Panic attacks

Panic Attacks - Questions and Answers

My wife has just been diagnosed as suffering from Panic Attacks. I thought she just had 'bad nerves', and now I feel guilty for telling her "Pull yourself together"! Can you help by telling me about these attacks?

Patients who suffer from Panic Attacks or Panic Disorder, as it is often called, cannot control the attack by 'pulling themselves together'.

A panic attack consists of the sudden onset of extreme anxiety, often discribed as an overwhelming feeling of terror and fear.

The sufferer also experiences many of the following distressing symptoms sweating :trembling, chest pain, shortness of breath, choking, palpitations (thumping heart), nausea, hot and cold flushes, feeling faint, fear of dying, fear of going crazy, hyperventilation (overbreathing), pins and needles in hands and around the mouth, and feelings of unreality.

There is often a sense of impending disaster, and the patient fears that they are going to lose control. There are two types of panic attack - one which comes on out of the blue, and the other which has a clear cause, although it may apparently seem an insignificant reason for the panic attack at the time.

Couldn't some of these symptoms be caused by real medical diseases?

Yes indeed. A patient presenting to a doctor with the any of the above problems should initially be checked out for heart disease, thyroid disorders, diabetes, anaemia, epilepsy and a rare condition called 'adrenal phaeochromocytoma'.

Who gets Panic Attacks?

Here is my 'File o' Facts' on Panic Attacks:

*They are more common in women.

*The age of onset is usually in the teens to 20's.

*It's rare in the over 65's.

*Up to 5% of the population may suffer from Panic Attacks.

*Between 30 - 50% of patients presenting to cardiologists with no evidence of heart disease may have Panic Disorder.

*Panic Disorder is more common in people who suffer from depression.

*Up to 20% of Panic Disorder sufferers may attempt suicide.

*Panic Disorder can run in families.

Patients' comments:

"Your heart feels as if it's going to jump out of your chest. Everything is distant and remote. You feel like you're loosing your mind."

"Every doctor I went to diagnosed anxiety. None of their tranquilliser treatments helped me. They never got to the core of the problem."

"When I got in the car, I had my first panic attack. I have now stopped driving, and I won't fly and I've now stopped seeing my friends. I'm now agoraphobic and won't go out. It's ruined my life."

How can Panic Attacks be treated?

There are two main aproaches:

1. Psychological therapy. The patient should keep a two week diary, to pinpoint any situations that trigger the attacks. This would help a psychologist to train the patient to cope with the causative factors. Gradual exposure to the triggering situation, under the specialist's supervision can be very helpful. Education and reassurance of the patient is very important pointing out that though the attacks are unpleasant, they are not life threatening, after all the patient has survived to tell the tale! Professional training can help many patients to cope with their symptoms.

2. Drug therapy. Various anti depressants have been useful in the prevention of panic attacks. One, in particular, called 'Anafranil' (or clomipramine), has produced encouraging results. The patient should start on a 25 mg capsule each day, increasing to 50 mg/day.

The latest research in America has shown that another medication, a potent relaxant, called 'Xanax' (or alprozalom), has been used with some success. At present this drug is not yet available in the UK for treating panic disorder, though it is used here for treating acute anxiety. However, as this is a benzodiazepine (like Valium), there is concern that long term treatment might lead to dependence.

Many specialists now feel that a combination of both psychological and medical interventions should be tried. But do remember, there is no need to suffer, Panic Attacks can be treated.
Best of health
IMPORTANT NOTICE : This content is from the Dr Chris Steele personal archive and is provided for convenience only. Information contained here may no longer agree with the most up to date medical advice. Please check with a medical professional before taking any action.

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