4/3/03
As many people who know me are aware, I have suffered from panic and anxiety disorders for almost 3 years now.
This essay is meant to do a couple of things. One, it is to educate those who don't know what panic or anxiety
disorders are but more importantly, to educate those who suffer from them in possible avenues of treatment. Let
me begin by saying, IANAD! For those of you who don't know what that means, it's internet lingo for: "I am not a doctor!"
Everything I'll say here is based on my own personal experiences and what others who suffer from these have told
me. You should discuss treatment options with your doctor before making a decision. I simply have this here because
I've found through my own experiences and experiences of others, that doctors are not generally well educated in
these disorders and there are risks of misdiagnosis and improper treatment. The better educated you are on the
subject, the better able you'll be to discuss options with your doctor and figure out what's best for you.
I started suffering severe panic attacks about 2 1/2 - 3 years ago. For those who have never had one, I'll do my best
to convey what it is like, but it will be inadequate. Unless you have experienced it, you simply can't understand.
Panic attacks are irrational and many times appear to come out of nowhere. There isn't necessarily a direct
cause and effect that the victim will notice, though there are usually external causes that trigger them. From a
medical point of view, a panic attack is simply the body's biochemical response to danger. Part of the
"fight or flight" mechanism that everyone has. Unfortunately, for people with panic attacks, this system doesn't
function properly. Suddenly the body is flooded with adrenaline and your body begins telling the mind that you're
in mortal danger.
For someone who suffers from panic attacks, here's what that's like: You suddenly begin breathing heavily. Your
heart begins pounding, maybe exceeding 120 or 150 beats/minute. Wherever you are, you have this overwhelming
impulse to "get out." You could be in the middle of a field in Kansas and you still need to "get out." You don't think,
you know, that you're dying, or that you're on the verge of losing your mind. Any second now you're either going to
just go completely insane or your heart will simply stop beating and you'll die. You may have chest pains or back
pains or any other sort of pain. You suffer many of the signs of a heart attack. This is what your body is telling
you and who are you to argue with millions of years of evolution?
The problem is that your body is mistaken. You're in no danger. And even the attack itself, with your heart beating
150 beats per minute, is no danger to you. I've been in the middle of an attack and tried to rationalize that.
It doesn't matter. You can't rationalize yourself out of an attack. Your body doesn't listen. I've called three
ambulances and had two emergency room visits caused by panic attacks. All because I didn't understand my body well
enough or didn't trust my rational side enough, to make it go away.
People who have panic attacks tend to be predisposed to them. Genetically or even due to drug or alcohol abuse, one
usually has some predisposition towards attacks. The bad part is that once they start, you can get rid of the
predisposition and the attacks will continue. The single most common cause of an attack is previous attacks. Once
you've had a few attacks, the fear of future attacks tends to be the culprit most of the time.
Most of my attacks happened while driving, and it wasn't long before driving would cause me to have attacks,
simply because I was afraid I'd have another attack while driving. First of all, let me point out that one of
the worst things you can do in a situation like this, is avoid the thing that brings on the attack. In my case,
driving. If I had stopped driving, chances are, I would have developped a phobia of driving that would have
taken a tremendous amount of time and work to overcome. If there are situations that cause panic attacks for your,
do not avoid them. It will only make things worse in the long run.
Okay, so now that we know what attacks are, let's discuss some of the facts of an attack.
An attack is not dangerous. You will NOT die from a panic attack. Many people suffer panic attacks their entire
life and live to a very old age, despite the attacks. You will not go crazy from an attack. People don't just
suddenly go crazy, whatever that really means, for no reason. The first step to dealing with panic attacks
is to recognize that it won't kill you.
First of all, if you are having chest pains, and think you're having a heart attack, call an abulance. Get an EKG.
Heart attacks kill, and you need to rule it out and be diagnosed with panic disorder by a doctor or psychiatrist before
making an assumption that that's what you have. Even if you're young. I've known people in their 20s and 30s who have
shown no previous signs, drop dead and die of heart attacks. So, don't take a chance.
Once you've been diagnosed with panic disorder, it's time to figure out how to treat it. There are several options.
First of all, I highly recommend seeing a psychiatrist that specializes in panic and anxiety disorders. A doctor is fine,
and a general therapist is fine, but see a specialist first. They can at least get you started with what you need to know.
I highly recommend
The Anxiety and Phobia Workbook, by Edmund Bourne. It is an excellent guide for anyone who suffers from panic attacks
and provides a number of mental tools for managing them. The number one weapon you have against panic is education. I can't
stress this enough.
So how do you treat it? Medication? Therapy? What works? It depends on the person, and it's a personal decision
about which route you want to take. I started with medication. I did therapy as well. Using a technique called
Cognitive Behavioral Therapy, I was able to manage my attacks to the point where I no longer need medication for
them. I highly recommend this route, but if you're like me, I really needed time on medication while I developped
the techniques and before I was mentally ready to take on the attacks.
