First of all, know that a person can have a "first" panic attack at any age, so there is nothing weird about yours hitting at age 32.
Second, please know that ONE panic attack does NOT mean you have an anxiety disorder.
I think the ER doc was correct to script you a low dose of Xanax for PRN (as needed) use. Also know that after a person experiences their first panic attack, they are, quite naturally, fearful of having another one. (They are VERY frightening, as you sadly found out)
I personally feel your PCP was overly hasty in putting you on Zoloft after ONE panic attack. I think he/she should have counseled you about anxiety disorders, and panic attacks specifically, then waited to see where this was going. Understanding not only the mechanics of anxiety and panic, but the various causes, can, and often does, go a very long way to prevent another episode.
I wish I had could explain what happened when you took your first 50mg dose of Zoloft and then, as you said, later that night, you took a .5mg of Xanax and ended up back in the ER with a massive panic attack. I've never heard of a reaction like that before.
We can NOT tell you to change the dosage of any medication. You must discuss that with your doctor and I don't advise doing it on your own.
In my humble and non-medical opinion, I would advise that you ask your doctor to take you off EVERYTHING! If you would feel "safer" having some Xanax on hand to be used "as needed," that might help calm you down, knowing you have something just in case.
I don't think 2 panic attacks warrants being put on an antidepressant. I don't think it warrants being put on a daily anti-anxiety med either.
That's MY opinion. I would suggest speaking with a therapist trained in anxiety disorders to help you figure out where these two attacks came from before the big pharmaceuticals are brought in. Again, that's just my opinion.
But if you can figure this out by talking with someone, you'd be saving yourself a nasty road you'll have to travel later.
As to your last question..........I can't possibly answer that as I have no way of knowing every single persons reaction to various drugs. We are all different and we all react differently. I CAN speak for myself..........I took Zoloft and Xanax together for several years and never had a problem. But that was ME.
I am not anti medication, but I DO believe too many doctors are in too big of a hurry to throw meds at us that we really don't need.....which then turns into a slippery slope.............my advice to you is to give this a little more time.
But, the bottom line is that you must do what you believe is the best for you.
I wish you the best
Dito on what RubyWitch has said...... I was on Zoloft and xanex for years and never had a problem but again we are all different... I know my primary started me on 25mg of zoloft and I went months on and off it because it made me feel awful, these drugs take time to work and we have to tell ourselves that...I would have days where I would need 3-6 mgs of xanex a day to get me through and then one day I just stopped taking the xanex and never needed it for years... Stay positive and talk with your primary...
This is in my opinion the problem in seeing a primary doc for mental issues -- the only thing primary docs are even remotely familiar with are drugs. I would think the first thing you'd want to do is see a psychologist and see if you can solve this without medication. It won't go anywhere. But as to the Zoloft, if you choose to go that way, yes, you can and most psychiatrists these days do taper you up on them slowly. But as ruby mentioned, only do this after consultation with a psychiatrist. And you've also discovered another problem with meds -- docs often won't tell you beforehand what the problems are, one being the difficulty in stopping them. I can tell you nobody ever told me. You unfortunately have to do some of your own homework with medication.