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When Panic Attacks
One night seven years ago, I completely lost my
mind!
By Lauren Russell Griffen
WebMD Feature from "Women's Health" Magazine
I
was lying in bed, staring at the ceiling, trying to
fall asleep. Suddenly, my nerves seemed to catch on
fire, my muscles became as stiff as steel rods, and
my heart felt like it would explode. I clutched the
mattress to steady the spinning room. I had three
thoughts: I'm going crazy. I'm going to do something
crazy. I'm dying.
I
was overcome by the urge to get the hell out of
there--to jump out of bed and run out the door or
crash through the window. But I couldn't move. I was
paralyzed with fear--the same feeling you get when
you step off a curb and realize a car is heading
straight toward you. Only there was no car. The
danger was all in my head.
Forty-five minutes later, it was over. At the time,
I was convinced I'd gone temporarily insane, but a
little research revealed a more probable diagnosis:
panic attack.
A
panic attack is clinically defined as a powerful,
inexplicable sense of terror that comes on without
warning, peaks within 10 minutes, and is marked by
at least four of the following symptoms: racing
heart; sweating; shaking; shortness of breath; chest
pain; a sensation of choking, nausea, dizziness, or
numbness; chills or hot flashes; fear you're going
nuts, losing control, or dying; and the feeling that
the world isn't real or that you're detached from
your body. I had experienced at least half a dozen
of these feelings. No wonder I was ready to check
myself into a psych ward.
Bring Out the Dread
Panic attacks aren't as rare as you might
think--experts estimate that more than a quarter of
all people will experience at least one in their
lifetimes. They often come on suddenly and without
warning, though studies have shown that attacks are
sometimes precipitated by highly stressful events.
"In
patients who have panic disorder, six to eight
months before the first attack we tend to see not
merely stress but stress caused by loss, whether
it's due to a job change, a move, a divorce, or even
marriage or pregnancy, which is a loss of your
former life," says Reid Wilson, Ph.D., a clinical
psychologist in Chapel Hill, North Carolina, and the
author of Don't Panic: Taking Control of
Anxiety Attacks.
"When you experience a loss or too many changes too
fast, it's easy to lose your grounding," says
Pauline Boss, Ph.D., a stress researcher and
therapist and the author of Loss, Trauma, and
Resilience: Therapeutic Work with Ambiguous Loss.
"You
can't fix the problem, you feel out of control, and
at some primitive level you can become panicked." If
you're prone to panic attacks, your internal
distress may continue to build as you go about your
normal life until finally it overflows, sending your
mind and body into a tailspin.
Given that, my own freak-out wasn't as random as it
seemed. The seeds of my attack had been planted six
months earlier, when I moved to Spain to study
abroad, then later returned to the States only to
transfer to a new university. Add an on-again,
off-again relationship to the mix and I was a panic
attack waiting to happen.
But
everyone gets stressed and experiences loss. Why do
some of us end up hyperventilating into a paper bag
while others can decompress with a few Mike's Hard
Lemonades and a round of PlayStation 3?
Experts still don't know exactly why or how stress
sets off an attack, but some believe it's a result
of faulty neural wiring.
"One
theory is that in some people the brain circuitry
responsible for processing emotion and fear is in a
state of hyperexcitability," Wilson says. "This may
cause the brain to mislabel nonthreatening, everyday
stress as highly dangerous and set off a false alarm
that sends your body into Defcon 1 status."
Sometimes this irrational response is genetic. Call
it an inherited proclivity toward panicking.
Brain scans show that many of the same stress
hormones that are activated during the body's
instinctive fight-or-flight response are triggered
during a panic attack.
Two possible culprits: adrenaline and
noradrenaline. "Evolutionarily speaking, these
hormones would be released when you're faced with a
lion or a bear," says Lindsay Kiriakos, M.D., a
clinical instructor in psychiatry at the UCLA
Neuropsychiatric Institute and the author of
Panic Disorder: How to Fight Back and Win.
Both
hormones shift your respiratory and circulatory
systems into overdrive to prepare you for action.
With massive amounts of oxygen pumping into your
muscles and brain, you can react quickly to a killer
grizzly. "The problem is that, during a panic
attack, this extreme response occurs without the
presence of any real outside threat," Kiriakos says.
Without a real enemy to respond to, whether it's the
snarling beast our ancestors had to contend with or
a modern-day carjacker, the rapid breathing and
muscle tension that would otherwise help us can
translate into hyperventilation and trembling.
"Sufferers can't figure out what's happening to
them, and the confusion can be terrifying," Kiriakos
says.
Some
scientists theorize that noradrenaline may be to
blame for much of that confusion. When this hormone
hits the frontal lobe, which is associated with
judgment and reasoning, among other things, your
ability to think clearly may get jammed up. Unable
to comprehend the ensuing cyclone of negative
sensations, people assume the worst: that they're
dying or having a heart attack.
In
fact, according to a 2003 study in the Canadian
Journal of Emergency Medicine, people with panic
disorder are significantly more likely than people
without the disorder to head for the ER due to chest
pain.
Other than being convinced that I had boarded a
one-way train to Reaperville, what scared me most
about my panic attack was that I wasn't doing
anything strenuous or out of the ordinary when it
hit. There was no obvious trigger--I was just lying
in bed.
