FM/CFS/ME RESOURCES - Anxiety and Panic Attacks


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Anxiety and Panic Attacks


Anxiety is a normal reaction to stress. It helps one deal with tense situations in the office, study harder for an exam, keep focused on an important speech. In general, it helps one cope. But when anxiety becomes an excessive, irrational dread of everyday situations, it has become a disabling anxiety disorder.

Anxiety can be accompanied by physical effects such as heart palpitations, nausea, chest pain, shortness of breath, stomach aches, or headaches. Physically, the body prepares to deal with what it perceives as a threat. Blood pressure and heart rate are increased, sweating is increased, blood flow to muscle groups increases and immune and digestive system functions are inhibited (the fight or flight response). External signs of anxiety may include pale skin, sweating, trembling and many others. Someone suffering from anxiety might also experience it as a sense of dread or panic.

Panic Attacks

Panic attacks are sudden surges of overwhelming fear that that comes without warning and without any obvious reason. It is far more intense than having anxiety or the feeling of being 'stressed out' that most people experience. One out of every 75 people worldwide will experience panic attacks at one time in their lives.

People who have full-blown, repeated panic attacks can become very disabled by their condition and should seek treatment before they start to avoid places or situations where panic attacks have occurred. For example, if a panic attack happened in an elevator, someone with panic disorder may develop a fear of elevators that could affect the choice of a job or an apartment, and restrict where that person can seek medical attention or enjoy entertainment

Panic attacks are not dangerous, but they can be terrifying, largely because it feels 'crazy' and 'out of control.' Panic disorder is frightening because of the panic attacks associated with it, and also because it often leads to other complications such as phobias, depression, substance abuse, medical complications, even suicide.

Facts About Anxiety and Panic Attacks

In any given year, approximately 40 million American adults 18 years and older are affected by anxiety disorders. This startling data means that anxiety disorders cost the United States more than $42 billion dollars a year. According to "The Economic Burden of Anxiety Disorders", a study commissioned by the ADAA and published in The Journal of Clinical Psychiatry, Vol. 60, No. 7 July 1999 this is almost 1/3 of the country’s $148 billion total health bill. Those with anxiety disorders are three to five times more likely to seek medical treatment and six times more likely to be hospitalized for psychiatric disorders than people that do not suffer from anxiety.

Approximately 6.8 million are affected by Generalized Anxiety Disorder, 6 million by anxiety attacks and panic attacks, 7.7 million by Posttraumatic Stress Disorder, 15 million by social anxiety disorder, 2.2 million by OCD, and 19 million by Specific Phobia. Anxiety attacks and panic attacks are the most common emotional disorders and are more common than bipolar disorder, schizophrenia, alcohol abuse or depression. People with Anxiety and panic attacks seek relief for symptoms that mimic physical illnesses which total more than $22.84 billion and are associated with repeated use of health care services.

What A Panic Attack Feels Like

The main symptom of a Panic Anxiety Disorder is the panic attack itself. Panic Anxiety Disorder is a medical disorder characterized by severe and sudden episodes.

It is important to mention that sudden episodes of the symptoms listed above caused by another reasonable cause are not panic attacks. Two such reasonable causes would be (1) a certain medical ailment that might mimic a panic attack, or (2) a life threatening experience immediately preceding the attack. If these reasonable causes are found not be the cause of the problem then there is the possibility of a Panic Disorder.

Panic attacks reach maximum intensity within a minute or two once they begin. They diminish slowly over the next 30 minutes or the next several hours. It is common for the first attack to cause a person to go to an emergency medical facility. Subsequent attacks occur several times a month and are often as severe as the initial attack.

About three fourths of Panic Disorder patients are women. Panic Anxiety Disorder begins most often when people are 20-30 years old. It begins less often in teenagers or persons in their forties. It is uncommon for the disorder to appear in the elderly for the first time.

It is important to note that although a few experts say it is more common in persons who experienced a separation experience as a child, many of experts feel that Panic Anxiety Disorder afflicts emotionally healthy people. Persons having Panic attacks are no more likely than the average American to have suffered from emotional problems at the time the disorder begins.

