January 20, 2013

Don’t Panic!!

Panic attacks (also referred to as anxiety attacks) can be terrifying and often cause people to rush to the emergency room because they think they are having a heart attack, suffocating or about to die. It can be disorienting to be told it’s “only”anxiety which is not a true physical threat but leaves you wondering what happened to you and what you can do about it.


Palpitations and pounding heart, rapid pulse


Trembling or shaking

Shortness of breath, a feeling of being smothered

Chest pain

Nausea or abdominal distress


Feeling of unreality or being detached from oneself

Fear of dying

Fear of losing control

Parasthesias, numbness or tingling in limbs


Sound awful? It is! To be diagnosed with Panic Disorder you need at least four of the above symptoms to occur, developing abruptly and reaching a peak within ten minutes. No wonder people rush to the emergency room.


For those without a previous history of anxiety disorders acute stress is a common cause. Major life changes including death, divorce, job loss or other personal catastrophe can bring on great anxiety in anyone and panic attacks in those who are susceptible. Panic may not come early after the stress occurs so that may make it more surprising and unexpected. It is usually not a first reaction to catastrophe but may develop a little later after a period of extended stress and chronic anxiety.

For those with a long term history of anxiety or worry it can develop at any time. People who suffer from panic often feel it “came out of the blue”. Because humans are logical we look for a source of the attack and wherever we were or whatever we were doing is viewed as related to the cause even though it may not be. Thus people who have had panic attacks may find themselves developing fears of driving, restaurants, shopping malls, grocery stores or whatever location is where the attack occurred.  Panic attacks are less likely to occur at home although in severe cases they occur there as well.

Some medications as well as certain medical conditions seem to increase the likelihood of developing panic attacks so it is always worth having a thorough medical exam to rule out underlying causes, especially in a person with a temperament that is not naturally anxious and when there are no particular stresses in the persons life.


The good news is that Panic Disorder is highly treatable with a very high success rate. Cognitive Behavioral Therapy (CBT) is very effective for panic disorder as are certain medications. A combination is usually the best approach. I prefer the combination because medication brings rapid relief and the sooner someone feels they are gaining control over the condition the sooner their symptoms of anxiety subside.  CBT promotes long term control and gives tools to diminish anxiety and thinking patterns which contribute to the onset of panic. There is controversy about the role of Benzodiazepines such as Xanax or Valium in the treatment. I believe they have a place as long as the person has no history of addiction.  The workhorse class of medications for this condition are the non-addictive SSRI’s such as Prozac, Zoloft and Lexapro but these medications as well as CBT take some time to be effective.  Benzodiazepines work immediately but are not effective for long term control so again, they offer the sufferer early relief and a sense of control, something well worth achieving. I urge my patients to make sure they always have one of these fast acting drugs in their wallet or purse so they KNOW they can stop a panic attack at the first sign of trouble.

Panic Disorder can be a terrifying condition but very effective treatments are widely available. Untreated Panic Disorder can lead to a more chronic anxiety condition so early treatment is of great value.

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