Question:
The times I have had panic attacks occurred when was
depressed or dysphoric...?
Answer:
I would discuss these attacks with your pdoc as there are effective meds
to treat them now.
A. Recurrent unexpected Panic Attacks
Criteria for Panic Attack:
A discrete period of intense fear or discomfort, in which four (or more)
of the following symptoms developed abruptly and reached a peak within
10 minutes:
1. palpitations, pounding heart, or accelerated heart rate
2. sweating
3. trembling or shaking
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 or going crazy
11. fear of dying
12. paresthesias (numbness or tingling sensations)
13. chills or hot flushes
B. At least one of the attacks has been followed by 1 month (or
more) of one (or more) of the following:
1. persistent concern about having additional attacks
2. worry about the implications of the attack or its consequences
(e.g., losing control, having a heart attack, "going crazy")
3. a significant change in behavior related to the attacks
C. The Panic Attacks are not due to the direct physiological
effects of a substance (e.g., a drug of abuse, a medication) or a
general medical condition (e.g., hyperthyroidism).
D. The Panic Attacks are not better accounted for by another mental
disorder, such as Social Phobia (e.g., occurring on exposure to feared
social situations), Specific Phobia (e.g., on exposure to a specific
phobic situation), Obsessive-Compulsive Disorder (e.g., on exposure to
dirt in someone with an obsession about contamination), Posttraumatic
Stress Disorder (e.g., in response to stimuli associated with a severe
stressor), or Separation Anxiety Disorder (e.g., in response to being
away from home or close relatives).
Panic disorder with and without agoraphobia is a debilitating condition
that will afflict at least 1 out of every 75 people in this country and
worldwide during their lifetime. Panic attacks are characterized by
sudden and unexpected discrete periods of intense fear or discomfort
associated with shortness of breath, dizziness, palpitations, nausea, or
abdominal distress. During an attack people often believe that they are having a heart
attack or, alternately, that they are losing their mind. Panic sufferers
often develop agoraphobia secondary to the occurrence of these
unexpected panic attacks. Consequently, they begin to avoid places where they fear a panic attack
may occur or where help would be difficult to obtain. If the agoraphobia
becomes severe enough, a person may become housebound.
A growing body of knowledge indicates that some medications and selected
psychosocial treatments are effective for panic disorder, with and
without agoraphobic avoidance. Two classes of antidepressants (i.e.,
tricyclics and monamine oxidase inhibitors) as well as certain
high-potency benzodiazepines (e.g., alprazolam, lorazepam, and
clonazepam) have been found to be effective in reducing or eliminating
panic attacks associated with the various forms of panic disorder.
Substantial research efforts continue the search for other medications
useful in the treatment of these conditions. Initial indications are
that some of these other agents, particularly the serotonin uptake
blockers, may be effective panic medications. The pharmacological agents
may present problems such as undesirable side effects, the risk of
dependence, and a significant relapse rate once medication is
discontinued.Several variations and combinations of behavioral and cognitive
treatment approaches also have demonstrated efficacy in the reduction
and/or elimination of panic attacks and agoraphobia. Early reports of
research specifically targeting panic attacks indicate that significant
numbers of patients are panic-free at the end of cognitive-behavioral
treatment and remain so at a 2-year followup.
Information is sparse on such issues as (1) the effectiveness of
combined psychosocial and pharmacological treatments, (2) the mechanisms
of therapeutic action, (3) demographic and other patient factors that
may predict responsiveness to either class of treatment, (4) the
long-term effectiveness of treatments for panic disorder once treatment
stops, and (5) the value of these treatments for those patients who
suffer from panic disorder in combination with other psychological and
psychiatric disorders. The latter group represents a significant segment
of those people suffering from panic disorder.
To help resolve questions surrounding these and other issues, the Office
of Medical Applications of Research of the National Institutes of Health
in conjunction with the National Institute of Mental Health convened a
Consensus Development Conference on the Treatment of Panic Disorder on
September 25-27, 1991. Following a day and a half of presentations by
experts in the relevant fields and discussion from the audience, a
consensus panel comprising experts in psychology, psychiatry,
cardiology, internal medicine, and methodology, as well as members of
the general public
