Letter From the bcalm inventor

Dear Sir/Ma’am

You don’t know me. I am a 69 year old psychiatrist with a burning passion for helping those with anxiety. I enjoyed your news commentary on anxiety.

More attention needs to be paid to this.

People trivialize anxiety.  For example, most people would guess, without any hesitation, that the leading cause of suicide attempts is depression. Wrong.

Poorly treated, or wrongly treated, panic disorder has the highest suicide attempt rate of all psychiatric disorders, 20%!(reference Myna Weissman MD, Amer Journ Psychiatry)

I want you to know about an important, completely new, medical device named Bcalm. Despite inventing it, I have made efforts early on to divest myself of nearly all profits that would possibly come of it. So, my passion about this device is not money. It is that I want it to help people with anxiety.

I worked on this for 42 years, with no grants or corporate financing. I did it out of my pocket in my spare time after work nights and weekends.

Let me recount a story. I had a new patient 6 weeks ago that came to see me for panic attacks. She was 27, the peak age for panic disorder to begin. When she sat down I said cheerfully, “What may I help you with?”

She burst into tears. She was crying as hard as a woman can cry, trying hard to answer my question. She was having a very, very severe panic attack that rapidly had reached peak intensity. I put up my hand and told her not to try to talk. I could not understand her words because she was crying so hard. I asked her to not try to talk and to rest. “We have an hour and a half. There is no hurry.” I gave her a Bcalm, “Here, breathe through this. It may help your panic attack.” I picked up a Bcalm and demonstrated how to hold it and modeled for her to breathe in and out through it as normally as her body instinctively wish to do. I was going to breathe 10 breath cycles. However, at eight breaths, she removed the Bcalm from her lips. I mistakenly assumed that meant it failed to help her; and she was giving up. I thought, “Shoot, she’s one of those that it does not help,” and I felt very sorry for her.

But, when she pulled it away from her face, I saw her facial expression was normalized. Her face was not in contorted agony and suffering and in fear. She was staring at the device, and said, “THAT’S magical!”

That was the first time I have seen the device used in a severest level panic attack, despite working on it all these four decades. It amazed even me. There exists nothing else save an intravenous bolus of  a benzodiazepine, that can reverse a full blown panic attack to zero in the time it takes to breath 6 or 7 breaths (20 seconds). And without medicine or CBT.

The three medicines I use to block panic attacks are antidepressants (except Wellbutrin, it makes them worse.), high potency benzodiazepines (Xanax, Ativan, Klonopin). and MAOI (monoamine oxidase inhibitors best one is Nardil).

CBT is used also, but it works best in milder cases. In fact it may not work at all in the same population that the medication works well in. To demonstrate one problem with CBT theories working as well as medication in all panic disorder persons: CBT devotees believe that panic attacks are caused by catastrophic fearful thoughts. The mechanism of CBT is to persuade the patient to think calm thoughts which will stop the panic attack.

I will have to call BS on that, as the young people now say. The NIMH did a study on persons with panic disorder who awaken from sleep with a panic attack. Now, how much more calm could you possibly be than to be asleep? The CBT camp counters that the person who awakens in a panic attack probably had a nightmare that scared them into the panic attack by thinking, dreaming, fearful things. The NIMH did EEG monitoring of patients known to have nocturnal panic attacks. When you sleep, you go from awake down to stage I, then stage II, then stage III, the stage IV, then you cycle up from that deepest stage of sleep to III, II, I, and then you dream in REM stage of sleep. These panic disorder persons awakened with panic attacks in stage III and IV sleep. Not in REM sleep, where dreams occur.

So the CBT premise of relaxing does not hold water. Don’t think I don’t value CBT. It is wonderful for depression, other forms of anxiety, and temper problems.

Another negating fact, of fearful thinking being the root of panic attacks, is that we can trigger classic panic attacks in 90% of these persons by giving them a 550 millimolar concentration solution of sodium lactate. I have done this. And yet the same infusion does nothing to non panic disorder persons. The attacks can also be triggered in,these  persons by giving them fresh air to breathe to which is added 5% CO2(carbon dioxide). Non panic disorder persons  do not react to this provocation to have panic attacks. Injections of adrenalin also, preferentially, trigger panic attacks in persons with panic disorder; but the shots don’t trigger panic attacks in normal persons. Finally, neither normal persons nor panic disorder persons had panic attacks in any of these studies from placebos that were given, which demonstrates the panic disorder group are not Nervous Nellies. These studies demonstrate that there is something PHYSICALLY DIFFERENT between the body of the person with panic disorder and the normal person.

There are 5 other equally compelling evidences of this contention, like age of onset data, and so on.

Well, Abraham Lincoln would be very annoyed at my failure to be brief.

I hope you do check it out and suggest it to any of your family or friends who suffer from panic attacks. My dream would be that you would write a favorable medical article about it. That would definitely save lives and reduce some drug and alcohol abuse.

Thank you for your patient reading.

Kindest regards,

Stephen M Cox MD

3135 Custer Drive
Lexington KY 40502

National Anxiety Foundation, Pres.