mom started developing serious anxiety issues and panic attacks back in late 2009, after a couple of episodes of extremely high blood pressure (EMTs recorded 260/118). All of a sudden, every little thing set mom off; storms, a future holiday, needing to take a car service to a dentist appointment. A limousine ride (a treat given to her by my SIL) to visit her elderly sister was "harrowing". While my mom was never the calmest person on the planet, this was a new experience for us.

We tried EVERYTHING! Explaining, reasoning, calming music, aromatherapy. Having aides stay with her 24/7. NOTHING worked.

My brother referred to all this as "stuff mom is doing to herself".

Mom's doctor had her on a low, PRN dose of Xanax which she hadn't used much. Now, even taken every day in wasn't making a dent. After two successive days of "emergencies" I took her to the doctor, who prescribed Zoloft. That made her suicidal after one pill (I swear, she read the package insert).

So on the third day (racing from work in the far reaches of Brooklyn to Westchester) I said enough is enough and we installed mom, first in AL and then in Independent Living.

There she was seen by a lovely on-site doctor, who gave her his cell phone number (that went a long way to calming mom down, but there was still underlying panic about a lot of other issues). He referred her to the visiting geriatric psychiatrist, who switched her to klonopin. Doctor called me after about 2 months and said:

"Barbara, you need to get your mom in for a neurocognitive evaluation to investigate her anxiety. I really want this worked up in the proper way so we can make a good treatment plan."

Cognitive? Mom? Mom was sharp as a tack!

Took mom for the two session, 6 hour testing. MRI, psychiatric visit, etc.

Mom had Mild Cognitive Impairment. She'd had a previously undiagnosed stroke which had essentially robbed her of her ability to prioritize, to reason and to see consequences (I'd be anxious too!)

Finding this out made the psychiatrist more comfortable with treating mom's anxiety with regular doses of Klonopin. Keeping her calm helped with the blood pressure as well.

Sometimes there is an underlying physical reason for anxiety. It pays to investigate.

Later, mom had a big stroke, which took out most of her language centers.  It also broke her brain in such a way that she was diagnosed with Vascular Dementia.  This led to MORE anxiety.  A cocktail of antidepressants and Klonopin got her through the last several years in a mostly non agitated state.

I refused to allow my mom to be in pain, psychic or physical.  She didn't deserve that at the end of her life.  Like Jeanne, I understand that there is a risk/benefit analysis to be made, but allowing demented elders to be panicked and anxious when there is a relatively easy fix is cruel. 

I can't imagine a doctor worth his oath not wanting to help anyone who is having anxiety attacks. I e had them. They come out of nowhere and are very traumatic. If there is a medication or meds she can take, why wouldn't the doctor prescribe them. Does she have any other health issues that would prevent her from taking these meds? Is she living at home or in a facility? My mom's nursing home tried several different meds when she became delusional and combative. She entered the facility when she was your mom's age. I think I might make an appointment with your mom's doctor and find out what his reasons are for not prescribing meds for her.

This is interesting to me. My mother has "panic attacks" (her term). She can't make herself move forward. One time she was trapped in her bathroom, gripping the handles of her rollator, until she finally lowered herself to the floor and crawled into her bedroom to the phone. She didn't even want to tell the doctor, but I was there and told the doctor at a regular appointment the next week.

I said the neurologist had noted that my mother had a lot of anxieties and that there were meds to help with that. The doctor (PCP) said she did not like to put her older patients on those kinds of meds.

Great...just great. My mother would refuse seeing a geriatic psychiatrist. She refuses to see that neurologist again, too.

My mother no longer even allows me into doctor visits with her, because she doesn't like them talking to me and not her. She's 91, with very poor balance, poor hearing, neuropathy in her feet, atrial fibrillation, only has eyesight in one eye...and she lives alone. Won't hire someone to clean or someone to monitor her when she showers (she's mentioned that stepping out of the bathroom is a problem, since she can't feel her feet very well).

And so it goes....she's "independent," dontcha know!

Unless he happens to have witnessed one, the OP's mother's doctor may not appreciate the impact that her anxiety attacks are having on her quality of life and the OP's ability to provide good care. See if you can get one on camera, maybe, or at least document them in detail. Then, if the doctor is still against medication (he may have very sound clinical reasons, we don't know), ask what he can suggest instead to alleviate the problem.

I agree that the Dr. has dropped the ball on this one. Your mom is 92 years old, not some teenager who is drug seeking. At her age she should have some peace and if she can't achieve that organically then her Dr. should prescribe anti-anxiety medication. Is the Dr. worried about your mom getting addicted? At 92??

However, if your mom lives alone I might be able to understand if the Dr. has concerns about her taking anti-anxiety medication while alone at her age.

I agree with Hugemom. Maybe make an appointment for your mom with her Dr. and go with her to advocate on her behalf.

I've had panic attacks my whole life. Didn't start treating them until I was 40. What a difference a tiny green pill makes in my life.

I have long since come to terms with the fact I am in fact, addicted to benzodiazepenes...and that's NOT the worst thing that can happen. My psych dc monitors me and it's just something that I have to deal with.

If your mother's clueless doc is letting her suffer needlessly, then fire him! Find a doc with some compassion and help mother. At 92, she isn't going to become addicted and if she does, so what? IS that going to be the primary thing that everyone talks about at her funeral? That she died addicted to valium?


Sorry to come of angry, but this kind of "lack of care" just boils me. Just b/c someone is "elderly" they suddenly can't have/do/be something--everyone is individual. Panic attacks are horrible--they can go on for DAYS and you want to scream, cry and throw things the whole time.

Poor mom. And those aren't coming out of "nowhere" they could be coming from a tired, dying brain. Point it, they are miserable. Until my hubby had a couple, he just thought I was nuts and should "man up" thru them.

How cruel and clueless her doctor sounds.

Cam you involve a geriatric psychiatrist in her care? My mom found relief from her panic, anxiety and dread with a combination of Remeron, Lexapro and a very low dose of klonopin.

The doctors at the VA were the same way with my Dad

They told me that the liver cannot sustain the drug damage at their age. With diminished liver function from a long life of prescription drugs...the risks are much much greater than for a younger person.

There comes a time when the risk/benefit equation is harder and harder to balance. Doc didn't want to come down on the wrong side of that

Doctors should certainly weigh the risks versus benefits. In this case it sounds like the doctor isn't fully considering the benefits of not having panic attacks.

A second opinion from a geriatric psychiatrist would be a wonderful next step.