Do you get panic attacks?

Dear Dr. Jao,

Greetings! It has been a year since I was diagnosed by a neurologist as suffering from panic attacks, which to my understanding, is an anxiety disorder. It was quite a difficult ordeal; I felt so alone, so depressed and so helpless. I had fears of being alone, I refused to go out and eventually became anti-social. I was too stressed out at that time.

For a person who has lots of energy and full of life and confidence, I cannot believe what happened to me. I guess the pressure of law school and the dreaded bar exams led to my panic attacks. My doctor prescribed Seroxat, an anti-depressant which I took for 11 months.

Thank God that with the support of my family, lots of prayers and a worry/stress-free life, I was able to pull through. I hope you can share and discuss in your column what a panic attack is all about. I know it will help enlighten people who work too hard, who are too competitive and who push themselves to the limit. More power and God bless!

Very truly yours,

Maia of Quezon City

Dear Maia,

Thank you for your letter. I’m sure a lot of the readers will be inspired because you were able to overcome your panic attacks. If you were not motivated to help yourself, recovery from panic attacks may take forever even with the most expensive medications and the best shrink. Congratulations! I hope you won’t get panic attacks again.

So what are panic attacks? According to the fourth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), a panic attack is defined as a discreet period of intense fear or discomfort accompanied by at least four of the following somatic or cognitive symptoms, which develop abruptly and reach a peak within 10 minutes:

1) Palpitations, pounding heart, or accelerated heart rate

2) Sweating

3) Trembling

4) Sensations of shortness of breath or smothering

5) Feeling of choking

6) Chest pain or discomfort

7) Nausea or abdominal distress

8) Feeling dizzy, unsteady lightheaded or faint

9) Derealization (feelings of unreality) or depersonalization (being detached from oneself)

10) Fear of losing control

11) Fear of dying

12) Paresthesias (numbness or tingling sensation)

13) Chills or hot flushes

Panic attacks can be seen in mental disorders other than panic disorder. Examples are specific phobia, social phobia and post-traumatic stress disorder. Panic attacks can be unexpected and can occur any time and can happen even without any identifiable psychosocial stressor. Panic attacks associated with a specific phobia or social phobia are usually expected and are associated with a specific stimulus. Some panic attacks occur when exposed to a specific triggering factor.

In the past, since those with panic attacks often consulted non-psychiatrists first, some cases were misdiagnosed as a serious medical problem like a heart attack or labeled as a hysterical symptom. In 1980, panic disorder was recognized as a separate mental disorder and since then mental health care providers have become better able to recognize a panic disorder.

Panic Disorder is said to be characterized by the spontaneous, unexpected occurrence of panic attacks. Such attacks may vary from several attacks during 24 hours to only a few attacks during a year. Panic Disorder may be accompanied by agoraphobia (fear of being alone in public places especially in places from which a swift exit would be difficult in case of the occurrence of a panic attack).

Women are said to be two to three times more likely to be affected than men. The social factor identified as contributory to the development of Panic Disorder is a recent history of divorce or separation. We usually see Panic Disorder in the young adult but this disorder may develop at any age. Actually, Panic Disorder has been reported to occur even in children and in adolescents.

Ninety-one percent of those with Panic Disorder and 84 percent of those with Panic Disorder with agoraphobia have at least one other psychiatric disorder. The other psychiatric disorder which usually exists with Panic Disorder with or without agoraphobia are major depressive disorder; other anxiety disorders; personality disorders; and substance-related disorders.

There are several causes of Panic Disorder. They can arise from biological factors, genetic factors and psychosocial factors. Though the major neuro-transmitter systems have been implicated, believe me, you’ll get bored if I discuss these.

The onset of Panic Disorder usually occurs during late adolescence or early adulthood. In general it is a chronic disorder. Sometimes, the clinical picture is complicated by depression. It is said that alcohol or other substance dependence may occur in 10 to 20 percent of patients with Panic Disorder. Obsessive-Compulsive Disorder may also develop. Patients whose day-to-day functioning before their illness was good and who experienced symptoms only briefly, like Maia of Quezon City, tend to do well.

With treatment, majority of patients have a dramatic abatement of symptoms of Panic Disorder with or without agoraphobia. So far, the two most effective treatments are psychopharmacotherapy (with anxiolytics like alprazolam and anti-depressants like setraline, paroxetine, clomipramine, venlafaxine and fluoxetine) and cognitive psychotherapy. For the rapid control of the anxiety symptoms, we use the anxiolytics. For the long-term treatment of panic with depression, the anti-depressants are preferred over the anxiolytics or minor tranquilizers.

So Maia of Quezon City, I’m glad you belong to the group with a good prognosis. To my dear readers, just in case you suddenly get extremely panicky, don’t prolong your agony. Consult a psychiatrist at the nearest medical center in your community.

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To Yeye99@aol.com who sent an e-mail to the Office of the Philippine Psychiatric Association last month regarding my prior article on the drug user, sorry for the delay in answering your e-mail. Please get in touch with me at tel. no. 633-3893 or send me your fax number so I can fax you my reply.

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(In case you have other problems, particularly about love, looks and relationships, you would want me to discuss in this column, do send your letters to The Philippine STAR c/o Allure Section or send them directly to Suite 506 Medico Bldg., Lourdes Street cor. San Miguel Avenue, Pasig; fax no. 621-3872.)