panic attacks

One of my patients, a middle-aged mother, regularly turns up at emergency chest pain ICUs with a "heart-attack". She develops trembling, giddiness, hyperventilation (rapid breathing), tingling in the hands and, most frightening of all, palpitations, chest pain and sweating. During an attack, she looks like she would collapse. Each time, after spending a fortune, she is sent home in 24 hours with the good news that she did not have a heart attack. She is fortunate that none of the centres she visited advised her to go in for an angiogram, angioplasty or offer her by-pass surgery.

What she actually had were classic "panic attacks" that were rapidly progressing to a "panic disorder". These attacks can start in childhood, when it may not be recognised as such, be present through adolescence and become incapacitating in adult life. It is more likely to affect women.

A panic attack is an exaggerated version of the body's normal "flight or fight" reaction to danger. The difference is that the chemicals and hormones causing the physical symptoms are released when there is no perceivable threat. Some people are more vulnerable to these chemical changes in the blood. This sensitivity can run in families. It may be in response to difficult changes in life, such as loss of a loved one, birth of a child or a change or loss of a job. It can also occur for no known reason.

These symptoms are not always caused only by a panic attack, they can also be due to smoking, consumption of excess caffeine (coffee, tea, cola, energy drinks, health supplements, weight loss products), some prescription and OTC medications, and cough mixtures as well as diseases, such as an over active thyroid gland, or cardiac issues like mitral valve prolapse or intermittent irregular heartbeats.

So before you dismiss such an episode as a panic attack, make sure the patient has a through examination and relevant tests done to rule out other reasons that could have led to the symptoms. These causes are usually treatable.

It is normal to have one or two panic attacks in a lifetime, especially if precipitated by major stress. However, if the attacks are frequent and for no reason, it is classified as a panic disorder and requires treatment. Otherwise, the person may start avoiding social situations or refuse to leave the house. He or she cannot function normally and may become depressed or suffer from other psychiatric disorders.

Sometimes you can stop panic attacks by making simple lifestyle changes.

• Have 4-6 helpings of fruits and vegetables a day. The antioxidants and flavonoids in these help control symptoms.

• Eat meals on time. This prevents jitteriness from low blood sugars.

• Avoid junk food.

• Limit caffeine and alcohol intake.

• Stop smoking

• Take a brisk walk or jog for 40 minutes in the fresh air everyday. This releases chemicals from the calf muscles that negate the panic causing chemicals.

• When the attack occurs, close your eyes and take deep breaths to slow the heart rate.

• Do yoga daily, concentrating on stretching and breathing.

• Meditate for 10-20 minutes a day.

Medication is required when panic attacks do not respond to lifestyle changes. Anti-depressants are effective but may have to be continued for several months. They may be prescribed along with sedatives to help relaxation. Unlike anti-depressants, some sedatives can be habit forming so they should be taken for only a short time.

Improvement takes time. Patience is the key. Maintain a diary and record the frequency of symptoms. It is important not to alter medications or dosage (stop, increase or decrease) without the doctor's permission. Medication works best when combined with psychotherapy. Regular sessions with a counselor may help.

Dr Mathai is a paediatrician and author of StayingHealthy in Modern India. Mail your questions to rhealthgm@yahoo.co.in