Panic Disorder

upset woman with nurse

Did You Know That…  Earl Campbell had Panic Disorder

Earl Campbell, an incredible athlete, a famous football running back.  He played for the Houston Oilers and New Orleans Saints.  He was a 1977 Heisman Trophy winner and was the No. 1 pick of the 1978 NFL draft.  During his football career he was NFL Most Valuable Player three times and All-Pro eight times.  Campbell became the centerpiece of Houston’s offense during the late 1970s and early 1980s.  In 1989, at age 34, his panic disorder was finally diagnosed.  His panic attacks included chest pain and the typical paralyzing fear.  Also typical, he thought he was dying of a heart attack.  It took him a year to understand what was happening to him.  He had never heard of panic disorder.  Campbell was quoted as saying, “The thing about it is if you have it, there’s some help available.  There are people who understand what’s going on with you and you have to deal with it.”  After he understood and learned how to manage his panic disorder he began to educate others about it.  He commented, “‘I’m still scared about it, but I’m not as scared as I used to be.  There was a period of time where I had my problems.  I lived in the house with sunshades on and crying.”

Articles related to Panic Disorder:

Panic Attacks are Remarkably Frightening and Upsetting

It is just not believable that an experience that does not harm you, where the medical consequence is trivial, can be so horrible in the moment.  It seems little comfort to people to tell them that a panic attack won’t kill them.  In the midst of one you’re both terrified you’re dying and wishing you could just die to make it stop.  Well, maybe not wishing you could die.  That goes a bit too far.  But it is true that, frightening as they seem, especially the first few attacks, one can eventually come to tolerate and later to control panic attacks.  And it is nonetheless true, and good news, that they are not medically dangerous or fatal.  Once a person understands what the panic attacks are and experiences a few attacks they become somewhat less frightening.  Each attack does go away at some point without the help of a health care provider even though you might seek an emergency room with the first few. 

What Are They?

The underlying pathophysiology 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 (like a person, for example) for fighting a threat or running away.  He called it the fight or run response, though later writers could not suppress the temptation to call it “fight or flight”.  Stress hormones are released, the heart rate speeds and the heart pounds, blood flow to digestion slows to push the blood instead to large muscle groups.  The body is readied for a maximal burst of physical energy output.  But in truth, in 2019, medical science has not completely outlined all the circuits, pathways, and physiological responses.

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 life to going only go to work or school.  Other joys of social life shrink.  The presence of panic disorder can easily become socially crippling.

A First-time Panic Attack Example

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 better though still upset and shaken by the whole experience.  The ER doc comes in to talk with her.  The tests were all normal.  He smiles and says, “You’ve had a panic attack.”

What the Book of Diagnoses Says

One system used to categorize medical diagnoses is DSM 5, and Panic Disorder is in there (See “A Bit of Medical History” below).  DSM 5 even gives it a diagnosis code number, 300.01.  Here’s a link that lists the specific signs, symptoms, and other criteria that a 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

What Do These Signs, Symptoms, and Criteria Look Like?

The story above of the woman having her first panic attack provides a good description.  The person is overcome suddenly, and often for no apparent reason, with overwhelming anxiety and fear.  If there was a stressor (in her case, the job interview) it seems like it should be in the past and irrelevant.  They feel that they have lost control of themselves.  While not officially listed, many people are terrified that they are going immediately and irreversibly insane.  This thought might be present especially during the first several attacks.  It does not make sense to them later, perhaps even feels silly, but in that moment of frightening terror it feels as if insanity is real and right now.  Then, surviving the first few, there’s always the worry that there’ll be another attack.

How Panic Disorder Is Usually Treated

The silver lining to this panicky black 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 an anxiety pill by itself is far less helpful than a good, prescribed medication linked with one of the effective available therapies.  There’s more treatment information on our Panic Disorder Treatment page.

https://www.neuroscirandd.com/panic-disorder-treatment/

First the Medications

The medications typically tried first are from a family of medications that usually come to mind for treating depression, the SSRIs (selective serotonin reuptake inhibitors).  Panic disorder is not depression.  It just so happens that these medications work for both.  Another family of medicines that was originally developed for depression, the “tricyclics” or TCAs, also at times work really well for panic disorder.  Getting to the best medication for you depends both on what works (efficacy) and what are the side effects.  There is also a whole group of medications, the benzodiazepines, that come to mind for anxiety.  These are popular medications that are used just to relieve anxiety in the moment but they might not be as safe for ongoing, long-term use.  The medical concern with benzodiazepines is a very real risk of overuse and addiction.  Some people who are more susceptible become badly trapped by these anti-anxiety medications.

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, practiced, 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 and don’t want psychotherapy.  Then there are relaxation skills, supportive group therapy, and individual interpersonal psychotherapy.  Find what helps and make it yours.

A Bit of Medical History… 

In the writings of ancient Greek and Roman physicians and philosophers are descriptions of disorders that could be, and likely were, anxiety and panic.  Human physiology has changed little in 2500 years and it’s likely that people then suffered much the same conditions as do we.  Then there’s the usual information and progress gap known as the Dark Ages.  After the Dark Ages, the thread of medical diagnosis and treatment is picked up in the Enlightenment of the Renaissance.  In the 1700s a diagnosis appears, “panophobia”, that might well have referred to what we now call panic disorder and other anxiety disorders.  Case reports appear that seem to describe panic attacks, but these episodes are called “melancholy” or the “vapors and melancholia” by the physicians of that period.  Just as now, anxiety and depression seem to have been blended in these early days of “modern” medicine.  The specific diagnosis of Panic Disorder was not made official until 1980 with the publication of the Diagnostic and Statistical Manual, Third Edition.

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