Panic disorder is a fairly common condition in which a person has uncomfortable episodes of fear or anxiety that occur suddenly and often without warning. The attacks – called panic attacks – can last from minutes to hours. They may occur occasionally or quite frequently and the cause or ‘trigger’ of these attacks may not be obvious right away. There is a familial tendency, with the age of onset before 25 years old. It occurs more often in women than men (2:1) and approximately 3-5% of the population is affected. Panic disorder can occur in children, but is often not recognized..
What happens during a panic attack?
The physiologic factors involved stem around arousal of the autonomic nervous system in the manner of a ‘fight or flight’ response to fearful inner impulses and emotions. This stress response results in the characteristic body sensations often seen in a person in a panic attack.
Panic attacks are often associated with physical symptoms such as shaking, a feeling your heart is pounding or racing, sweating, chest pain, shortness of breath, a feeling of choking, nausea, cramping, diarrhea, dizziness, an out-of-body sensation (a feeling of being apart from oneself), tingling in the hands, chills or hot flashes, and headache. A person may also have an extreme fear of losing control, going crazy or dying during a panic attack. It is very rare for a person to have all of these symptoms at once, although the presence of at least 4 symptoms strongly suggests the diagnosis of panic disorder.
Once panic starts, stresses that normally would have been small and manageable become overwhelming. A palpable, screaming fear rises inside and for no apparent reason; sufferers feel they are being choked by a panic that races the heart and paralyzes. Not surprisingly, they begin to fear the attacks themselves. This can lead to agoraphobia. Agoraphobia occurs when a person finds it difficult to leave home or another safe area because of the fear of having a panic attack in public or of not having an easy way to escape if the symptoms start.
Many of the symptoms that occur during a panic attack are the same as the symptoms of diseases of the heart, lung, intestine or nervous system. The similarities of panic disorder to other diseases may add to the person’s fear and anxiety during and after a panic attack. Panic is not necessarily brought on by a recognizable circumstance, and it may remain a mystery to the person involved. These attacks come ‘out of the blue’. At other times, excessive stress or other negative life conditions can trigger an attack.
Nowadays, panic attacks and agoraphobia can be treated successfully in the majority of cases. In fact, it is estimated that the appropriate therapy from a knowledgeable therapist helps close to 90% of panic attack sufferers.
What can contribute to Panic Attacks?
- Estrogens Low. There have been research studies in the past that showed association of panic attacks with decreased levels of estrogen in women. In one article , the authors concluded that womens’ brains have been shown to be an estrogen target organ. It is proposed that whenever brain estrogen levels fall below the minimum brain estrogen requirement, for whatever reason and at whatever age, brain center dysfunction may ensue and may cause symptoms of anxiety.
- Thyroiditis. Occasionally an under-active thyroid condition called Hashimoto’s autoimmune thyroiditis, known as HAIT or, simply, thyroiditis has been associated with a range of anxiety symptoms including panic attack.
- High Sugar Diet. Eating a lot of foods high in refined sugar increases blood lactate levels and may induce panic in susceptible persons.
- Smoking. A history of smoking may play a small role in the onset of panic disorder in women, but not men. In comparing 217 patients with panic disorder to 217 age-matched controls, it was found that female patients with panic disorder had a significantly higher smoking prevalence at the onset of their illness than did control subjects 10 years previously (54% versus 35%). Current smoking prevalence was also higher in those patients with panic attack versus controls (40% versus 25%). Male smoking rates did not differ between the groups and caffeine intake did not appear to explain these findings.
Should I seek treatment if I’m having panic attacks?
Because of embarrassment or the fear of taking medicine, many people who have panic attacks don’t seek medical care. If you have panic attacks, it is very important to seek medical care and discuss your problem with your doctor. After you have been evaluated thoroughly, your doctor will be able to tell you if the panic attacks are related to panic disorder or are caused by another problem.
Other treatment considerations.
