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Panic Disorder 101: What do I really need to know?

Panic Disorder Overview:

Some of the main characteristics of panic disorder are short-term, sudden, intense feelings of fear, terror or sense of losing control and begin without warning during activities that are believed to be nonthreatening. Many individuals experiencing panic disorder go to the emergency room because of the intensity of their physical symptoms which may include a rapid heartbeat, breathing difficulty and sometimes a choking sensation giving the appearance of a possible heart attack. Many patients believe that they are having a heart attack and need to consult a doctor immediately.

Panic attacks usually peak within approximately 10 minutes and they seem to go away over a 20 to 30 minute period of time. Panic attacks are usually characterized by a combination of at least several of the following symptoms:

• hyperventilation or shortness of breath
• discomfort in the chest
• dizziness or feeling faint
• trembling or shaking
• Heart palpitations
• stomach pain, nausea or choking
• cold or hot flashes
• tingling or numbness
• a sense of feeling detached from one’s surroundings
• a fear of dying or losing your mind.

Many individuals with panic disorder also experience other symptoms of anxiety as well as depression. While some patients will have some relief from antidepressant medications from their symptoms of depression and panic attacks, others may need totally different medications for a panic disorder than would usually be given for depression and anxiety.

Prevalence of panic disorder:

Estimates of the prevalence of panic disorder are usually between 1% and 2% among both men and women. The first attacks frequently begin in the late teens or early 20’s and will frequently go for a significant period of time misdiagnosed, undiagnosed and often untreated. Some studies have found that as few as one in four people with a potential diagnosis of panic attacks or panic disorder receive appropriate care.

Panic attacks and Agoraphobia:

Agoraphobia can be one of the most common complications associated with panic disorder. The symptoms of agoraphobia include fear of being in public places alone, and future attempts to avoid situations that are triggered by panic attacks in the past. If untreated, Agoraphobia and panic attacks can tremendously restrict an individual’s activities and lifestyle, since they will tend to avoid situations that may result in another panic attack. Another negative byproduct of panic disorder is that it may frequently increase the risk for depression, alcohol and drug dependency and even possibly suicide.

Treatment for Panic Disorder:

Treatment for panic disorder frequently involves a combination of psychotherapy and psychiatric medications. Successful treatment may necessitate being referred to a therapist that specializes in treatment of panic disorder or anxiety disorders. Many studies have found support for the effectiveness of cognitive and behavioral therapy that involves incremental exposure to situations that provoke symptoms of anxiety or panic.

Tricyclic antidepressants and MAO inhibitors seem to currently be the mainstream psychopharmacological intervention for panic disorder. These medications have been identified to be approximately 80% to 90% effective in blocking panic attacks. However, they’ve also been found to frequently take between 6 to 12 weeks to be effective. Alprazolam (Xanax), a benzodiazepine, has been found to be effective within several days and cause fewer side effects than the antidepressants. Unfortunately, Xanax can be very addictive as with all the other benzodiazepines. Also unfortunately, a relapse of panic symptoms can occur in anywhere from 30% to 60% of patients within 6 to 12 months after medications have been discontinued. Additionally, the SSRI’s such as Zoloft and Paxil have been approved by the FDA for the treatment of symptoms of panic disorder. Beta blockers can also reduce the physical symptoms of panic attacks but do not eliminate the fear or the actual panic itself.

By Paul Susic Ph.D. Licensed Psychologist

What is the difference between anxiety and anxiety disorders?

Anxiety overview:

Anxiety is a normal part of our daily experience and may be sometimes be useful in improving a person’s performance when experiencing many of life’s challenges. Some people however feel that anxiety can get out of control and cause severe discomfort and difficulty in their lives.

Anxiety disorders are different from anxiety in that they are usually characterized by frequent, persistent and sometimes recurrent physical symptoms that interfere with normal everyday functioning. They may continue even in the absence of the precipitating stressors and may appear as excessive responses to these antecedents. According to research, anxiety disorders can possibly result from hyperactivity in certain areas of the brain or potentially due to a decrease in activity of specific neurotransmitters referred to as gamma-aminobutyric acid (GABA), which is believed to suppress the action of specific neurons in the brain.

Some types of anxiety began to appear during adolescence or early adulthood, although it may occur at any time including in mature adults. Researchers have found that as many as 20% of individuals 65 and older have symptoms of anxiety that require them to seek treatment.

Medical conditions and drugs may mimic or cause anxiety disorders.

There are some conditions and even drugs that can either mimic the symptoms of anxiety or even cause it at times. These medical conditions include deficiency in folate or vitamin B12, overactive thyroid, heart attack, asthma, and alcohol withdrawal. Also, drugs might cause or mimic specific anxiety symptoms including bronchodilators, such as ephedrine (which is frequently found in weight loss drugs) or epinephrine. Also, there are some psychostimulants such as methylphenidate (Ritalin) and thyroid hormones which may cause or exacerbate underlying anxiety.

Common symptoms of anxiety:

Some of the more common psychological symptoms of anxiety include irritability, worry, intense fear, and frequently difficulty concentrating. These symptoms also may be accompanied by physical symptoms such as restlessness, trembling, muscle tension, palpitations, chills, dizziness, dry mouth or sweating.

Symptoms of anxiety disorders:

As previously stated, anxiety disorders are more than common anxiety. They usually cause a heightened awareness of symptoms and sometimes an increase in disability or functioning in an individual’s normal, everyday life. Anxiety disorders are usually broken down into various anxiety states including panic disorder, generalized anxiety disorder, obsessive-compulsive disorder, posttraumatic stress disorder and phobic disorders.

By Paul Susic Ph.D. Licensed Psychologist

Some information from The Johns Hopkins Medical Guide to Health After 50

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