Read Other Mental Health Articles PANIC ATTACKS OR HEART ATTACK   DR.   AMBRISH SINGAL M.D [PSYCHIATRY] MIPS, MAPA, AIASP, MIAPP, MCSEPI CONSULTANT PSYCHIATRIST CONTACT  +91-9815333660     WHAT IS PANIC ATTACK People with panic disorder have feelings of terror that strikes suddenly and  repeatedly with no warning. One can’t predict when an attack will occur, and many develop intense anxiety between episodes, worrying when and where the next one will strike.        If you are having a panic attack, you can hear your heart beat / heart will pound and you may feel sweaty, weak, faint, or dizzy. Your hands may tingle or feel numb, and you might feel flushed or chilled.      You may have nausea, chest pain or difficulty in breathing, tightness in chest a sense of unreality, or fear that something bad will happen or loss of control. Feeling of going crazy.     You may genuinely believe that you ’re having heart attack or losing your mind, or on the verge of death. Panic attacks can occur at any time, even during sleep.    An attack generally peaks within 10 minutes, but some symptoms may last up to 30 minutes.       Panic disorder affects about 2.4 million adult Indians and is twice as common in women as in men. It most often begins during late adolescence or early adulthood. Risk of developing panic disorder appears to be inherited. SYMPTOMS OF PANIC DISORDER?     It’s in the form of sudden episodes of intense and overwhelming fear that seem to come on for no apparent reason?   It may occur even if you are laughing or having good time with your friends, and may not have any sort of stress on your mind. Such a presentation makes it feel like a serious episode, much resembling a heart attack.  That’s why many patients land up with Heart Specialist rather than a Psychiatrist. Racing, pounding, or skipping heartbeat  Chest pain, pressure, or discomfort Difficulty catching your breath Choking sensation or lump in your throat Excessive sweating Lightheadedness or dizziness Nausea or stomach problems Tingling or numbness in parts of your body Chills or hot flashes Shaking or trembling Feelings of unreality, or being detached from your body During these episodes, you have the urge to flee, or the feeling that you need to escape? During these episodes, you think something terrible might happen—that you might die, have a heart attack, suffocate, lose control, or embarrass yourself?  After the episode you remain terrified as the episode leaves you in a very frightened state so much so that you start worrying and get fearful that it might not happen again? And this fear causes you to avoid places or situations that you think might have triggered the attack? If you answered yes to most of these questions, chances are you are suffering from panic disorder. If so, you are not alone. Panic disorder is very different from everyday anxiety. More than 3 million American adults have, or will have, panic disorder at some time in their lives. Most frequently, it starts in young adulthood. Usually, it does not go away by itself. But with proper treatment, people with panic disorder can be helped. PANIC DISORDER    Not everyone who experiences panic attacks will develop panic disorder —for example, many people have one attack but never have another. For those who do have panic disorder, though, it ’s important to seek treatment. Untreated, the disorder can become very disabling.   Many people with panic disorder visit the hospital emergency room repeatedly or see a number of doctors before they obtain a correct diagnosis. Some people with panic disorder may go for years without learning that they have a real, treatable illness. Panic disorder is often accompanied by other serious conditions such as depression, drug abuse, or alcoholism and may lead to a pattern of avoidance of places or situations where panic attacks have occurred. For example, if a panic attack strikes while you ’re riding in an elevator, you may develop a fear of elevators. If you start avoiding them, that could affect your choice of a job or apartment and greatly restrict other parts of your life. EFFECTS OF PANIC DISORDER ON ONES LIVES        Some people ’s lives become so restricted that they avoid normal, everyday activities such as grocery shopping or driving. In some cases they become house bound. Or, they may be able to confront a feared situation only if accompanied by a spouse or other trusted person. Basically, these people avoid any situation in which they would feel helpless if a panic attack were to occur. When people’s lives become so restricted, as happens in about one-third of people with panic disorder, the condition is called agoraphobia. Early treatment of panic disorder can often prevent agoraphobia. Panic disorder is one of the most treatable of the anxiety disorders, responding in most cases to medications or carefully targeted psychotherapy.   