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The Panic Button

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Photo by Francisco Moreno on Unsplash.

The sudden onset of a pounding heartbeat, drenching sweats, chills, shortness of breath, tingly hands, chest pain, and nausea, accompanied by an overwhelming fear for your life or a sense of impending doom might make you think you are having a heart attack, and to be sure, if you have never experienced this collection of symptoms before you would be wise to rule out a cardiac event.

However, for many of us, up to 10% of the population, these symptoms signal the onset of a panic attack, an episode that feels as serious as a heart attack, and that can develop into a condition known as panic disorder when it repeats consistently over time. About a third of us will have a panic attack at some point in our lives, but for those who experience them as regularly as a couple of times a month up to several times a week, the disorder can be a debilitating illness.

Everyday impact of panic disorder

There can be a kind of hangover characterized by brain fog, sluggishness, and achiness, prolonging the suffering.

Besides the actual event which may typically last from 5-30 minutes, panic disorder spills over into everyday life, making the sufferer constantly anxious about another attack and even afraid to go places where an attack has occurred in the past. A person with panic disorder may have difficulties in work or school settings owing to the incessant apprehension of another episode. Furthermore, in the wake of an episode that has caused the nervous system to create all the body’s chemical changes that put it in “fight, flight, or freeze” mode, there can be a kind of hangover characterized by brain fog, sluggishness, and achiness, prolonging the suffering.

Causes and symptoms

It is not completely understood what causes panic attacks, but most theories suggest an imbalance in brain chemistry, involving cortisol, serotonin, and GABA (gamma-aminobutyric acid), with some individuals prone to hyper-excitability in some areas of the brain. Genetic studies indicate the odds are 40% greater for developing the disorder if a close family member has been diagnosed with it.

According to the definition of panic disorder laid out in the Diagnostic and Statistical Manual of Mental Health Disorders (DSM), panic attacks occur without warning and with no obvious specific trigger. Besides the symptoms mentioned above, the sense of loss of control, as well as the sense of being disconnected from reality, and a detachment from the sense of self are often experienced. All of these symptoms whip up in just a few minutes and their aftermath creates a pervasive dread of recurrence that can take over one’s life.

Treatment options

Treatment and management of the disorder can be through various kinds of talk therapy or drugs.

Patients suffering from panic disorder have higher rates of cardiovascular, gastrointestinal, and respiratory problems, along with other social and psychological issues including obsessive-compulsive disorder and social phobia. Because most sufferers experience such pronounced physical symptoms during attacks, they often refuse or avoid mental health treatments and instead seek medical solutions that are not effective.

Treatment and management of the disorder can be through various kinds of talk therapy or drugs. Cognitive Behavioral Therapy (CBT) is one of the most popular and effective modalities of therapy. Because people with panic disorder are often susceptible to negative thoughts and emotional patterns, CBT relies on retraining the mind to identify and replace the negative patterns. Because the patient typically responds to an attack by wanting to suppress symptoms, they may actually be fueling the fire of the attack pattern because when the brain identifies a threat, the nervous system ramps up in response and a vicious cycle begins. Through CBT, the brain learns a different approach, relieving the nervous system of its threat response.

The most effective pharmaceuticals used in the treatment of panic disorder are selective serotonin reuptake inhibitors (SSRIs), a kind of anti-depressant, which can bring the condition under control in as little as 2-4 weeks. SSRIs are not without side effects and compliance can be an issue with this kind of treatment.

Treatment is not a guarantee that symptoms won’t return, unfortunately. As many as 60% of patients will have a recurrence of panic attacks within 6 months. Additionally, most sufferers of the disorder have other mental health issues, muddying the waters of finding a precise treatment. Panic disorder is not considered curable. Quality of life is compromised by accompanying social and medical issues, leading to poor outcomes.

Differentiation from anxiety attacks

Anxiety attacks generally are triggered by an identifiable event or condition.

It’s important to note that anxiety attacks are not the same as panic attacks. Anxiety attacks generally are triggered by an identifiable event or condition, and the symptoms tend to be less severe, although they can be comparable in duration. The DSM does not recognize anxiety attacks, merely mentioning anxiety as a factor in numerous other conditions.

If you or someone you love suffers from panic attacks, it is best to acknowledge the situation and seek help. Far too often the stigmatization of mental health issues will cause a person to pursue purely medical treatment, which at best is little more than a band-aid. It is through confronting the underlying thought patterns and brain chemistry that the most lasting remedies have a chance at success.

Panic attacks jumped in incidence during the early days of the pandemic, and have increased in general alongside the spiking rise in stress levels across the globe. We are all in this together, so let’s do what we can to help each other manage stress and make more space for kindness and compassion.

Ann Constantino, submitted on behalf of the SoHum Health’s Outreach department.