Panic at­tacks can de­rail prospects for nor­mal life

Sherbrooke Record - - LOCAL SPORTS -

ASK THE DOC­TORS By Robert Ash­ley, M.D.

Dear Doc­tor: Could you ex­plain panic at­tacks? I never knew what peo­ple were talk­ing about un­til a few months ago, while sit­ting at the com­puter. I felt as if I had stopped breath­ing; I thought I was dy­ing. I ended up in the ER, but no prob­lems were found. This has hap­pened sev­eral times since, and I want my life back.

Dear Reader: Panic at­tacks are truly a scary ex­pe­ri­ence, es­pe­cially if you’ve never had them be­fore. Many of the symp­toms are sim­i­lar to those of a heart at­tack, caus­ing peo­ple to seek im­me­di­ate at­ten­tion in an ur­gent care depart­ment or emer­gency room. The symp­toms, which de­velop sud­denly, can in­clude chest pain, heart pal­pi­ta­tions, sweat­ing, nau­sea, short­ness of breath, light­head­ed­ness and, for many, the feel­ing that they’re go­ing to die.

Such at­tacks are sur­pris­ingly com­mon. One-third of peo­ple have at least one panic at­tack dur­ing their life­time. Those who ex­pe­ri­ence re­cur­rent panic at­tacks not re­lated to gen­er­al­ized anx­i­ety, de­pres­sion, ob­ses­sive-com­pul­sive dis­or­der or post-trau­matic stress dis­or­der have what is termed panic dis­or­der. Peo­ple with panic dis­or­der have a per­sis­tent worry about hav­ing an­other panic at­tack and the con­se­quences of fu­ture at­tacks. That leads them to avoid sit­u­a­tions that may in­duce panic at­tacks, which, in turn, leads to a pro­found al­ter­ation in qual­ity of life. Panic dis­or­der af­fects nearly 3 per­cent of the pop­u­la­tion, ages 15 to 54.

Peo­ple with panic dis­or­der of­ten re­port an in­crease in stress­ful life events over the past year and, even more of­ten, within the past month. Ge­netic fac­tors also play a role. A per­son who has a first-de­gree fam­ily mem­ber with panic dis­or­der is three times more likely to de­velop the dis­or­der com­pared to peo­ple with­out such a tie. Fur­ther, an iden­ti­cal twin is five times more likely to have anx­i­ety and panic if his or her twin has the dis­or­der.

The symp­toms of panic at­tacks are essen­tially a nor­mal “fight or flight” re­sponse to a very stress­ful sit­u­a­tion, such as an en­counter with a lion, tiger or griz­zly bear. How­ever, panic at­tacks oc­cur with­out the lion, tiger or bear. Some ex­perts hy­poth­e­size that panic at­tacks are ab­nor­mal cen­tral ner­vous sys­tem re­sponses to even the most mun­dane stim­uli. Such re­sponses arise in the brain’s lim­bic sys­tem, which nor­mally pro­cesses sen­sory in­for­ma­tion into emo­tional re­sponses, be­hav­ior and mem­ory. The hy­per­re­spon­sive­ness to sen­sory in­puts — and even the in­puts from one’s own think­ing — leads to a poor reg­u­la­tion of the au­to­nomic ner­vous sys­tem, which con­trols heart rate, the con­trac­tion of the heart, blood pres­sure, the gas­troin­testi­nal sys­tem and sweat­ing. MRI stud­ies have con­firmed al­ter­ations in the lim­bic sys­tem in peo­ple with panic dis­or­der.

Panic at­tacks can also be pre­cip­i­tated by stim­u­lants such as caf­feine, co­caine and am­phet­a­mine as well as with­drawal from al­co­hol, opi­ates or ben­zo­di­azepines like Val­ium, Ati­van and Xanax. Al­though pa­tients some­times use ben­zo­di­azepines to stop a panic at­tack, th­ese med­i­ca­tions can in­duce re­bound panic when the drug is out of the sys­tem, mak­ing them a poor treat­ment op­tion.

Cog­ni­tive be­hav­ioral ther­apy shows the great­est sus­tained ben­e­fit in stop­ping panic at­tacks, be­cause it can al­ter the un­der­ly­ing brain re­sponses. Se­lec­tive sero­tonin re­up­take in­hibitor med­i­ca­tions also can help.

In sum­mary, start­ing ther­apy and pos­si­bly med­i­ca­tion will be the first steps in get­ting your life back.

Robert Ash­ley, M.D., is an in­ternist and as­sis­tant pro­fes­sor of medicine at the Univer­sity of Cal­i­for­nia, Los An­ge­les.

Newspapers in English

Newspapers from Canada

© PressReader. All rights reserved.