Several kinds of psychological counseling are very effective for treating panic disorder and are as effective as medicine, but do not work as quickly. If an underlying contributing condition can not be found, a combination of both psychological counseling and medicine seems to be the best treatment for panic disorder. Types of behavioral therapy involving counter-conditioning treatment of fear responses have helped to abort panic attacks, but are of little use during the attack. By
imagining a scene a person is just a little afraid of and then using relaxation techniques and affirmations to overcome the fear, people have been able to progressively face more stressful imagined fearful scenes until they were able to tolerate their worst fears.
One study reported that in 9 of 22 patients with panic disorders, attacks were more frequent in winter. The authors suggest that, since there was positive benefit from light therapy in a single patient who underwent light treatment, seasonal panic disorder may be a variant of seasonal affective disorder (SAD). They encouraged the possibility of light therapy in patients with seasonal panic disorder.
Urine samples were taken from 14 untreated panic attack patients and compared to those from 13 age- and sex-matched controls. It was found that panic attack patients had significantly higher pH (alkaline) levels than controls (7.0 versus 5.5). It was suggested that panic disorder individuals may have a series of subtle hyperventilating episodes (breathing too rapidly and/or deeply) that may account for this alkalinity. Urine pH could be a simple way to evaluate respiratory status and subsequently the success of breathing retraining in patients with panic disorder. Since slowing down the breathing rate or breathing into a paper bag will help restore normal pH, these techniques have helped reduce symptoms in some cases.
Additional support for an overly acidic system, apart from breathing, comes from the fact that in people with chronic anxiety unrelated to life events, an injection of sodium lactate can trigger a panic attack.
How long does treatment last?
How long treatment should continue depends on you. The complete elimination of panic attacks is a reasonable goal. Your doctor will design a treatment plan just for you. A treatment period lasting at least 6 to 9 months is usually recommended. Some people with panic disorder are able to stop taking medicine after only a short time, and some people need treatments over long periods of time or even for their lifetime.
Psychiatric specialists from the University of Göttingen in Germany recently reported results from a new study that found levels of the adrenal stress hormone cortisol surging in the beginning phase of a panic attack. Researchers had twenty-five patients with panic disorder collect multiple saliva samples over a two-hour period while in the grips of a panic attack. Then the patients collected samples again twenty-four hours later, after the attack had subsided. Investigators discovered that levels of cortisol were markedly higher, by nearly 40%, during the early stages of the panic attack than they were the next day, when symptoms had abated.
Signs, symptoms & indicators of Panic Attacks
Panic attacks
Counter Indicators
(No) history of panic attacks
Risk factors for Panic Attacks
Chronic Thyroiditis
Hashimoto’s autoimmune thyroiditis has been associated with a range of anxiety symptoms including panic attack.
Mitral Valve Prolapse
People with mitral valve prolapse (MVP) seem somehow to be ‘wired’ differently. Their autonomic response can be much more volatile and unstable so that normal stresses and surprises set off an exaggerated response, flooding their systems with stress hormones called the catecholamines. In fact, there may not be a specific stressor; people with MVP are intermittently and unpredictably awash in their own catecholamines. This leaves them alternately innervated and exhausted – “wired but tired” is a common feeling.
If the sympathetic nervous system of a person with MVP is aroused, they can suddenly feel crushing chest pain, with heartbeat racing and pounding. They may begin to hyperventilate, feel short of breath, and break out into a cold sweat. This may occur without warning or immediate threat. There can be sensations of chest pain, a feeling of doom or detachment, a fear of dying, or a desire to flee. If they don’t know why this is happening, the symptoms themselves are scary, and the fear of the unknown can prompt an even greater release of stress hormones, driving them into the kind of meltdown of the autonomic nervous system called a panic attack. This is an intense and scary experience, the sensations of which can easily be confused with those of a heart attack. Once people experience this, they generally have a persistent fear of having another attack, which puts them on a “hair trigger”, ready to respond to the slightest symptoms by releasing the very stress hormones that induce the panic attacks, thus escalating a new attack.
