Dr Michael McDonough, Consultant Psychiatrist and head of our Anxiety Disorders Service recently spoke about panic attacks on RTÉ Radio 1's John Murray Show. If you missed the show, you can listen to it here or you can read Dr McDonough’s blog below.
A panic attack is a sudden onset of intense anxiety or terror without any obvious threat. It is a misfiring of the so called “fight flight or freeze” adrenalin reaction.
Panic attacks can include usually four or more of the following:
Panics can be full blown or milder “near” panics and they usually build to a crescendo in 10 minutes. Often the person understandably makes a catastrophic interpretation of what’s happening
Panics burn out after several minutes but lingering effects may last hours.
Panic Disorder may be diagnosed when there are recurrent panics that disrupt a person’s life. Once someone has one they understandably fear another will happen which can often generate new episodes.
An example of a typical agoraphobic panic:
Get on train – wary of getting trapped, stuck – start to feel tense, sweaty – try to calm self down – stand near exit – hold onto something to steady self – reinforces the idea that something bad is on the way – train stops between stations – I am trapped – try to catch breath – rapid breathing – makes dizzy – fear of fainting – feel unreal – intense terror – fear I am dying – leave at next station
The physical symptoms tend to be much the same but the focus of fear tends to vary for different people. Some fear collapsing, others a heart attack or others a feeling of losing control
Trigger situations that provoke the panics can vary also
By looking at the symptoms and the fact that the main sensation is fear.
A few medical problems can mimic panic but the signs are usually fairly obvious of the medical problem.
Common examples are:
Most people suspect a medical cause with their first panic and go to A/E or to their GP
Some are misdiagnosed has having a medical or heart problem though there is more awareness of panic now than there used to be.
Yes very much. Less than half have isolated so called panic disorder.
Panics often accompany depression and if mood and energy is low this should be considered as a possible underlying cause. When we are down we tend to be more anxious and more vulnerable to panic feelings
50% develop agoraphobia – a fear of being away from safety usually home
Panic may also be a sign of another anxiety disorder such as
In one third of people, the panic is mixed with alcohol or drug misuse
Panic attacks are very common, 7-9% of the population suffer from them and twice this amount if milder panics are included.
Who is more likely to suffer from panic attacks?
Breathing and relaxation training is no longer considered the best approach. They tend to subtly maintain the idea that panic is dangerous or life threatening.
To “go with it”. This is similar to the meditational idea of “detached acceptance”. Test out whether the panic will really harm you by riding it out. Stay in the situation if you can until panic subsides. Learn that although very unpleasant panic isn’t dangerous and won’t cause lasting harm
However each person is different. If panic is linked with another problem like past trauma or abandonment feelings or depression then it may not be best to tough it out. A more compassionate therapeutic approach may be needed initially. This highlights the importance of a careful assessment
If panics are causing significant disruption to your life they should be addressed early, the earlier the better.
A brief focused therapy using Cognitive Behaviour Therapy aims to break the maintenance cycle and is very effective for typical panic. It usually takes 4 to 10 sessions
But as mentioned earlier, it is important to note that panic can indicate a more complex underlying problem so a careful mental health assessment is needed to start with.
Expert assessments can be done by mental health teams or CBT therapists and can be set up through GPs.
Increasing numbers of GPs have good expertise in anxiety but not all GPs are familiar with the latest developments in this area so it’s helpful to do your own research on what proven therapies are available.
Sometimes serotonin boosting antidepressants are used especially if depression is present but good psychotherapy is the preferred treatment for most. Valium like sedatives are best avoided.
Some individuals require longer term therapies to address underlying problems with confidence, relationships or past traumas.
This long term therapy tends to be taken on by therapists with a different training to the standard CBT therapy mentioned before
It is important to note also that some people have addictions to alcohol or sedative drugs and panics are a symptom of drug or alcohol withdrawal. These individuals obviously need their addiction addressed first.
Dr. Michael McDonough | Anxiety Disorders Service
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