First, let's discuss medication. The first line of defense for long-term treatment, is usually a family of anti-depressants
called SSRIs, or Seratonin Specific Reuptake Inhibitors, or SNRIs, Serotonin/Norepinephrine Reuptake Inhibitors.
Prozac, Luvox, Celexa, Zoloft, and Paxil are members of the SSRI family. Effexor is a member of the SNRI family. Many
people who are initially prescribed an anti-depressant for an anxiety disorder will ask, "Isn't there something just
for anxiety or panic?" These drugs are for panic and anxiety. They're also for depression. Anti-depressant is a bit
of a misnomer, so don't let the category confuse you. These drugs are what's used and they can be quite successful.
First of all, let me state up front that not all drugs work alike for everyone, and these drugs are no different.
Expect that it may not work. Give the drug 4-6 weeks to be sure, but if after 6 weeks it's not working, have your doctor
try another. In most cases, one of these drugs will prove to be successful.
These drugs DO have side-effects. Sometimes intolerable side-effects, and if you can't handle it, don't give up. Some people
will suffer side effects from one and none of the others. All of these drugs, even though they're in the same family,
work differently and affect people differently. Don't give up just because one was intolerable. For example, I took Paxil and
had no side-effects (though I did have withdrawal effects, which I'll discuss later) while my cousin took a single
Paxil and had such bad side-effects, he could never take it again.
Expect to have a rough road finding the right drug. While you're looking for the right drug, you might want to talk
to your doctor about getting on a benzodiazapine drug in the meantime. Drugs in this family include Valium, Klonopin, Ativan,
Xanax, Tranxene, and Buspar. These drugs are VERY effective in treating anxiety, but should usually not be used for long-term
treatment. While they're very effective, with some people they can be addictive. In addition, taking them for long periods on
a regular basis can make withdrawal a dangerous prospect. If you take any of these for long periods, DO NOT QUIT COLD TURKEY.
I can't stress this enough. Withdrawal from these drugs after developping a long term dependence can KILL YOU! Taper off
under a doctor's supervision. Your doctor will know whether or not you have been taking the drug long enough and often enough
to require tapering off. DO NOT DECIDE FOR YOURSELF!
Now, that said, and getting the warnings out of the way, I took Valium for a two year period while I was on Paxil. But during that
two year period, I never took it steadily, and I never abused it. After all, for me, it was my only sure fire way of getting
rid of a panic attack. I wouldn't have risked abusing it and having my only safety net taken away.
I want to discuss withdrawal from SSRIs and SNRIs for a moment. In particular, Paxil and Effexor have notorious withdrawal effects. Some other SSRIs
and SNRIs do as well, but usually not to the same degree as Paxil or Effexor. Paxil and Effexor have a very short "half-life." Half-life is best described as
the time it takes for your body to metabolize half of the drug in your system. Over x amount of time, half of the drug will
be gone. In another x amount of time, half of what remains will be gone, and so on and so forth. Because Paxil's half-life is so short,
when you stop taking it, it leaves your system quickly and your body is unable to make up for the lack of the drug in your body
as well and many people suffer from very difficult side-effects. In my case, I suffered from a dizziness and a feeling of electricity
running through my head for nearly 3 weeks. After that, I went through 3 weeks of fairly severe depression (I have never
suffered from depression in my life, other than these 3 weeks). I did not taper off,
as I would recommend to anyone on the drug. There are various reasons for why I didn't, but had it become unmanageable, I would
have tapered. For many people, sudden withdrawal is unmanageable and even tapering off can lead to severe withdrawal. So, do
discuss quitting this or any SSRI/SNRI drug with your doctor. Be prepared for some discomfort.
One final note; I honestly don't think withdrawal from these drugs is physically dangerous, in most cases.
This is not a doctor's opinion, but from most of the reports I have seen, the withdrawal is simply
anywhere from somewhat to extremely uncomfortable and persistent. It's certainly no fun.
Finally, let's discuss the non-drug treatment. For me, it was Cognitive Behavioral Therapy, or CBT. For more information on CBT, I
recommend the The National Association for Cognitive Behavioral Therapists web site.
CBT is largely based on managing your thoughts and feelings and learning to replace unwanted feelings with healthier feelings. This
is a very poor description I think, and I don't really know how to phrase it better. This sounds almost sappy, and it isn't. It's
not hocus pocus, it's not weird. It's simply managing your thoughts and feelings in a way that helps you control and possibly
eliminate panic attacks. And from experience, I can tell you it works. It may not work for everyone, and it may not work for you,
but it definitely works for some of us and it's worth looking into. For me, I simply got tired of taking medication every day.
While I still suffer from some anxiety problems, I largely have it under control and I'm much happier being off of medication.
[Note - Apr. 3, 2003: As of Feb. 2003, I started taking Valium again periodically. Guess I didn't have things as under
control as I thought.]
Finally, if you do suffer from panic or anxiety disorder, check out the The Anxiety Disorders Association
of America web site. In particular, join the message boards. You can learn from other people who suffer the same
problems. It's very comforting to know you're not alone and you can pick up a lot of advice on how to manage
your problem. And before long, you may find yourself helping others who are suffering as well.
