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Jewish World Review March 21, 2001 / 26 Adar, 5761

Michael Woods

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Consumer Reports

Coping with panic disorder -- THE fear hits like a punch.

It happens in a shopping mall, on the street, in a crowded room. Your heart pounds, and it's difficult to breathe. You may feel dizzy, weak, lightheaded, tremble, develop chest pain, tingling sensations, chills, hot flashes or abdominal distress.

The overwhelming sensation is terror - that you are going to die, have a heart attack, go insane, or fall victim to some other catastrophe. The spell passes, but may happen again without warning.

An estimated 2.5 million people experience at least one panic attack like that every year, according to the National Institute of Mental Health.

Panic attacks are sudden, unexplainable spells of intense fear and unpleasant physical sensations. The attacks usually peak within 10 minutes, and then pass.

Doctors use a different term - panic disorder - for panic attacks that happen again and again, interfering with everyday life. Panic disorder is among a whole group of diseases, called anxiety disorders, that affect an estimated 1 out of every 4 persons in the United States.

Panic disorder can be disabling, making it impossible for people to keep jobs, perform routine activities, travel and keep social ties. That's because many people with panic disorder develop phobias about places and situations where panic attacks have occurred. Then they begin avoiding those places.

Some people with panic disorder develop agoraphobia, a fear of leaving home. They may stop working, going to school or shopping and become recluses. Left untreated, panic disorder also can lead to clinical depression, and a risk of attempted suicide is about 20 times higher than with people in the general population.

Fortunately, panic disorder can be treated easily with medications or a type of brief psychotherapy.

Getting a diagnosis may mean going through a battery of medical tests to make sure that the symptoms are not caused by heart disease or some other life-threatening disorder.

Banish any thought that panic disorder occurs because a person is emotionally "weak"; most research suggests panic disorder results from a malfunction in brain circuits that prepare people to respond to danger. People with panic disorder develop inappropriate physical responses to situations that pose no real danger.

Panic disorder usually begins in young adulthood. About half of all people with panic disorder develop it before 24. Women are twice as likely to be diagnosed as men. The condition also may run in families. About half of the people with panic disorder have a relative who also had panic attacks.

Drug treatment usually involves a newer family of medicines called selective serotonin reuptake inhibitors, which work by prolonging the effects of serotonin, a natural brain chemical. They are used for several other conditions, and include Zoloft, Paxil, Prozac, Celexa and Serzone.

Selective serotonin reuptake inhibitors often have fewer side effects than an older group of medicines, the tricyclic antidepressants, that include Tofranil, Elavil, Anafranil and Norpramin. Doctors may prescribe other drugs, as well, including tranquilizers like Valium, Xanax or Klonopin.

Studies have shown that a short-term psychotherapy, called cognitive-behavioral therapy, also is effective. CBT teaches individuals how to view panic attacks differently, and manage anxiety-provoking situations.

Patients may learn, for instance, to avoid "catastrophizing" - viewing the shortness of breath, thumping heart and other panic-attack symptoms as life-threatening. That often creates a cycle of fear that triggers still more symptoms. Instead, they learn that the symptoms are harmless, and pass within a few minutes.

Cognitive-behavioral therapy may also teach patients techniques to cope with anxiety, such as avoiding rapid shallow breaths, and instead take slow deep breaths from the diaphragm.

The National Institute of Mental Health estimates that treatment can prevent or reduce panic attacks in 70-90 percent of cases.

Michael Woods writes for the Toledo Blade. Comment by clicking here.


© 2001, SHNS