By Raul J Rodriguez, M.D., DABPN, DABAM, MRO
If you have ever had an actual panic attack then you probably started reading this because you NEVER want to have another one. Panic attacks are bad. They feel like death; like what we imagine a heart attack to feel like if not worse. They scare us and terrify us as much as a near death experience would. I would argue that many actual heart attacks do not feel as bad as most panic attacks do. Panic attacks are truly horrible yet so common. Why do they happen? How do you make them go away? In order to accomplish that, you must first understand how they work.
A panic attack is an abrupt, intense escalation of anxiety that overwhelms the affected individual with disabling physical and psychological symptoms. The symptoms include any combination of a racing heart, difficulty breathing, a sense of loss of control, shaking, light-headedness, sweating, intense fear, nausea, tunnel vision, and a sense of impending death. They can occur for any number of reasons, including just coming on spontaneously for no apparent reason. The experience can be so bad that anticipatory anxiety can develop, with a persisting fear of when the next attack may occur. Anticipatory anxiety can lead to avoidant behavior, with an affected individual starting to avoid situations that they associate with an attack. This a big part of why many people cannot use elevators, go on planes, go into supermarkets, or drive on the highway. Left untreated, the world of an affected person can shrink quickly. This is why proper identification and treatment of a panic attack related disorder is so important.
Proper diagnosis of a panic attack related disorder includes consideration of contributing factors and situations. Excessive anxiety to an irrational degree due to a specific object, animal or situation can indicate a Specific Phobia. Examples of this include Arachnophobia (fear of spiders), Acrophobia (fear of heights), and Coulrophobia (fear of clowns). When the provocative situation specifically involves social interactions with other people, Social Phobia is suspected. Abuse of drugs and overuse of caffeine could easily cause panic attacks in many otherwise calm people. Random panic attacks out of the blue, with no apparent trigger, can be seen in Panic Disorder. Treatment is critical, to avoid psychological progression and worsening of any of these conditions.
Contrary to popular belief, medications are not the best way of controlling a panic attack that has already started. Medications take time to be absorbed into the bloodstream, typically longer than the duration of an actual attack. Breathing in and out of a small paper bag, as often depicted in the movies, actually works to subdue an active eruption of anxiety. This technique, known as “carbon dioxide rebreathing”, works by normalizing the pH of the blood that would otherwise have risen too high from breathing off too much carbon dioxide during hyperventilation. Meditation, visual imagery, and calming mantras can also stop attacks. Leaving or “escaping” from an anxiety-provoking situation may alleviate symptoms in the moment, but can worsen fear of similar situations in the future. Prevention of future attacks is the ultimate goal of treatment.
Medications and psychotherapy can be very effective in the prevention of anxiety and panic. Medications that act by increasing Serotonin, such as the entire class of Serotonin Selective Reuptake Inhibitors (often called SSRI’s), are preferred over tranquilizers such as Xanax, Valium and Ativan. These types of tranquilizers, from the Benzodiazepine class of medications, are effective for controlling anxiety in the short term but much less adept at long term prevention. They tend to create physical dependence if taken regularly for a prolonged period of time and have the potential for causing addiction. SSRI’s have the potential to completely prevent the occurrence of future panic attacks and can be weaned off over time, especially following a successful course of psychotherapy.
Psychotherapy, especially Cognitive Behavioral Therapy (CBT) and Dialectical Behavioral Therapy (DBT), can be highly effective in teaching tools and coping skills to manage and prevent anxiety. These benefits are much longer lasting and are the best ways to allow someone to come off of medications at some point. Therapy is often done in combination with the medications at first, to give the most relief in the shortest amount of time. Other non-medical fundamentals such as eliminating caffeine, increasing exercise, and getting enough sleep will help yield the best results. Certain medical tests, such as screening for thyroid disease, help assess for treatable medical causes of anxiety.
Unchecked anxiety and panic attacks can ruin a person’s quality of life. This is completely avoidable now with so many medical and non-medical treatments available. If you already suffer from panic attacks or another anxiety disorder, realize that your condition is very treatable and potentially curable. The next step is to seek out help and engage an effective treatment regimen.
Dr Rodriguez is the founder, CEO and Medical Director of the Delray Center For Healing, which offers outpatient anxiety treatment programs for comprehensive treatment of Generalized Anxiety Disorder, Panic Disorder, Phobias and Posttraumatic Stress Disorder (PTSD).