Symptoms of a Panic Attack

  • raging heartbeat
  • difficulty breathing, feeling as though you 'can't get enough air
  • terror that is almost paralyzing
  • nervous, shaking, stress
  • heart palpitation, feeling of dread
  • dizziness, lightheadedness or nausea
  • trembling, sweating, shaking
  • choking, chest pains, distress
  • fear, fright, afraid, anxious
  • hot flashes, or sudden chills
  • tingling in fingers or toes ('pins and needles')
  • fearful that you're going to go crazy or are about to die

Treatments for Panic Attacks

Self-Care at Home

Taking care of panic attacks at home is possible, but be careful not to mistake another serious illness (such as a heart attack) for a panic attack. In fact, this is the dilemma that doctors face when people experiencing panic are brought to a hospital's emergency department or the clinic.

There are things that people with panic disorder can do to assist with their own recovery. Since substances like caffeine, alcohol, and illicit drugs can worsen panic attacks, those things should be avoided. Other tips for managing panic attacks include engaging in aerobic exercise and stress-management techniques like deep breathing and yoga on a regular basis, since these activities have also been found to help decrease panic attacks.

Although many people breathe into a paper bag in an attempt to alleviate the hyperventilation that can be associated with panic, the benefit received may be the result of the individual thinking it will help (a placebo effect). Unfortunately, breathing into a paper bag while having trouble breathing can worsen symptoms when the hyperventilation is caused by a condition associated with oxygen deprivation, like an asthma attack or a heart attack.

If a person has been diagnosed with panic attacks in the past and is familiar with the signs and symptoms, the following techniques may help the person stop the attack. You may also try these tips for overcoming the symptoms of a panic attack.

  • First, relax your shoulders and become conscious of any tension that you may be feeling in your muscles.

  • Then, with gentle reassurance, progressively tense and relax all the large muscle groups. Tighten your left leg while taking a deep breath in, for example, hold it, then release the leg muscles and the breath. Move on to the other leg. Move up the body, one muscle group at a time.

  • Slow down your breathing. This may best be done by blowing out every breath through pursed lips as if blowing out a candle. Also, place your hands on your stomach to feel the rapidity of your breathing. This may allow you to further control your symptoms.

  • Tell yourself (or someone else if you are trying this technique with someone) that you are not "going crazy." If you are concerned about not being able to breathe, remember that if you are able to talk, you are able to breathe.

  • If a person is diagnosed with any medical illness, especially heart disease, home treatment is not appropriate. Even if the person has a history of panic attacks, home care is not appropriate if there is any new or otherwise worrisome symptom.

Panic Attacks Medical Treatment

Generally, panic attacks are treated with reassurance and relaxation techniques. By definition, panic attacks last less than an hour, so many times a person already feels much better by the time he or she makes it to the doctor's office. Nevertheless, because the diagnosis is made by excluding more dangerous causes, people may be given medications during their attack.

  • If the doctor is suspicious of a cardiac (heart) cause, then the person might be given aspirin and various blood pressure medicines. An IV line may be started and fluids given. Some doctors will prescribe various antianxiety medicines such as diazepam (Valium) or lorazepam (Ativan) during the evaluation.

  • Once the diagnosis of panic attack is made, however, the person may be surprised that no medicines are prescribed. Before medications are started, the person requires further evaluation by a mental-health professional to check for the presence of other mental-health disorders. These may include anxiety disorders, depression, or panic disorder (a different diagnosis than panic attack).

  • If medications are prescribed, several options are available. Selective serotonin reuptake inhibitors (SSRIs), selective serotonin and norepinephrine reuptake inhibitors (SSNRIs), and the benzodiazepine families of medications are considered to be effective treatment of panic disorder. SSRIs include:

    SSNRIs include:

    Clinical trials have shown SSRIs reduce the frequency of panic attack up to 75%-85%. SSRIs must be taken three to six weeks before they are effective in reducing panic attacks and are taken once daily.

