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Panic Attacks

Patrick Stang, M.D., Clinical Director

A fairly frequent visitor to emergency rooms across the country is the patient with the onset of a rapid heartbeat, shortness of breath, nausea, and sweating. The patient often gives no history of recent exertion and is otherwise in good health. The patient also during the episode experiences acute anxiety, even though he may or may not have had a recent stressful event. He is often certain that he is going to die of these symptoms, although his EKG is normal. After an examination by the ER physician and some tests, he is told that there is nothing wrong with his heart and to return home. Alternatively, he may be scheduled back for a series of extensive and expensive tests, after which he is told the same thing: his heart is normal.

This patient obviously did the correct thing in consulting his physician or emergency room. With cardiovascular disease being a top killer in this country, strange sensations concerning one's heart should not be taken lightly. A significant proportion of patients presenting to emergency rooms with the above symptoms have, however, nothing wrong with their hearts. Instead, they may have a condition called panic disorder or panic attacks.

Panic attacks are sudden episodes of acute anxiety or nervousness, rapid heart beat, shortness of breath, and sometimes dizziness. Along with these symptoms, patients may experience nausea, sweating, trembling, and choking sensations. They may sometimes feel that their surroundings are not real, or they may experience an intense fear of dying or losing control. The symptoms may be initially brought on by a stressful event, but they may also occur spontaneously. The attacks tend to recur on a weekly or even daily basis, sometimes prompting multiple visits or calls to their doctor.

After having a panic attack, the patient may live in fear of having another, especially around other people. This fear may lead them to restrict their activities. In severe cases, this fear has left people literally house-bound, a condition called agoraphobia.

The diagnosis of panic disorder may be made by an astute physician, or sometimes by patients themselves after reading about others with the condition. Fortunately, there are excellent treatments for panic disorder, even in its most severe forms. A variety of medications, including antidepressants and antianxiety medications, are very effective in this disorder. In addition, supportive therapy and behavioral therapy are effective for many people.

Altogether, over 70 percent of patients can have their symptoms completely or markedly eradicated within a few months of therapy.

Of course, any unusual symptoms should be evaluated by a physician to make sure that there is no serious underlying physical cause. Panic disorder is, however, a fairly common disorder, but it is a diagnosis which can be missed if it is not considered. This can be unfortunate, as it is one of the most treatable psychiatric problems.