That's common during what's called a spontaneous
panic attack--one that isn't clearly connected to
any fear-inducing situation, says Jordan W. Smoller,
M.D., Sc.D., associate professor of psychiatry at
Harvard Medical School.
Though it's true I had been under a fair amount of
pressure in the months leading up to the attack,
because it didn't arise as an immediate reaction to
my stress, I didn't make the link until later on.
In
other cases, it's easier to connect the dots. A
panic attack may strike when a person encounters
something that trips a specific phobia, as when a
claustrophobe enters a confined space.
Asthmatics--who, researchers have found, are about
twice as likely as people without asthma to have
panic attacks--may experience one at the first sign
of shortness of breath. Or a chemical trip could
shove you over the edge: Substances such as
caffeine, nicotine, and other drugs can spark a
panic attack because they induce arousing symptoms
(like the jitters you get after a few rounds of
espresso) that people who are vulnerable to attacks
interpret as dangerous.
"About a third to half of my patients report that
their first panic attack occurred while they were
taking a drug like marijuana," Kiriakos says.
Your Panic Plan
If
stress usually precedes a panic attack, then the
obvious prescription, you'd think, would be to
double up on yoga classes or try some head-calming
meditation. Unfortunately, more "om" isn't the
answer. There's no scientific proof that
stress-reducing techniques will stifle future panic
attacks.
Because there's often no predicting when or whether
another attack will strike, doctors usually don't
recommend therapy or taking meds regularly unless
your attacks are frequent and debilitating. But if a
panic attack does occur, how you respond can steer
you clear of uncontrollable hysterics.
Here's how to wage your own war on terror:
Before it happens know that a panic attack will not
harm you. "In therapy, we teach patients that
although panic attacks are uncomfortable, there's
nothing physically dangerous about them," says
Kimberly Wilson, Ph.D., a cognitive-behavioral
therapist in the San Francisco Bay area and a
psychiatry instructor at Stanford University.
Open up about your attacks. If you know you're
susceptible to panic attacks, let friends, family,
or even a trusted coworker know the symptoms, so
they can recognize one when it's happening and
reassure you that you'll get through it, Kiriakos
says.
Pack a pill. If you've had a panic attack
before, you can talk to your doc about getting a
prescription for a small amount of a benzodiazepine,
such as Xanax or Valium, to have on hand in case
another one strikes. A benzodiazepine takes only a
few minutes to increase the activity of a
neurotransmitter called gamma-aminobutyric acid (GABA),
which has a calming effect in the brain.
"They're not recommended for chronic panic sufferers
(because they can be addictive), but they can be
effective against isolated attacks," says Alexander
Neumeister, M.D., an associate professor of
psychiatry at Yale University.
"Sometimes just having the pill in her purse can
prevent a patient from having an attack in the first
place," he says.
During an attack sit tight. If you're afraid
you're going to faint, tense the muscles in your
legs, arms, and gut until your face feels flush,
about 30 seconds. This forces the blood up to your
head, which can prevent you from passing out.
Distract yourself. "Counteract the flood of
negative thoughts by doing something familiar and
comforting," Kiriakos says. "I've had patients sit
in total silence or watch TV; one even tuned in to
Howard Stern." Or, ridiculous as it might seem,
start organizing. "Find some little piece of your
environment that you can control," Boss says. "Even
something as simple as straightening up the hangers
in your closet or organizing your desk can help keep
you grounded."
As a last resort, go to the ER. It's unlikely
that you're having a heart attack or stroke, but if
you absolutely can't shake the belief that
something's terribly wrong, ask someone to take you
to the hospital, where a doctor can reassure you and
treat you with anti-anxiety meds if he or she thinks
they'll help.
When it's over don't be a trouper. "The goal is
to keep yourself from becoming preoccupied by the
attack and to return to your usual activities as
soon as possible," Kiriakos says. That said, it's
okay to take some time before you jump back into
work or whatever situation you were in when the
attack occurred. "It's normal for mild anxiety to
linger for a day or two," Kiriakos says. But if
you're still upset after three days, ask your doctor
whether you could benefit from seeing a therapist.
See your doctor. Always check in with your
regular physician after an attack and describe your
symptoms precisely. He or she will quiz you on your
medical history and current health to determine
whether the attack was triggered by a health
problem.
Uh-oh, Not Again
When panic attacks won't stop
Full-blown panic disorder, which is marked by a
persistent fear of having further attacks, is
believed to be caused by an inherited deficiency of
serotonin, the brain chemical that stabilizes your
mood and gives you a feeling of well-being.
Four
years ago, researchers determined that people with
panic disorder have fewer of a certain kind of
serotonin receptor--by up to 30 percent.
(Individuals who have isolated panic attacks may
also lack serotonin, but scientists have yet to
prove it.).
Though panic disorder can be debilitating, know that
"it's also one of the most treatable mental
disorders out there," Reid Wilson, Ph.D., says.
"Cognitive-behavioral therapy alone or combined with
antidepressants can reduce or prevent panic attacks
in 70 to 90 percent of sufferers, often in a matter
of weeks or months."
©
WebMD. All rights reserved.
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