  • Beta-blocker medications like propranolol are sometimes used to treat the physical symptoms associated with panic.

  • Benzodiazepines are often used to provide short-term relieve of panic symptoms. Clonazepam (Klonopin) and lorazepam (Ativan) are examples of this group of medications. Although another benzodiazepine, alprazolam (Xanax), is often used to treat panic attacks, the short period of time that it works can cause the panic sufferer to have to take it multiple times each day. Benzodiazepines tend to be effective in decreasing panic attacks by up to 70%-75% almost immediately; however, they sometimes require taking up to four times per day to be effective. Additional drawbacks include sedation, memory loss, and after several weeks, tolerance to their effects and withdrawal symptoms may occur.

  • Tricyclic antidepressants such as imipramine (Tofranil) and MAO inhibitors such as phenelzine (Nardil) have also been used, but many individuals experience side effects that are difficult to tolerate.

  • The person being treated will be closely monitored for the possibility of side effects that can range from minor to severe and can sometimes even be life-threatening. Because of the possible risks to the fetus of a mother being treated with medications for panic attacks, psychotherapy continues to be the treatment of first choice when treatment of this symptom is given during pregnancy.

  • Psychotherapy is at least as important as medication treatment of panic disorder. In fact, research shows that psychotherapy alone or the combination of medication and psychotherapy treatment are more effective than medications alone in overcoming panic attacks. To address anxiety, cognitive behavioral therapy is widely accepted as an effective form of psychotherapy. This form of therapy seeks to help those with panic disorder identify and decrease the self-defeating thoughts and behaviors that reinforce panic symptoms. Behavioral techniques that are often used to decrease anxiety include relaxation and gradually increasing the panic sufferer's exposure to situations that may have previously caused anxiety. Helping the anxiety sufferer understand the emotional issues that may have contributed to developing symptoms is called panic-focused psychodynamic psychotherapy and has also been found to be effective.

Often, a combination of psychotherapy and medications produces good results. Improvement is usually noticed by about three months. Thus, appropriate treatment for panic disorder can prevent panic attacks or at least substantially reduce their severity and frequency, bringing significant relief to up to 90% of people with panic disorder.

Alternative Medicine

Researchers have explored a number of natural remedies as possible treatments for anxiety disorders, including panic disorder. Studies to date have concluded that two alternative therapies, in particular, have potential in the treatment of panic disorder.

  • Relaxation training. Relaxation techniques include deep breathing, yoga, meditation and progressive muscle relaxation, which is accomplished by tensing one muscle at a time, and then completely releasing the tension, until every muscle in the body is relaxed. Studies have found that these techniques may be as effective or nearly as effective as cognitive behavioral therapy for some people with panic disorder.

  • The nutritional supplement inositol. This oral supplement, which influences the action of serotonin, may reduce the frequency and severity of panic attacks.

Talk with your doctor before trying any natural therapies. These products can cause side effects and may interact with other medications. Your doctor can help determine if they are safe for you.

Lifestyle and Home Remedies

While panic attacks and panic disorder benefit from professional treatment, you can also help manage your symptoms on your own. Some of the lifestyle and self-care steps you can take include:

  • Stick to your treatment plan. Facing your fears can be difficult, but treatment can help you feel like you're not a hostage in your own home.

  • Join a support group for people with panic attacks or anxiety disorders so that you can connect with others facing the same problems.

  • Avoid caffeine, alcohol and illegal drugs, all of which can trigger or worsen panic attacks.

  • Practice stress management and relaxation techniques. Meditation, yoga and guided imagery may be good options.

  • Get physically active, since aerobic activity may have a calming effect on your mood.

  • Get sufficient sleep — enough so that you don't feel drowsy during the day.

There's no sure way to prevent panic attacks or panic disorder. However, getting treatment for panic attacks as soon as possible may help stop them from getting worse or becoming more frequent. Sticking with your treatment plan can help prevent relapses or worsening of panic attack symptoms. Practicing relaxation and stress management techniques may be helpful, too.

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