WHY SEEKING TREATMENT IS CRITICAL    Repeated episodes of fear—commonly called panic attacks—that are typical of panic disorder can be devastating. The panic attacks, or avoidance of them, can completely take control of your life. 1)   Without treatment, you may continue to have panic attacks for years. The disorder can seriously interfere with your relationships with family, friends, and co-workers. 2)  Without treatment, your life may become severely restricted. For example, you may start to avoid certain situations where you fear you will experience a panic attack—even normal, everyday activities, such as grocery shopping or driving. In extreme cases, people with untreated panic disorder grow afraid to leave the house, a condition known as agoraphobia. 3)  Without treatment, you may find it difficult to be productive at work. Your symptoms may keep you from getting to your job or staying there once you arrive. You may turn down promotions or job assignments that you believe will make you more likely to have panic attacks. Some people with panic disorder even quit their jobs. Many can keep working but otherwise rarely leave home. 4)  Without treatment, you may become severely depressed. You may try unsuccessfully to numb the symptoms of panic disorder or depression with alcohol or other drugs. You may even begin to have thoughts about suicide. You do not have to live this way. You need to know that panic disorder is treatable. In fact, proper treatment completely prevents panic attacks in 70 to 90 percent of people. Many people feel substantial relief in just weeks. Unfortunately, some people are reluctant to pursue treatment. Perhaps they think their condition is not serious. Perhaps they feel embarrassed. They may blame themselves or have trouble asking for help. Perhaps they dislike the idea of medication or therapy. Or, maybe they have sought help but are frustrated because their condition was not diagnosed or treated effectively. Do not let these or any other reasons stop you from getting proper treatment. If you have panic disorder, you should get whatever help is necessary to overcome it, just as you would for any serious medical illness. Do not be discouraged if some people say, "It's nothing to worry about," "It's just stress," "It's all in your head," or "Snap out of it." While they often mean well, the fact is that most people who do not have panic disorder do not understand that it is REAL and, therefore, tend to doubt its seriousness. Most importantly, do not try to numb the effects of panic attacks with alcohol or other drugs. This will only make the problem worse. GETTING A DIAGNOSIS  IS THE MOST IMPORTANT STEP   Since panic disorder can mimic a variety of medical conditions, such as HEART PROBLEMS/ HEART ATTACK and   DIGESTIVE COMPLAINTS, the  first  thing you should do is have a full Psychiatric evaluation. Although it is important for you and your doctor to concentrate on your physical symptoms, you should not overlook the emotional aspects of your attacks. You should tell your doctor anything you notice about how your attacks make you feel and when they usually occur. Information on both the physical and emotional aspects of the attacks can be very useful to the doctor in making a diagnosis. For example, the doctor will want to know if your attacks, or fear of having attacks, keep you from carrying out any of your normal activities. Many people with panic disorder also suffer from depression—feelings of intense sadness, even hopelessness, an impaired ability to think, concentrate, and enjoy the normal pleasures of life. Be sure to make your doctor aware of these symptoms as well. If you have been drinking or using drugs to try to control your symptoms, let your doctor know about that too.. TREATMENTS FOR PANIC DISORDER     Treatment for panic disorder can consist of taking a medication to adjust the chemicals in your brain. Its Just like that you take medicine to correct a thyroid imbalance or the treatment might involve working with a Psychiatrist to gain more control over your anxieties--just as some people work with specialists to learn techniques to control their blood pressure. Research shows that both kinds of treatment can be very effective. For many patients, the combination of medication and psychotherapy appears to be more effective than either treatment alone. Early treatment can help keep panic disorder from progressing. MEDICATIONS The medications act by altering the ways by which  chemicals interact in the brain, and thus they  stop as well as  prevent panic attacks and decrease anxiety. Two major categories of medication that have been shown to be safe and effective in the treatment of panic disorder are antidepressants and benzodiazepines. There are several types of antidepressants available nowadays and your Psychiatrist is the best person who can select the drug which can best suit you according to your symptoms     Each medication works differently. Some work quickly and others more gradually. All of them have to be taken on a regular basis. Some medicines increase and some have to be decreased over passage of time according to your symptom control. Usually, treatment with medication lasts at least 6 months to a year.  