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Panic attacks at evenings

My brother is having panic attacks im evening since few months. It all started after sudden demise of our dad due to cardiac arrest a year ago, before that he had milder anxiety attacks few years ago which went away after few days. He is 38 and has no other health issues. The panic attacks are quite severe in his cases and thrice we had to take him to hospital to rule out heart attack. We visited a cardioloigist as well and he ruled out any heart related issue after looking at his reports. My brothers blood pressure rises whenever he feels anxious and during panic attack it reached upto 150.
He feels helpless and is unable to do anything with feeling of impending doom. It usually happens between 6-8pm. After few months of psychatric medicines (anti depressents) he was feeling ok and anxiety was managable but the attacks started again as he stopped medication. We are not sure what diagnosis should be done further and how to get rid of this issue completely. Is it completely pschological issue or may be a physical issue as well. Please advise.
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Avatar universal
Anxiety can be a physiological issue, yes.  Many things can cause what seem to be panic attacks, including blood sugar problems, thyroid problems, and other things.  But if this was something he went through before and it started when your Dad died, then that's probably the catalyst and what he needs to work on.  For that, he'll need to see a psychologist for therapy to learn why he has become so insecure.  Losing a parent affects people very differently, but this appears to be how it affected your brother and he needs to learn why.  You also say he was using meds and they worked but he stopped them.  Did he stop them abruptly, or did he taper off of them as slowly as necessary to prevent withdrawal?  Stopping medication too quickly for a particular person can also cause anxiety attacks.  It is curious it happens only at a particular time of day.  Is that the time of day your Dad died?  Why only then?  These are things medication can treat symptomatically, but can't fix permanently.  But therapy might.  In the meantime, if life is not liveable, it is sometimes necessary to take medication to get back to balance, but again, no, there is no medication yet found that permanently fixes emotional problems if that's what this is because science doesn't yet know what or even whether something within the body goes wrong that causes this and if so what it is that's gone wrong.  So the best we can do with meds is tamp down the symptoms.  For many, that's the best that can be done.  But if you know the trigger that started the problem, therapy works better for that than for those who just get these problems out of nowhere, which can be harder to deal with in therapy.  
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And just curious, if the meds were working, why did he stop?  And if stopping them set it off again, why hasn't started on them again?  That won't make therapy unnecessary, but just curious.
Thanks for your reply. He takes some meds for SOS when he thinks he will get a panic attack. He stopped anti depressents gradually but since symptoms returned we were thinking if is it purely pschological or  could be any other thing. Based on your info it seems a something more of pschological factors.
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