May 28, 2008 — Panic attacks are different than nervousness or general anxiety. They are different to the extent that although they involve intense anxiety or fear or discomfort, they are intense and often come on suddenly and sometimes worsen greatly and come to a peak of discomfort within about ten minutes.

Panic attacks also usually involve intense anxiety or fear accompanied by physical symptoms which could include tremor or shaking or sweating or lightheadedness or chest discomfort or nausea or feeling of choking. Other physical symptoms can also be involved including, but not limited to, feeling of coldness or flushing and hot feelings. The panic attack may involve a combination of several or many of these symptoms and the person having the attack may also feel the need to escape from the current situation or may fear losing control or have fear of becoming psychotic.

Some of the above symptoms are also characteristic of heart attack or a stroke or other phsyical condition. So how do you know that you are not actually having a life threatening heart attack or stroke or other severe physical condition? The answer is that you do NOT know. Therefore, if you have not had a very recent physical evaluation by a physical doctor who has done cardiac tests and other physical tests and or if you experience what seems like a panic attack for the first time, then you should go to the nearest hospital emergency room for evalualtion. And, even if you have been physically evaluated, chest pain or severe symptoms, such as the ones mentioned in the sentences above, should alert you to obtain quick emergency help in evaluating your current physical status.

Feeling anxiety, including intense anxiety, does NOT prove that you are not having a heart attack or stroke or other severe physical condition. Heart attack or stroke, technically called CVA, can itself bring on intense feelings of anxiety and other fear emotions and other panic like symptoms.

Therefore, always be safe and get a complete physical evaluation by an E.R. doctor or family doctor or medical specialist to make sure whether or not these panic –like symptoms are or are not likely to be caused by something strictly physical.

If you have had complete physical medical check up, and that doctor has determined that he or she finds no physical cause for the symptoms that I mentioned in paragraph one, then it is appropriate to see a psychiatrist for medications or specific types of cognitive behavioral psychotherapy or both psychotherapy and medications.

In regard to psychotherapy, the approach and type of treatment that works for one patient may not work for another. Your psychiatrist can help you determine which type of treatment is best for you. For example, in the treatment of panic disorder, I use or teach a variety of techiniques, including systematic desensitization, deep muscle relaxation , autogenic training, guided imagery, anchoring , and other techniques. Sometimes, I combine use of several of these techniques. Other time, using only one technique is sufficient. A description of what is involved in each of these techniques is beyond the scope of this article.

There is also the option of using a tranquillizer to treat or help prevent panic, e.g. fast acting short lived xanax, or longer acting tranqullizers, such as clonazepam or diazepam or lorazepam. There are advantages and disadvantages to these medications. Disadvantages include the fact that they are all potentially habit forming and can be addicting and they can cause drowsiness which is, of course, dangerous when driving a car or operating machinery or doing other work that calls for good reflexes and alertness. These tranquillizers should NOT be used by users of alcohol or by people who are taking other medicines or drugs that cause drowsiness. Also, I do NOT approve of combining use of more than one of these tranquillizer drugs, except under extremely rare and temporary circumstances.

Some of the older antidepressants are effective in decreasing frequency and intensity of panic attacks, and these medicines would include tofranil or elavil or sinequan. These drugs are not thought to be habit forming, but they can cause long term effects of drowsyness or unusal somatic sensations. These medications are not well tolerated by most people, but a select few people do very well with these medications. Also, some people with panic attacks benefit by the newer serotonin reuptake blocking antidepressants, such as zoloft or paxil or prozac, or combination serotonin/ norepinephrine reuptake blocking drugs such as Effexor or other similar medications.

This column is written by John Schepman, D. O., Psychiatrist, who has an office in the Frank Lyons Medical Building in Olive Hill, Kentucky. Dr. Schepman is accepting new patients by appointment. Call Dr. Lyons office at 1 606 286 1000. (The opinions expressed by Dr. Schepman are based on his clinical experience and his review of psychiatric literature. Other doctors may differ in their opinions based on their own clinical experience and studies. Always get a psychiatrist’s help weighing risks vs benefits)