What dose of propanolol did you try? The GP can prescribe up to 40mg, three times per day for anxiety. Propanolol is a beta blocker - it interferes with the release of adrenaline.
I'm wondering if will help you to think about what is happening when you have a panic attack:
- Your physical symptoms of your panic attack is because your fight or flight mode has misfired and your brain has got the signal that you're in danger but you're not.
- Your body has released adrenaline. Adrenaline shuts down digestion and prioritises your heart and your muscles, so you're strong and you can run. You are breathing faster to try and get oxygen to your muscles.
- Unfortunately, when we breath rapidly, we exhale lots of carbon dioxide. That makes us feel panicky and light headed. Our brains then get confused and think that we need to breathe even more deeply and faster. It's a viscious circle.
- We feel unsafe because our heart is pounding, we feel light headed and we feel dizzy.
This circle goes around and around, and if it doesn't stop, sometimes people can pass out, which ironically, halts the circle because breathing returns to normal.
So propanolol can reduce the physical symptoms by reducing the adrenaline, but we can also tell our brains what's happening.
'Ah, that's the adrenaline. It's making my breathing too fast and that's why I'm feeling dizzy.'
The simplest solution is to have a paper bag with you. Clamp it around your mouth and breathe as slowly as you can into it. It will restore your carbon dioxide levels and reduce the dizziness and reduce your heart rate. Don't worry that you're breathing fast when you start. It's just the process.
Then you can do the 5 things: Look around you. Something you can see, something you can hear, something you can feel, something you can smell and something you can taste. Even if it's a metallic taste in your mouth. It's just bringing you back to reality.
Square breathing is good for controlling your breathing. Imagine a square. Breathe in as you trace up the left side of the square, breathe out as you trace along the top of the square, breathe in as you trace down the right hand side of the square, breathe out as you trace along the bottom of the square.
If you're having a panic attack by walking down the path, don't. Walk to the back door and just stand outside the back door for 30 seconds. Then a minute, then 5 minutes, then 10 minutes. Then, you can take two steps outside the back door, repeat. Then three. It's a 'how to boil a frog' situation. Frogs are cold blooded so if you put them in a pan of boiling water, they'd jump out. But if you put them in cold water and gradually turn up the heat, they don't notice and they'd stay there even though they were boiling. In the same way, you need to reassure your brain that it's ok, you're just standing outside the back door - how dangerous can that be?? Then you're just standing one step away. Then you're just standing two steps away, and one step was fine, wasn't it?
Phone/use the online form to the GP and say you can't leave the house but need a telephone call or a home visit. You need a medication review. Although think about the fact that if you managed A&E you possibly could manage the GP, even if you know it will give you an anxiety attack - that's quite useful for the GP, even if it's awful for you.
Hopefully the CBT will help. Do you know what has triggered this?