How to put a stop to PANIC and ANXIETY

36 I’m having panic attacks a few times a week — is there anything I can do to stop them?

ESSENTIALLY, a panic attack is an overreaction to an everyday event which triggers a physical reaction in the form of a flood of adrenalin. This, in turn, can lead to physical feelings such as a racing heart, dizziness or loose bowel movements.

‘Once these physical feelings begin, the other element of the panic attack starts — the catastrophising — thinking that there is something terribly wrong,’ says Dr Cosmo Hallstrom, a psychiatrist in private practice.

‘Panic attacks can be really unpleasant. And the trouble is that if you don’t deal with them suitably, then they are a problem that can grow.

‘People may avoid doing things for fear it will provoke another attack and they may stop going out — leading to another problem, agoraphobia, a fear of being away from the security of home.

‘Many people who have panic attacks don’t recognise them as a panic attack and think they’re going to die — they can end up at A&E with what they assume is a heart attack, for example.’

Dr Hallstrom says the first step to treating panic attacks is accepting you have them and developing coping mechanisms for when they strike.

‘You have to remember they cannot kill you and that the symptoms, while horrible, won’t last long,’ he says.

‘It’s worth learning a little message that you repeat to yourself when they strike, something like, “I know it’s not nice, I know what it is and I know I’m going to be okay”.’

Cognitive behavioural therapy (CBT) — which aims to change how you react to everyday events — can be beneficial but waiting lists are lengthy as there is limited availability and it is a labour intensive treatment.

‘If you’re going through an acute stage with lots of severe panic attacks, then medication such as an occasional Valium tablet is effective to get you through a bad 24 hours,’ says Dr Hallstrom. ‘However, because GPs are wary of giving Valium, they often prescribe 2mg, which is too small a dose to be properly effective and it really needs to be 5mg.

‘While this is good for an acute attack, unless you deal with the underlying problem you will just want the Valium again. But you really shouldn’t be on it for longer than a few days.’

Other effective medication that can be taken longer-term includes antidepressants known as SSRIs (selective serotonin reuptake inhibitors), such as citalopram or fluoxetine.

‘We don’t know why they help, but they do, although they tend to take three to six weeks to work well,’ says Dr Hallstrom.

37 Am I depressed? What can I do about it without taking antidepressants?

‘TRUE depression is where you feel depressed more days than you do not, which is not true if you are simply unhappy,’ says Dr Hallstrom.

‘Depression is an illness, while unhappiness is a reaction to events or the situation you find yourself in: most people are somewhere between the two.’

There are tests on the internet that you can use to assess your state of mind, he adds.

‘One, called PHQ-9, is used a lot and your GP will also probably ask you to complete it,’ says Dr Hallstrom. ‘It gives you a score out of 27 and tells you whether you’re depressed or not.’

Questions include asking whether you have little interest in doing things and about your appetite. There are many drugfree options for depression.

‘Counselling can be great but it takes work,’ says Dr Hallstrom. ‘It can drag up sadness in itself and you need to be aware you won’t suddenly feel better after the first three sessions.’

Another option is cognitive behavioural therapy (CBT) — a form of therapy that aims to change how you react to everyday events.

This can be accessed on the internet and there are good books on the subject that can suggest self-help techniques, says Dr Hallstrom.

‘Depression For Dummies, available as a book or via the website (dummies.com), is good.’ As well as drug treatments, it covers nutrition and relaxation.

‘And before anyone dismisses pills, I would urge them to remember that what they want is not necessarily what’s best for them,’ stresses Dr Hallstrom.

‘I think it’s sad that people are so scared of antidepressants as they can work miraculously well and are quick and effective.

‘Of course, people have the option of trying them and, if they don’t work, then stopping them after a couple of months. They take up to six weeks to work fully. If there’s no obvious benefit after eight weeks on a proper dose, then it is worth stopping the medication and considering alternatives.

‘GPs deal with depression all the time, so don’t be afraid to take their advice — even if that means taking medication.

‘Discuss any problems or sideeffects with your GP rather than giving up over any setbacks. If you benefit from the medication, continue it for at least six months.’

38 I’m really anxious. Can I have some Valium?

‘ANXIETY is just as serious as depression but in my view it’s harder to treat,’ says Dr Hallstrom. ‘This is partly because there’s no one-size-fits-all approach to treatment, but also because people are frightened of doing the things they need to overcome it — confronting their fears and, for example, going out when they’re anxious about doing so.’

There are questionnaires online that can give you an idea of the severity of your anxiety. The Generalised Anxiety Disorder (GAD-7) scale or the Beck scale are both widely used by doctors to assess patients. You will be asked to rate your feelings, such as sadness, on a scale of 0 to 3.

In some cases, medication such as Valium can be beneficial. ‘However,’ says Dr Hallstrom, ‘Valium can lead to dependency, so if someone is going through a bad few days I might give it to them — but only if they were having an absolute crisis and then only for those few days.’

Guidelines say you should be on such drugs for no more than two to four weeks at a time.

The SSRI class of antidepressants can also help anxiety. Though not viewed as habit forming, these shouldn’t be stopped abruptly as doing so can result in withdrawal symptoms such as jitteriness.

‘But SSRIs take time to work and can make it worse for the first day or so,’ says Dr Hallstrom. ‘You need to take them regularly for a month at least to see if they have an effect.’

He says people need to approach their treatment as a long-term solution, not a short-term fix which means considering counselling as well as medication.