A 35 year old woman is driving on the Garden State Parkway in a rush to get to an appointment when suddenly she is seized by terror, heart palpitations and shortness of breath. She pulls over to the side of the road unable to drive any further. A month later, though she has gotten up the courage to drive on local roads, she is not able to return to driving on highways.
The DSM-V defines panic attacks as “A discrete period of intense fear or discomfort, in which four of more of the following symptoms develop abruptly and reach a peak within ten minutes.” These symptoms are:
1) Palpitations or accelerated heart rate
2) Trembling or shaking
4) Sensations of shortness of breath or smothering
5) Feelings of choking
6) Chest pain or discomfort
7) Nausea or abdominal distress
8) Feeling dizzy or lightheaded
9) Derealization or feelings of unreality
10) Fear of losing control or going crazy
11) Fear of dying
12) Paresthesias or numbness and tingling sensation
13) Chills or hot flashes
For people who suffer from panic disorder, the fear that they will get a panic attack takes on a life of its own, and eventually they find themselves limited from engaging in activities that were second nature to them, i.e. going to the supermarket, driving on a highway, taking an elevator and going on an airplane, because they fear they will have a panic attack in these situations. A panic attack arises “out of the blue” while engaged in one of the aforementioned activities and the resulting fear of having a panic attack then becomes the deterrent from partaking in the activity again. Panic disorder can either occur with or without agoraphobia which is fear of being in places where escape may be difficult, such as in planes, elevators or trains. More typically, those who suffer from panic disorder have agoraphobia as well.
According to the National Institute of Mental Health (NIMH), the 12 month prevalence of panic disorder in the United States is 2.7 percent only 59.1 percent of whom are getting treatment, making panic disorder a formidable problem that costs the country millions of dollars a year in lost productivity and greatly detracts from the quality of life that the sufferer experiences. The good news is that there is help for those who suffer from panic disorder both on a psychotherapeutic level and on a medication management level. A Cognitive Behavioral Therapist (CBT) can work to retrain a sufferers brain so that the “automatic thought” that pops into an individual’s head when they think of being in an anxiety provoking situation, does not automatically lead to an emotion of fear, which in turn limits them from the activity. A therapist works to normalize anxiety (some degree of anxiety is normal, and everyone has anxiety,) and can help one challenge their negative thoughts, specifically, “I’m not going to go crazy, lose control or die from a panic attack.” They teach the individual that the sensations they are feeling are not dangerous and one doesn’t need to be in control 100 percent of the time. They also work to teach the individual suffering from panic attacks acceptance, “I can accept my arousal/anxiety and negative thoughts and watch them go up and down.” They help them with predictions, “Just because I predicted that I would have a panic attack in the past, doesn’t mean I actually had one, and in turn doesn’t mean I will have one now.” Finally, they work with an individual on deep breathing and muscle relaxation exercises, that can help one mitigate a panic attack once it occurs, and when performed daily can greatly reduce the number of panic attacks one experiences.
Finally, there are psychiatric medications that can help ameliorate the symptoms of panic disorder. There are both addictive and non-addictive medications that are being used to treat panic disorder. The benzodiazepines such as long acting Klonopin and Valium and short acting Xanax and Ativan are very popular, however because of their addictive potential, there is room for abuse. There are also non-addictive medications such as Buspar, Vistaril, Neurontin and Seroquel which have proven to be very effective as well. There are also anti-depressants such as the SSRI’s and SNRI’s (Serotonin reuptake and Serotonin and Norepinephrine reuptake inhibitors), that can help reduce the symptoms of the disorder. Many other medications are prescribed off-label as well, such as the antipsychotics and mood-stabilizing medications that help with panic disorder as well. All in all, with a combined approach of both therapy and medications, one with panic disorder can get much relief and go back to the activities that they deemed off-limits due to the fear of having a dreaded panic attack.
By Shani Stein, MD
Shani Stein, MD is a psychiatrist with a private practice in Teaneck. She can be reached at 201-591-5230.