Excess Sugar Consumption
Eating a lot of foods high in refined sugar increases blood lactate levels and may induce panic in susceptible persons.
Cigarette Smoke Damage
Female patients with panic disorder had a significantly higher smoking prevalence at the onset of their illness than did control subjects 10 years previously (54% vs. 35%). Current smoking prevalence was also higher in those patients with panic attack versus controls (40% vs. 25%). Male smoking rates did not differ between the groups. [Psychiatric Research, 1992;43: pp.253-262]
Low Progesterone or Estrogen Dominance
It has been reported that women with low progesterone levels experience less intense or less frequent panic attacks after progesterone supplementation. In some cases, sublingual progesterone in olive oil has produced immediate benefit.
Low Estrogen Levels
There has been research showing an association of panic attacks with decreased levels of estrogen in women.
Low Adrenal Function / Adrenal Insufficiency
When adrenal function is low, caffeine consumption may contribute to panic attacks. Caffeine interferes with adenosine, a brain chemical that normally has a calming effect, and raises the level of lactate, a biochemical known to produce panic attacks.
EFA (Essential Fatty Acid) Type 3 Requirement
In one study, 3 out of 4 patients with panic attacks or a history of agoraphobia for 10 or more years improved within 3 months after taking flaxseed oil.
Panic Attacks suggests the following may be present
Mitral Valve Prolapse
People with mitral valve prolapse (MVP) seem somehow to be ‘wired’ differently. Their autonomic response can be much more volatile and unstable so that normal stresses and surprises set off an exaggerated response, flooding their systems with stress hormones called the catecholamines. In fact, there may not be a specific stressor; people with MVP are intermittently and unpredictably awash in their own catecholamines. This leaves them alternately innervated and exhausted – “wired but tired” is a common feeling.
If the sympathetic nervous system of a person with MVP is aroused, they can suddenly feel crushing chest pain, with heartbeat racing and pounding. They may begin to hyperventilate, feel short of breath, and break out into a cold sweat. This may occur without warning or immediate threat. There can be sensations of chest pain, a feeling of doom or detachment, a fear of dying, or a desire to flee. If they don’t know why this is happening, the symptoms themselves are scary, and the fear of the unknown can prompt an even greater release of stress hormones, driving them into the kind of meltdown of the autonomic nervous system called a panic attack. This is an intense and scary experience, the sensations of which can easily be confused with those of a heart attack. Once people experience this, they generally have a persistent fear of having another attack, which puts them on a “hair trigger”, ready to respond to the slightest symptoms by releasing the very stress hormones that induce the panic attacks, thus escalating a new attack.
Post Traumatic Stress Disorder
New Geisinger-lead research dispels a recent notion in psychiatry that if a person experiences a panic attack during a traumatic event that they will likely suffer from post-traumatic stress disorder (PTSD) in the future.
The study appears in the April edition of the journal Psychiatry Research and was co-authored by Geisinger Senior Investigator Joseph Boscarino, Ph.D., MPH, and Kent State University social psychologist Richard E. Adams, Ph.D.
The new research suggests that factors such as a prior history of depression, a person’s emotional support network and self-esteem are better indicators of a person’s susceptibility to PTSD.
It was previously thought that panic attacks immediately following traumatic events such as a car accident would trigger or predict PTSD in the long-term. But the study’s authors say there is more to it.
“Clinicians should look at other signs of mental-health stress such as not sleeping, recently experiencing stressful life events and withdrawing from social interactions,” Boscarino said. “Our study suggests that many factors contribute to post-traumatic stress disorder not just panic attacks during the event.” [08 Apr 2009 ]
Recommendations for Panic Attacks
Kava
Germany’s Commission E, that country’s official herb-regulating body, has authorized the use of kava as a medical treatment for “states of nervous anxiety, tension, and agitation.”