It takes approx 4- 8 weeks, to effectively block the panic attacks. This much time is sufficient for panic attacks to get controlled.  Clinical experience suggests that for many patients with panic disorder, a combination of CBT and medication may be the best treatment. COGNITIVE-BEHAVIORAL THERAPY    Cognitive-behavioral therapy (CBT) teaches you to anticipate and prepare yourself for the situations and bodily sensations that may trigger panic attacks. CBT usually includes the following elements: ·   A therapist helps you identify the thinking patterns that lead you to misinterpret sensations and assume "the worst" is happening. These patterns of thinking are deeply ingrained, and it will take practice to notice them and then to change them. ·   A therapist can teach you breathing exercises that calm you and that can prevent the over breathing, or hyperventilation, that often occurs during a panic attack. ·   A therapist can help you gradually become less sensitive to the frightening bodily sensations and feelings of terror. Helping you, step-by-step, does this, to safely test yourself in the places and situations you've been avoiding. CBT generally requires at least 8 to 12 weeks. Most panic disorder patients are successful in controlling or preventing their panic attacks after completing treatment with CBT. CBT requires a motivated patient and a specially trained therapist. Make sure any therapist you work with has proper training and experience in this method of panic disorder treatment. Indeed, in our country, there are limited professionals trained and experienced in CBT. HOW  TO CHOOSE THE RIGHT TREATMENT FOR YOU A Psychiatrist is the professional who have the training and experience needed to treat panic disorder.  Sometimes panic disorder patients need treatment by both by a Psychiatrist as well as psychologist.   Many people begin looking for treatment by visiting their family doctor or a local clinic or. Other places to seek help include your local health department or community mental health clinic. When seeking a health care professional to treat your panic disorder, you may want to ask the following questions: ·   How many patients with panic disorder have you treated? ·   Do you have any special training in panic disorder treatment? ·   What is your basic approach to treatment—cognitive-behavioral therapy, medication, or both? If you provide only one type of treatment, how do I get the other if I need it? ·   How long is a typical course of treatment? ·   How frequent are treatment sessions? How long does each session last? ·   What are your fees? ·   Can you help me determine whether my health insurance will cover this? HOW TO MAKE YOUR TREATMENT SUCCESSFUL    From the beginning, it is important to be a full participant in your treatment. Be active and assertive. Ask questions. Maintain open communication with your treatment professional and let him or her know your concerns. Every patient responds differently, but it is important to know that  none of the treatments for panic disorder works instantly. So, you must stick with a particular treatment for at least 8 weeks to see if it works. If you do not see significant improvement within that time, you and your treatment professional can adjust your treatment plan. It may take a bit of trial and error before you find what works best for you. Be patient and be sure to communicate with your Psychiatrist. Remember that Panic attacks are fully treatable. If your treatment involves medication, talk with your doctor about how often and in what manner your dosage will be monitored. No matter what medication you are taking, your doctor is likely to start you on a low dose and gradually increase it to the full dose, till you get relieved of the attacks. You should know that every medication has side effects, but they usually become tolerated or diminish with time. If side effects become a problem, the doctor may advise you to stop taking the medication and to wait a week or so before trying another medication. When your treatment is near an end, your doctor will decrease the dosage gradually and stop it in the end. TAKE THE STEP TODAY    Panic disorder is far too serious—and far too treatable—to delay getting help. Recognizing the situation is the first step to recovery. Now take the next step. I am hope from this article you may now be well informed about panic disorder and If you think you or your loved one have panic disorder, act now. See your Psychiatrist for a diagnosis and then follow the suggestions and educate yourself about your condition. The more you know about panic attacks and panic disorder, the better you will understand your role in treatment. I shall like to finish my topic here with a positive note that: PANIC DISORDER IS COMPLETELY TREATABLE, PLEASE DON’T PANIC-TRUST YOUR PSYCHIATRIST.