SYMPTOMS:
Some common symptoms of a panic attack are:
- Pounding heart, rapid heartbeat
- Chest pain
- Sweating
- Choking feeling or tightness in the throat
- Lightheadedness
- Nausea, stomach distress
- Shortness of breath
- Dizziness
- Shaking, or trembling.
- Feelings of doom
- Extreme fear of heart attack, stroke, or death
During an attack a person may fear they are going to die, “lose control,” or are “going crazy.” Symptoms are so severe in some cases that many people having a panic attack go to the emergency room. In addition, the symptoms can be similar to those of heart attack. Panic attacks can be mistaken for other medical conditions like hyperthyroidism, heart problems, alcohol abuse, prescription medication withdrawal, or caffeine overuse. In addition, certain medical conditions, like epilepsy and asthma, which lead to sudden and scary symptoms, can increase the risk of developing panic attacks.
The aftermath of a panic attack is also difficult. Feelings of depression and helplessness are usually experienced. The greatest fear is that the panic attack will come back again and again, making life too miserable to bear.
DIAGNOSIS
PANIC ATTACK
A panic attack is the sudden development of extreme fear or anxiety along with one or several of the classic symptoms of panic. The episode usually reaches its worst point at ten minutes and generally subsides after 30 minutes.
PANIC DISORDER
Panic disorder develops when a person who has panic attacks becomes anxious about the possibility of having another attack. It is diagnosed by report of at least 2 unexpected panic attacks along with the fear or worry about having another panic attack or losing control, and avoiding situations which may trigger them. The disorder is characterized by changes in lifestyle to avoid attacks.
OTHER PHOBIAS
A person may start to avoid public places if this triggers panic attacks. This leads to a second condition known as agoraphobia, or fear of being in public places. Panic reactions often develop into a range of phobias–from agoraphobia (fear of being in public places, which Jan developed), to acrophobia (fear of heights), fear of spiders, snakes, germs, and a whole host of other phobias.
PREVALENCE
An estimated four percent of the American population suffers from panic attacks. This translates to over four million Americans. That number is likely to be a low estimate, because many people who experience panic attacks never receive the proper diagnosis. Among emergency room visits, as many as one third of visits for suspected heart attack are diagnosed as panic attacks.
Panic attacks usually develop after the age of 25 and more often in women than men. Most often, a person has one or two episodes in a lifetime. Occasionally the attacks become more frequent and lead to the disorder.
TREATMENT
The specific cause of panic attacks and panic disorder is not fully understood, therefore treatment is aimed at relieving symptoms. If you have panic attacks but not a full-blown panic disorder, you can still benefit from treatment. If panic attacks aren't treated, they can get worse and develop into panic disorder or phobias. Panic treatment may involve lifestyle recommendations, medication, and/or psychological therapy.
Sadly, many people do not seek help for panic attacks, agoraphobia, and anxiety-related difficulties. This is unfortunate since panic and the other anxiety disorders are some of the most successfully treated psychological problems. Today, panic attacks and agoraphobia can be treated successfully in the vast majority of cases. In fact, it is estimated that the appropriate therapy from a knowledgeable therapist helps close to 90% of panic sufferers.
The first step in treating panic attacks is to rule out other causes such as thyroid and heart problems. Secondly, some basic lifestyle steps can help. These include:
§ Joining a support group for people with panic attacks or anxiety disorders.
§ Avoiding possible triggers such as caffeine, alcohol and recreational drugs.
§ Stress management and relaxation techniques.
§ Getting physically active to elevate mood and relieve stress.
§ Getting enough sleep.
Psychiatric Treatment
The most effective long-term treatment for anxiety is cognitive behavioral therapy. Therapists using this method focus on the present panic and how to eliminate it. This type of therapy can help patients identify and correct negative thought patterns that either trigger or intensify panic attacks. Patients learn to recognize things that trigger their own panic attacks or make them worse, such as specific thoughts or situations. They observe how they overestimate danger, overreact to external situations or obsess about ‘what if’ situations that are extremely improbable. Patients then learn ways to cope with the anxiety and physical symptoms associated with panic attacks. These may include breathing and relaxation techniques. Some therapists recommend carrying a slip of paper that simply says “It’s just a panic attack”, to remind the person in the event of an attack that no major harm can come from this.
As scientists learn more about the biology of fear, our ability to treat panic disorder can only improve. Rather than allowing panic to shrink their social, family and working lives, those who suffer panic attacks need to seek help from a physician or psychiatrist experienced in treating the disorder.
Treatment may include weekly meetings at first. After a few weeks, symptoms tend to improve. Within several months, symptoms usually go away. As symptoms improve, visits frequency is decreased and eventually stopped at about a year. However, panic attack symptoms do sometimes come back. Seek prompt treatment if they do, and make sure that you're managing any stressful life situations.
MEDICATIONS
Short term treatment of panic may include some prescription drugs. If therapy is not sought, drugs may be needed indefinitely. Medications can help reduce symptoms associated with panic attacks, as well as depression if that is an issue. Several types of medication have been shown effective in managing symptoms of panic attacks, including:
SSRIs. Two categories of drugs, which are also used as antidepressants, are used as first line drugs for anxiety. These include SSRIs (selective serotonin reuptake inhibitors) and SNRIs (selective norepinephrine reuptake inhibitors). Because these medications are generally safe and have a low risk of causing serious side effects, they are typically recommended as the first choice in medication options to treat panic attacks. The SSRIs include citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Prozac Weekly), paroxetine (Paxil, Paxil CR) and sertraline (Zoloft). The SNRIs are duloxetine (Cymbalta) and venlafaxine (Effexor, Effexor XR).
TCAs. These medications are in the class of antidepressants called tricyclic antidepressants. While effective, they pose a risk of serious side effects, including heart and blood sugar problems. They include desipramine (Norpramin), imipramine (Tofranil) and nortriptyline (Pamelor).
Benzodiazepines. These medications are mild sedatives. They belong to the group of medicines called central nervous system (CNS) depressants. Benzodiazepines may be habit-forming (causing mental or physical dependence), especially when taken for a long time or in high doses. These include alprazolam (Xanax), clonazepam (Klonopin) and lorazepam (Ativan). The class of drugs known as benzodiazepines were at one time used alone to treat anxiety. Benzodiazepines work on GABA (gamma-aminobutyric acid) which is present in most areas of the brain and has a calming effect, minimizing the effects of stress.
Other drugs that may be prescribed either alone or in combination include Tiagabine (Gabitril), which acts in a similar way to benzodiazepines, and the medications gabapentin and pregabalin. These diminish the release of glutamate, a chemical that increases anxiety in the brain. By using drugs that work in different and complementary ways a physician can improve control of symptoms and sometimes achieve full control for a patient.
If one medication doesn't work well for a patient, doctors may recommend switching to another or combining certain medications to boost their effectiveness. It can take several weeks after first starting a medication to notice an improvement in symptoms. All medications have a risk of side effects, and some may not be recommended in certain situations, such as pregnancy. Be sure to talk to your doctor about the possible side effects and risks.
People who experience panic and agoraphobia, are not "crazy" and do not need to be in therapy for extended periods of time. Sessions depend on the severity, length of the problem, and willingness to actively participate in treatment. When a person with panic is motivated to practice and try new techniques, that person is literally changing the way their brain responds. Changing the way your brain responds leads to reduced anxiety and panic and eventual cure of the problem.
Michelle Herbert Thomas, PharmD, CDE
Clinical Director, Richmond Apothecaries, Inc.