Alkalizing Agents/Diet
For people with chronic anxiety unrelated to life events, injection of an acid such as sodium lactate can trigger a panic attack, suggesting a connection with tissue pH.
Sugars Avoidance / Reduction
Eating a lot of foods high in refined sugar increases blood lactate levels and may induce panic in susceptible individuals.
Caffeine/Coffee Avoidance
Coffee can cause adrenal insufficiency which in turn can lead to panic attacks.
Sunlight / Light Exposure
A study found that 9 of 22 patients had panic attacks more frequently in winter.
Tobacco Avoidance
A history of smoking may play a small role in the onset of panic disorder in women, but not in men.
Test Thyroid Function
Hashimoto’s autoimmune thyroiditis has been associated with a range of anxiety symptoms including panic attack.
Inositol
Inositol has been found to be effective in treating panic disorder. Inositol works by regulating the action of serotonin, a calming neurotransmitter, within the nerve cells. Its safety has been noted up to 20gm per day.
Visualization / Relaxation Techniques
Types of behavioral therapy involving counter-conditioning treatment of fear responses have helped to abort panic attacks.
Counseling
“Children who are not cured of their phobias run a great risk of developing other areas of anxiety later on. It’s therefore important to find effective forms of treatment that can reduce this risk. The method we have now tested also functions for other types of phobias,” says Lena Reuterskiöld.
In a one-session treatment the children, together with their therapist, gradually approach what they are afraid of in a controlled and planned manner. The therapist describes and carefully demonstrates before the child is allowed to try. Because the children remain in the anxiety-inducing situation, they can experience how their anxiety and fear abates and how the expected catastrophe in fact does not occur. With the patient remaining in the situation for an extended period, without running away, new learning occurs, producing a development toward a new behavior. This is all done on a voluntary basis, which is also a precondition for successful treatment.
“One-session treatment has also proven to be effective over time. Adults who have been treated with this method have been able to notice the effects of the treatment more than a year after the session. And nothing indicates that the effect would taper off sooner in children, which we assume will soon be confirmed by a follow-up study,” says Lena Reuterskiöld.
Besides the time aspect, the treatment offers other positive consequences.
“In cases where there anxiety problems of another kind than that targeted by the treatment, they too were alleviated in connection with a one-session treatment. This seems to indicate that the children take with them the knowledge they attain from this brief intervention and apply it to other problem areas,” says Lena Reuterskiöld.
The dissertation is based on three empirical studies of children and adolescents with various specific phobias in Stockholm, Sweden, and in Virginia in the US. The overarching purpose of the treatment was to contribute to our understanding of fears, anxiety, and specific phobias in children and to evaluate the efficacy and the transferability of one-session treatment for specific phobias in children from one culture to another.
Key
| Weak or unproven link |
| Strong or generally accepted link |
| Proven definite or direct link |
| Very strongly or absolutely counter-indicative |
| May do some good |
| Likely to help |
| Highly recommended |
Glossary
Panic Disorder
A condition whereby an affected individual has recurrent and unexpected panic attacks and worries a great deal of the time about having another. The individual may also have persistent concern or fear that a panic attack might cause unrelated health problems or a demonstrable change in usual behavior. The symptoms of panic disorder must be present for at least one month to confirm the diagnosis.
Anxiety
Apprehension of danger, or dread, accompanied by nervous restlessness, tension, increased heart rate, and shortness of breath unrelated to a clearly identifiable stimulus.
Panic Attack
A brief, irrational episode of fear that is perceived as so real that an individual may be driven to escape from the place or situation where it occurs. The attack is sudden and increases in severity until it leaves, usually within ten minutes. Panic attack symptoms are numerous and involve both mental and physical signs and symptoms. A panic attack can occur in other anxiety states such as agoraphobia and with certain activities and places. It may occur spontaneously without an apparent cause.
