Panic Disorder

upset woman with nurse

It Might Not Feel Like It but You Will Be Okay

Frightening as they seem, especially the first few, one can eventually come to tolerate and even control panic attacks.  The good news is that they are not fatal.  Once a person understands what panic attacks are and experiences a few attacks they become somewhat less frightening.  Each attack does go away without the help of a health care provider even though you might seek an emergency room with the first one or two.  The underlying physiology of panic attacks is not known.

It seems that it must be based on W. B. Cannon’s work in the 1920s when he described bodily changes preparing an organism for fighting a threat or running away.  Hormones are released, the heart rate speeds, blood flow to digestion slows to push the blood instead to large muscle groups.  The body is readied for a maximal burst of output.  But in truth, in 2019, medical science has not completely outlined all the circuits, pathways, and physiological responses.

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Well, Okay, Yes, But…

Despite a person having had panic attacks and knowing what is happening, no one wants to have an attack, especially an attack in a public place or while driving.  The person with panic disorder tends to go out less, socialize less, and starts to restrict life activities.  They might narrow lift to going only go to work or school.  Other joys of social life shrink.

A Panic Attack Story

A woman, healthy and relatively calm, is walking quickly down the stairs to the subway after a tense job interview.  Suddenly she has a severe pain in her chest and feels dizzy.  She grabs the metal stair rail, feeling nauseated, and then her vision goes weird.  Everything seems to look small and far away then everything starts to go black.  She can’t catch her breath and starts to fall despite her death grip on the metal handrail.  “Oh, God, what’s happening, I must be dying”, she thinks, “I must be having a heart attack”.  She tries to fumble in her purse for her cell phone but can’t think and can’t see what she’s doing.

One of the people coming down the stairs sees her struggling, breathing hard, and sweating profusely.  This Good Samaritan calls 911.  He stays with her.  The chest pain has eased but her breathing is still labored.  She’s still confused when the paramedics arrive.  They get her in the ambulance and rush off to the ER.  The medical tests begin.  Three hours later she’s feeling fine.  She’s still upset and shaken by the whole experience.  The ER doc comes in to talk to her.  The tests were all normal.  He smiles and says, “You’ve had a panic attack.”

What the Book Says

One system used to categorize medical diagnoses is DSM 5, and panic disorder is in there.  DSM 5 even gives it a diagnosis number, 300.01.  Here’s a link that gives the things health care professional needs to see to make the diagnosis:

https://www.medscape.com/answers/286227-14544/what-are-the-dsm-5-criteria-for-diagnosis-of-panic-disorder

The story above describes a first panic attack pretty well.  The person is overcome suddenly, and often for no apparent reason, with overwhelming anxiety and fear.  If there was a stressor (the job interview) it seems like it should be in the past.  They feel that they have lost control of themselves.  There’s always the worry that there’ll be another attack.   While not on the official list, many are terrified that they are going immediately and irreversibly insane, at least this thought can be present during the first several attacks.  It does not make sense to them later, but in that moment of frightening terror it feels as if it could be all too real.

How Panic Disorder Is Usually Treated

The silver lining to this cloud is that there are many good treatments for panic disorder.  There are a whole variety of therapies that do not involve medication and several effective medications that help greatly.  Just taking a tablet by itself is far less helpful than a medication linked with one of the available therapies.  A great deal more about treatment is reviewed in our Member Pages but we did wanted to give a broad outline here.

First the Medications

A group of medicines usually thought of as for depression, the SSRIs (selective serotonin reuptake inhibitors), are often tried first.  Understand that panic disorder is not depression.  But for reasons that are not completely clear there are some medications that work for both.  Another family of medicines originally for depression, the “tricyclics” or TCAs, also at times work really well.  Getting to the best medication for you depends both on what works (efficacy) and what are the side effects of the medication that works.  There are medications that are used just to relieve anxiety but these might not be as safe for ongoing, long-term use.  The big concern with these medications is overuse and addiction.  Some susceptible people get badly caught up in these anxiety medicines and can get into trouble with addiction.

Many People Like the Therapies

All sorts of therapies are available to lessen the intensity of panic disorder.  These therapies help people to have fewer and fewer, and less severe, panic attacks over time.  And, when they do feel panicky the attack is milder.  There are “tricks of the trade”, special ways of doing things, that when learned and used can be quite helpful to lessen panic attack frequency and severity.  One well-known therapeutic technique is CBT, or Cognitive Behavioral Therapy.  It’s really popular and often works quite well.  It’s a therapy that’s makes rational sense to many people who see themselves as reasonable and logical.  Then there are relaxation skills, supportive group therapy, and individual interpersonal psychotherapy.  Find what helps and make it yours.

Helpful links:

National Institutes of Health, National Institute of Mental Health

https://www.nimh.nih.gov/health/publications/panic-disorder-when-fear-overwhelms/index.shtml

National Library of Medicine (United States), Medline Plus

https://medlineplus.gov/panicdisorder.html

Anxiety and Depression Association of America

https://adaa.org/understanding-anxiety/panic-disorder

The Mayo Clinic

https://www.mayoclinic.org/diseases-conditions/panic-attacks/symptoms-causes/syc-20376021

American Psychological Association

https://www.apa.org/topics/anxiety/panic-disorder.aspx