I was making a distinction between a biological process, or a physiological process, and a psychological process
honestly I don't know what you're talking about. they're physiological, they aren't physiological, what are they?
If he doesn't have any history of mental illness besides these panic attacks, it tends to make me think that they are a physiological manifestation, which therapy would be useless for. Panic attacks are not solely caused by psychological trauma. And if these are indeed due to a physiological trigger, what else can you do but treat the symptoms. Also, even if he was to have a history of mental illness or some recent traumatic experience I still would recommend treating the symptoms as they appear, as psychotherapy tends to take a long while to provide any relief. Or if he were to choose to try a different pharmacotherapy such as TCAs or SSRIs, there's a significant delay between initiating treatment and realizing if they will provide any benefits, in which case benzodiazepines are again the golden standard.
I just realized that you might not know the sort of damage that recurrent panic attacks can effect on one's psyche. To say he should not take benzodiazepines as they can be addictive or possibly make you high, would be the same to say to a chronic pain patient with an unknown etiology that they shouldn't take painkillers because they're addictive and only palliative.
And another thing, these antiepileptics you mentioned are NOT indicated for panic disorder and while there is little anecdotal evidence that they might have some effect on anxiety, they also cause severe withdrawal symptoms similar to benzodiazepines.
Its all about weighing the pros and cons for the patient as an individual. While yes there are other non addictive treatments out there, which have a significantly lower success rate, if this man uses benzos under the supervision of a medical doctor, he should be fine. If it does so happen that he starts taking them more often then not, and for a prolonged period of time, his doctor should be able to set up a taper using something such as phenobarbital that will mitigate all signs of withdrawals.
Also I have a big problem with one of your statements, "If the question is Benzo. are good because they make you feel better than Cocaine and Opium are good too. " It seems you're implying that benzos can be used to get high, and that its likely this man will too, which is presumptuous and utterly wrong. Yes people do abuse them in an attempt at catching a buzz, when infact, benzos act in a way the reduces one's ability to feel high.
I think you should read some objective studies on benzodiazepines instead of relying on some media hype campaign on the internet.
if one had very high fever he might need to take Paracetamol but you can't think of Paracetamol as a therapy you need to find the origin of the fever.
treating the symptoms only in a possibly degenerative condition might be as smart as switching off the fire alarm without even checking where the fire is.
What's twisted with psychotropic drugs is that they are pushed as therapy when they are only palliative.
If the question is Benzo. are good because they make you feel better than Cocaine and Opium are good too.
they might be Godsend but they send you to hell.
The poster above me seems to be fear mongering. Benzodiazepines are one of the most effective treatments for panic attacks, and will not definitely make them worse. While i recommend not taking them all the time, taking one when you feel a panic attack coming on can give you a sense of control, and lessen the fear and discomfort associated with panic attacks. Please do not believe the previous poster because if you are having true panic attacks, benzos can be a godsend.
taking Benzodiazepines is part of your panic problem, not the solution. It is typical for a person who is moved by fear, to unintentionally get from worse to worst. Taking a tranquilizer is that type of move.
It will worsen your panic attacks in the long term, you can't take them all the time because you'll get addicted and you'll have a horrible time coming out of it. Look up Benzodiazepine withdrawal syndrome.
You won't die for high blood pressure or heart attack if you're generally healthy, regular ECG etc. the panic can worsen your high blood p. but the cause of it is somewhere else.
There are things that worsen your fear: poor information and maybe bad assistance. You probably don't trust too much your Doctor and you don't feel you're being looked after properly by someone.
Before taking any more tranquilizers you should talk to a specialist, there are some new anti-epileptic drugs that in high doses can work as mood stabilizers or sedative (Gabapentin).
You must get informed about what panic attack can cause so that when it happens you can manage it.
Increased heart beat - this is dangerous in a elder, cardiopathic person.
Hyperventilation - this is important because you'll get too much oxigen and feel like fainting and think you're dying. control your respiration.
Your adrenaline will be high, you need to walk to release it. don't stay still.
control your diet, panic attacks are easily caused by a lowering of blood sugars. keep some packed sugar with you all the time and eat it when you start feeling the symptoms. avoid coffee and stimulants.
Good Luck!