Nervous System
A system in the body that is comprised of the brain, spinal cord, nerves, ganglia and parts of the receptor organs that receive and interpret stimuli and transmit impulses to effector organs.
Nausea
Symptoms resulting from an inclination to vomit.
Diarrhea
Excessive discharge of contents of bowel.
Estrogen
One of the female sex hormones produced by the ovaries.
Thyroid
Thyroid Gland: An organ with many veins. It is at the front of the neck. It is essential to normal body growth in infancy and childhood. It releases thyroid hormones - iodine-containing compounds that increase the rate of metabolism, affect body temperature, regulate protein, fat, and carbohydrate catabolism in all cells. They keep up growth hormone release, skeletal maturation, and heart rate, force, and output. They promote central nervous system growth, stimulate the making of many enzymes, and are necessary for muscle tone and vigor.
Autoimmune Disease
One of a large group of diseases in which the immune system turns against the body's own cells, tissues and organs, leading to chronic and often deadly conditions. Examples include multiple sclerosis, rheumatoid arthritis, systemic lupus, Bright's disease and diabetes.
Refined Sugar
The term 'refined sugar' includes not only the “sugar” listed in ingredient listings, but also brown sugar, glucose, fructose and dextrose. Obvious sources include jams and jellies; hidden sources are often mayonnaise, ketchup, salad dressings and other condiments.
pH
A measure of an environment's acidity or alkalinity. The more acidic the solution, the lower the pH. For example, a pH of 1 is very acidic; a pH of 7 is neutral; a pH of 14 is very alkaline.
Score
a:10:{s:4:"type";s:4:"text";s:12:"instructions";s:0:"";s:8:"required";i:0;s:17:"conditional_logic";i:0;s:7:"wrapper";a:3:{s:5:"width";s:0:"";s:5:"class";s:0:"";s:2:"id";s:0:"";}s:13:"default_value";s:0:"";s:11:"placeholder";s:0:"";s:7:"prepend";s:0:"";s:6:"append";s:0:"";s:9:"maxlength";s:0:"";}
Chronic
Usually Chronic illness: Illness extending over a long period of time.
Sodium
An essential mineral that our bodies regulate and conserve. Excess sodium retention increases the fluid volume (edema) and low sodium leads to less fluid and relative dehydration. The adult body averages a total content of over 100 grams of sodium, of which a surprising one-third is in bone. A small amount of sodium does get into cell interiors, but this represents only about ten percent of the body content. The remaining 57 percent or so of the body sodium content is in the fluid immediately surrounding the cells, where it is the major cation (positive ion). The role of sodium in the extracellular fluid is maintaining osmotic equilibrium (the proper difference in ions dissolved in the fluids inside and outside the cell) and extracellular fluid volume. Sodium is also involved in nerve impulse transmission, muscle tone and nutrient transport. All of these functions are interrelated with potassium.
Hormones
Chemical substances secreted by a variety of body organs that are carried by the bloodstream and usually influence cells some distance from the source of production. Hormones signal certain enzymes to perform their functions and, in this way, regulate such body functions as blood sugar levels, insulin levels, the menstrual cycle, and growth. These can be prescription, over-the-counter, synthetic or natural agents. Examples include adrenal hormones such as corticosteroids and aldosterone; glucagon, growth hormone, insulin, testosterone, estrogens, progestins, progesterone, DHEA, melatonin, and thyroid hormones such as thyroxine and calcitonin.
Catecholamine
Any of various amines (as epinephrine, norepinephrine, and dopamine) that function as hormones and/or neurotransmitters.
Sympathetic Nervous
Sympathetic nervous system: Portion of the autonomic nervous system that is generally associated with “flight or fight” reactions by increasing blood circulation and respiration and decreasing digestion.
Sublingual
Situated or administered under the tongue, for example sublingual glands or sublingual tablets.
PTSD
Post Traumatic Stress Disorder.