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Don’t Panic!

Dr. Sarah DeMichele
March 14, 2011

Panic attacks affect 2-5 percent of people in their lifetime. A panic attack, by definition, occurs “out of the blue” and can include shortness of breath, increased heart rate, overwhelming anxiety, fear of dying, chest pain or discomfort, numbness in hands, feet or face, sweating or chills, shaking, dizziness and a sense of “doom”. It can last anywhere from 5-20 minutes, but if you are experiencing a panic attack, that short time can seem endless. People use the expression “I had a panic attack” in a lot of circumstances- before a test, during a presentation, after a fight with a family member, but often they are referring to a milder anxiety reaction. Panic Disorder is diagnosed after one attack that causes a month of increased anxiety afterwards, or after more than one attack. Panic Disorder is a type of anxiety disorder, and can be disabling. It is thought to have some genetic basis, and often develops in a time of stress.

Panic attacks themselves are debilitating- the sufferer cannot focus on anything else at the time or be productive in any way. Perhaps even more debilitating, however, is the worry about having another panic attack. That worry is called “anticipatory anxiety” and can take over the life of a person with Panic Disorder. Since the experience of having an attack is so dreadful, the person understandably worries that another might happen. That worry can get worse and worse, and can cause a person to avoid anything that might trigger an attack. If they have had a panic attack while driving, they may avoid driving. If they have had a panic attack at work, they might resist returning to work. If they had an attack at a family dinner, they might decline to attend future dinners.

Untreated, this can continue to worsen, such that the person is reluctant to even leave the house. This is called agoraphobia, and itself can worsen the fear—by avoiding the stressor, the person has no chance to have a successful family dinner or car ride or work experience, so the fear continues to grow. Seeking help is also a challenge. First, recognizing that panic attacks are not “normal” is important. Second is reaching out to a trusted friend or family member to let them know of the struggle. Third is to seek treatment. Different types of psychotherapy and medications are used in the treatment of panic disorder. Cognitive behavioral therapy is particularly useful type of therapy that helps a person identify any triggers and/or warning signs of a panic attack, and learn strategies to manage symptoms if they occur. These skills can be “permanent” (if used regularly) and have no “side effects.”

Two different medication approaches are often used, sometimes together. First are medications used if a panic attack is occurring, like Valium or other benzodiazepines. These medications work fairly quickly to relieve symptoms in the moment, but have a risk of dependence and tolerance. Another medication approach is to use serotonin or serotonin-norepinephrine reuptake inhibitor medications, like Prozac, Zoloft, Paxil, Celexa, Lexapro, Effexor and Cymbalta. These medicines are often thought of as “just” for depression, but they are very effective for a wide range of anxiety disorders, including Panic Disorder. These medications are taken daily, and take time to become effective, but can lessen the frequency, intensity and severity of panic attacks. They can have different side effects for different people, and it is important to discuss this with your doctor. The most effective approach is a combination of medication and psychotherapy. There are also important lifestyle changes that should help: regular exercise, avoiding caffeine as well as alcohol, regular sleep and maintaining a balanced diet.

If you have panic attacks or are concerned that you do, talk to your doctor, see a therapist or psychiatrist, and begin the process of recovery.

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Dr. Sarah DeMichele is CFR's Director of Medical Services and Senior Staff Psychiatrist in our University City and Center City offices. She can be reached at 215-382-6680 ext. 3111.

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